Postal

Postal Service Health Benefits (PSHB)—NALC Member Frequently Asked Questions

Find answers to the most common questions about the Postal Service Health Benefits (PSHB) Program for NALC members. Whether you’re enrolling for the first time, reviewing plan options, or coordinating with Medicare, this guide will help you understand your coverage and benefits.

Postal Service Health Benefits (PSHB) Program

What is the Postal Service Health Benefits (PSHB) Program?

The PSHB Program is a health insurance program for eligible United States Postal Service employees, retirees, and their eligible family members, established under the Postal Service Reform Act of 2022. It operates within the Federal Employees Health Benefits (FEHB) framework but is exclusively for the postal population.

Who is eligible to enroll in PSHB?

Eligibility includes USPS career employees, annuitants (retirees), and eligible family members such as spouses and children under age 26. Certain former employees and survivors may also qualify if they meet enrollment and eligibility rules.

How to Enroll →

When does PSHB coverage start for eligible members?

For current PSHB enrollees, PSHB coverage began January 1, 2025, if you selected a PSHB plan during the 2024 Open Season. New hires or those with qualifying life events will have coverage begin the first day of the pay period after your enrollment is processed.

High Option Plan

What is included in the NALC High Option Plan coverage?

The High Option Plan provides comprehensive coverage for medical, hospital, prescription drug, preventive care, maternity, mental health, substance use disorder treatment, and other essential health benefits. It also includes access to a nationwide provider network and worldwide coverage.

Are preventive care services covered at 100% under the High Option Plan?

Yes. The High Option Plan covers recommended preventive services — such as routine screenings, immunizations, and annual physicals — at 100% when provided by an in-network provider.

High Option Preventive Care →

How do I update my contact information or dependent details?

Changes to your address, phone number, email, or dependent enrollment must be made through your employing agency (if active) or OPM Retirement Services (if retired). The Plan itself cannot directly update your official enrollment records.

Does the High Option Plan cover contraceptives and family planning?

Yes. The High Option Plan covers FDA-approved contraceptive methods, sterilization procedures, and related counseling for women, without cost-sharing when received from in-network providers. Some limits and prior authorization requirements may apply for certain products.

Will I receive important NALC High Option Plan updates?

Yes. Members will receive important updates such as member mail and newsletters. Ensure your mailing address is current with your employing agency, or OPM. Members can also register for our Member Portal to receive digital communications.

How do I report fraud, waste and abuse?

Suspected fraud, waste, and abuse should be reported directly to the Plan’s Special Investigations Unit by contacting the SIU Hotline at 888-636-NALC (6252). Reports are kept confidential, and you may remain anonymous.

Where can I estimate the cost of common medical procedures under the high option plan?

The Plan offers an Online Cost Estimator Tool through mycigna.com, or by selecting Cigna from the "our partners" section within our Member Portal. This tool can help you compare costs for common medical services based on your location and provider network.

What are my rights and protections against surprise medical bills?

The Plan complies with the federal No Surprises Act, protecting you from balance billing for emergency services, certain non-emergency services at in-network hospitals, and air ambulance services from non-network providers.

Consumer-Driven Health Plan (CDHP)

How does the Personal Care Account (PCA) work under the CDHP?

The PSHB CDHP includes a Personal Care Account funded annually by the plan. These funds can be used to pay for eligible medical expenses before you meet your deductible.

Do unused CDHP PCA funds roll over each year?

Yes. Unused PCA funds roll over from year to year, up to the maximum balance allowed by the plan, making it easier to save for future medical expenses.

Are preventive services covered at 100% under the Consumer Driven Health Plan?

Yes. The PSHB CDHP covers recommended preventive services — such as routine screenings, immunizations, and annual physicals — at 100% when provided by an in-network provider, without using your PCA or deductible.

Will I receive important CDHP communications?

What are the eligible expenses for my Personal Care Account?

PCA funds can be used for most qualified medical expenses as defined by IRS Publication 502, including office visits, prescriptions, lab tests, and certain over-the-counter medications. Cosmetic procedures and non-medical items are excluded.

How do I report fraud, waste and abuse?

Suspected fraud, waste, and abuse should be reported directly to the Plan’s Special Investigations Unit by contacting the SIU Hotline at 888-636-NALC (6252). Reports are kept confidential, and you may remain anonymous.

Can I estimate the cost of care?

Yes. The Consumer Driven Health Plan offers an online cost estimator through mycigna.com to help you understand and compare the costs of common services before scheduling care.

How to Enroll in the Postal Service Health Benefits (PSHB) Program

How do I enroll in a PSHB plan if I am an annuitant, survivor, or active USPS employee?

To enroll, OPM hosts an enrollment portal for all PSHB enrollees, which will require a login.gov account. Visit www.login.gov for more information on how to set up an account.

For additional assistance you can also contact the PSHB Helpline at 844-451-1261.

How to Enroll →

Can I enroll in a PSHB plan over the phone or by mail?

Yes. OPM accepts phone enrollments for annuitants and survivors, and will mail paper forms upon request. Active employees must use the USPS online benefits portal unless they receive special permission for a paper form.

What information do I need to complete my PSHB enrollment?

You will need your Social Security number, employing office number (for active employees), the plan code for your preferred PSHB Plan, and proof of eligibility for dependents you would like to enroll.

When can I enroll in a PSHB plan?

You may enroll during the annual Open Season, within 60 days of a qualifying life event (QLE), or within 60 days of being hired as a new USPS employee.

Can I change my PSHB plan after I enroll?

Yes. You can change your plan during any future Open Season or within 60 days of a Qualifying Life Event.

Medicare and the Postal Service Health Benefits (PSHB) Program

How does the PSHB program work with the NALC Health Benefit Plan and Medicare Parts A and B?

If you are enrolled in both the NALC Health Benefit Plan and Medicare, Medicare is generally the primary payer for your covered medical services. The Plan will act as secondary payer, while paying Medicare deductibles, coinsurance, copayments and lifetime reserve days as 100%

Do I need to enroll in Medicare to keep my PSHB coverage?

Yes, most annuitants and eligible family members who are entitled to Medicare Part A must also enroll in Medicare Part B to maintain PSHB coverage. This requirement began in the 2025 plan year for those who are Medicare eligible.

How does Medicare affect NALC HBP premiums?

What happens to my NALC HBP coverage if I delay Medicare enrollment?

If you are required to enroll in Medicare Part B and fail to do so, you risk losing your NALC HBP coverage within the PSHB program. You may also be subject to a Medicare late enrollment penalty if you enroll later.

Wellness and Preventive Care in the PSHB Program

What preventive services are covered at no cost with NALC HBP?

The NALC HBP covers recommended preventive services - such as annual checkups, screenings, immunizations, and certain counseling - at 100% when received from in-network providers.

Does NALC HBP offer wellness incentives or rewards?

Yes. The NALC HBP offers incentives for completing health risk assessments, participating in biometric screenings, or engaging in other programs as describe in our Plan brochure under "Wellness Reward Programs".

Can I access health coaching through my NALC Health Benefit Plan?

Yes. The NALC HBP offers health coaching services to help manage chronic conditions, improve lifestyle habits, and reach personal health goals.

What disease management programs are available under the NALC Health Benefit Plan?

The NALC HBP offers disease management programs for conditions such as diabetes, heart disease, asthma and COPD.

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