The NALC HBP High Option Plan - Comprehensive Care Built For You
The NALC High Option Plan offers postal employees and retirees predictable costs, smart nationwide coverage, and extensive wellness support for you and your family.
Why Choose the NALC High Option Plan?
For over 75 years, postal employees have trusted the NALC Postal High Option Plan for strong, reliable coverage and straightforward costs.
Benefits at a Glance
Who Should Choose the NALC High Option Plan?
This plan isn’t one-size-fits-all—it’s built for postal employees and retirees who want reliable, full-coverage care. See if this plan fits your needs:
-
Families Who Want Simpler Health Coverage
No need to manage a health fund. Just use your benefits. The plan includes low fixed copays for office visits, no-cost preventive care, and a nationwide provider access—making care easier for your whole household.
-
Retirees with Medicare
If you’re enrolled in Medicare A & B, this plan could mean no cost sharing for most services—plus SilverScript® PDP drug coverage and up to $75/month in Medicare Part B premium support.
- 2025 Calendar year RX cap – $2,000.00
- 2026 Calendar year RX cap – $2,100.00
-
Members Taking Maintenance Medications
With mail-order pharmacy options, CVS Maintenance Choice, and lower copays for generics (especially for asthma, diabetes, and hypertension), this plan helps you manage prescriptions affordably and conveniently.
-
Members Who Want Built-In Wellness Tools
From Hinge Health to Hello Heart® and Maven Clinic, this plan supports your physical and mental health with easy-to-use programs—all included at no extra cost.
PSHB High Option Plan Rates
The NALC High Option Plan offers competitive premiums for Postal employees and retirees. Below are the 2025 & 2026 biweekly and monthly rates
Detailed Benefits of the NALC High Option Plan
See what’s covered — and what you pay — for every part of your care.
|
Benefit |
You Pay (In-Network) |
You Pay (Non-PPO) |
|---|---|---|
|
Annual Routine Physical Exam (age 3 or older) |
Nothing |
35% after $300 deductible* |
|
Adult Routine Immunizations & Tests |
Nothing |
35% after $300 deductible* |
|
Well Child Care (through age 2) |
Nothing |
35% after $300 deductible* |
|
Routine Immunizations (through age 21) |
Nothing |
35% after $300 deductible* |
|
Benefit |
You Pay (In-Network PPO) |
You Pay (Non-PPO) |
|---|---|---|
|
Maternity |
Nothing |
35% after $450 per admission copay* |
|
Medical Room and Board |
$350 copayment per admission |
35% after $450 per admission copay* |
|
Mental Health/Substance Use Room and Board |
$350 copayment per admission |
35% after $450 per admission copay* |
|
Benefit |
You Pay (In-Network PPO) |
You Pay (Non-PPO) |
|---|---|---|
|
Medical/surgical |
15% after $300 deductible |
35% after $300 deductible* |
|
Emergency Medical |
15% after $300 deductible |
15% after $300 deductible* |
|
Observation Room |
$350 copayment per admission |
35% after $300 deductible* |
|
Benefit |
You Pay PPO |
You Pay Non-PPO |
|---|---|---|
|
Initial office visit / Office visit on day of manipulation |
$25 copayment per visit |
35% after $300 deductible* |
|
Manipulations (24 per calendar year) |
$25 copayment per visit |
35% after $300 deductible* |
|
One set of spinal x-rays annually |
15% after $300 deductible |
35% after $300 deductible* |
|
Benefit |
You Pay (In-Network PPO) |
You Pay (Non-PPO) |
|---|---|---|
|
Office visits |
$25 copayment per visit |
35% after $300 deductible* |
|
NALCHBP Telehealth |
$10 copayment per visit |
- |
|
X-rays, other diagnostic services |
15% after $300 deductible |
35% after $300 deductible* |
|
Benefit Description |
You Pay (In-Network PPO) |
You Pay (Non-PPO) |
|---|---|---|
|
LabCorp or Quest Diagnostics |
Nothing |
- |
|
Other lab facility |
15% after $300 deductible |
35% after $300 deductible* |
|
Benefit Description |
You Pay (In-Network PPO) |
You Pay (Non-PPO) |
|---|---|---|
|
Office visit |
$25 copayment per visit |
35% after $300 deductible* |
|
Telemental virtual visit |
$10 copayment per visit |
35% after $300 deductible* |
|
Other diagnostic services |
15% after $300 deductible |
35% after $300 deductible* |
|
LabCorp or Quest Diagnostics |
Nothing |
- |
|
Other lab facility |
15% after $300 deductible |
35% after $300 deductible* |
|
Benefit Description |
You Pay (In-Network PPO) |
You Pay (Non-PPO) |
|---|---|---|
|
Accidental dental injury (to a sound natural tooth) |
15% within 72 hours |
35% after $300 deductible within 72 hours* |
|
Benefit Description A generic equivalent will be dispensed if it is available, unless your physician specifically requires a brand name
|
Network |
Non-Network |
|---|---|---|
|
Retail Pharmacy There is a 30-day plus one refill limit at local retail. |
1st and 2nd fill: Generic: 20% of Plan allowance (10% of Plan allowance for asthma, diabetes, & hypertension) Formulary brand: 30% of Plan allowance Non-Formulary brand: 50% of Plan allowance Note: You may purchase up to a 90-day supply (84-day minimum) of covered drugs and supplies at a CVS/Caremark Pharmacy or through our Maintenance Choice Program. You will pay the applicable mail order copayment for each prescription purchased. |
Retail: 50% of Plan allowance* |
|
Mail Order Program |
60-day supply: $10 generic / $60 Formulary brand / $84 Non-Formulary brand 90-day supply: $15 generic / $90 Formulary brand / $125 Non-Formulary brand ($8 generic / $50 Formulary brand / $70 Non-formulary brand for asthma, diabetes & hypertension) |
|
|
Specialty drugs (requires prior approval) We use the NALC's Advanced Control Specialty formulary |
Caremark Specialty Pharmacy Mail Order:
|
|
|
Medical/Mental Health and Substance use disorder care |
You pay nothing after deductible, coinsurance and copayment expenses total:
|
|---|---|
|
Prescription |
You pay nothing after coinsurance amounts for prescription drugs dispensed by a CVS National Network pharmacy and mail order copayment amounts total:
|
|
Benefit |
You Pay (In-Network) |
You Pay (Non-PPO) |
|---|---|---|
|
Annual Routine Physical Exam (age 3 or older) |
Nothing |
35% after $350 deductible* |
|
Adult Routine Immunizations & Tests |
Nothing |
35% after $350 deductible* |
|
Well Child Care (through age 2) |
Nothing |
35% after $350 deductible* |
|
Routine Immunizations (through age 21) |
Nothing |
35% after $350 deductible* |
|
Benefit |
You Pay (In-Network PPO) |
You Pay (Non-PPO) |
|---|---|---|
|
Maternity |
Nothing |
35% after $450 per admission copay* |
|
Medical Room and Board |
$350 copayment per admission |
35% after $450 per admission copay* |
|
Mental Health/Substance Use Room and Board |
$350 copayment per admission |
35% after $450 per admission copay* |
|
Benefit |
You Pay (In-Network PPO) |
You Pay (Non-PPO) |
|---|---|---|
|
Medical/surgical |
15% after $350 deductible |
35% after $350 deductible* |
|
Emergency Medical |
15% after $350 deductible |
15% after $350 deductible* |
|
Observation Room |
$350 copayment per admission |
35% after $350 deductible* |
|
Benefit |
You Pay PPO |
You Pay Non-PPO |
|---|---|---|
|
Initial office visit / Office visit on day of manipulation |
$25 copayment per visit |
35% after $350 deductible* |
|
Manipulations (24 per calendar year) |
$25 copayment per visit |
35% after $350 deductible* |
|
One set of spinal x-rays annually |
15% after $350 deductible |
35% after $350 deductible* |
|
Benefit |
You Pay (In-Network PPO) |
You Pay (Non-PPO) |
|---|---|---|
|
Office visits |
$25 copayment per visit |
35% after $350 deductible* |
|
NALCHBP Telehealth |
$10 copayment per visit |
- |
|
X-rays, other diagnostic services |
15% after $350 deductible |
35% after $350 deductible* |
|
Benefit Description |
You Pay (In-Network PPO) |
You Pay (Non-PPO) |
|---|---|---|
|
LabCorp or Quest Diagnostics |
Nothing |
- |
|
Other lab facility |
15% after $350 deductible |
35% after $350 deductible* |
|
Benefit Description |
You Pay (In-Network PPO) |
You Pay (Non-PPO) |
|---|---|---|
|
Office visit |
$25 copayment per visit |
35% after $350 deductible* |
|
Telemental virtual visit |
$10 copayment per visit |
35% after $350 deductible* |
|
Other diagnostic services |
15% after $350 deductible |
35% after $350 deductible* |
|
LabCorp or Quest Diagnostics |
Nothing |
- |
|
Other lab facility |
15% after $350 deductible |
35% after $350 deductible* |
|
Benefit Description |
You Pay (In-Network PPO) |
You Pay (Non-PPO) |
|---|---|---|
|
Accidental dental injury (to a sound natural tooth) |
15% within 72 hours |
35% after $350 deductible within 72 hours* |
|
Benefit Description A generic equivalent will be dispensed if it is available, unless your physician specifically requires a brand name
|
Network |
Non-Network |
|---|---|---|
|
Retail Pharmacy There is a 30-day plus one refill limit at local retail. |
1st and 2nd fill: Generic: 20% of Plan allowance (10% of Plan allowance for asthma, diabetes, & hypertension) Formulary brand: 30% of Plan allowance Non-Formulary brand: 50% of Plan allowance Note: You may purchase up to a 90-day supply (84-day minimum) of covered drugs and supplies at a CVS/Caremark Pharmacy or through our Maintenance Choice Program. You will pay the applicable mail order copayment for each prescription purchased. |
Retail: 50% of Plan allowance and any difference between our allowance and the billed amount |
|
Mail Order Program |
90-day supply: Generic = 20% of the Plan allowance, maximum of $250 per prescription Formulary brand = 30% of the Plan allowance, maximum of $350 per prescription Non-Formulary brand = 50% of the plan allowance and any difference between our allowance and the charge, maximum of $500 per prescription |
|
|
Specialty drugs (requires prior approval) We use the NALC's Advanced Control Specialty formulary |
Caremark Specialty Pharmacy Mail Order:
|
|
|
Medical/Mental Health and Substance use disorder care |
You pay nothing after deductible, coinsurance and copayment expenses total:
|
|---|---|
|
Prescription |
You pay nothing after coinsurance amounts for prescription drugs dispensed by a CVS National Network pharmacy and mail order copayment amounts total:
|
Key Programs & Digital Tools
Members deserve health care that’s simple and dependable. With the NALC High Option Plan, you get easy online tools, helpful resources, and wellness programs that support your health—anytime, anywhere.
Maven
Maven offers virtual care for every stage of life.
- 24/7 video visits for pregnancy, menopause, parenting, and more
- Care navigation and provider referrals
- Unlimited chats and support from real experts.
Hello Heart
Ideal for members with cardiac conditions.
- high blood pressure, high cholesterol, issues during pregnancy, or experiencing menopause
Hinge Health
Relieve back, joint, and pelvic pain—no surgery needed.
- Personalized exercise therapy at home
- Reduce pain and avoid medications
- Available to members and dependents 18+
NALC HBP Telehealth App
Get care from home—anytime, anywhere.
- 24/7 access to doctors through your phone or tablet
- No appointment needed
- Prescriptions can be sent to your local pharmacy
myCVS On The Go App
Stay connected to your prescriptions and pharmacy benefits wherever you are.
- Refill and track prescriptions easily
- Find nearby in-network pharmacies
- View your benefit and savings information
Member Portal App
All your health info—in one secure place.
- View claims and deductibles
- Access your digital ID card
- Communicate directly with experienced representatives
Wellness & Chronic Condition Support
The NALC Postal High Option Plan supports your well-being with programs that go beyond routine care. You’ll find tools, coaching, and resources to help you build lasting habits, manage chronic conditions, and stay healthy at every stage of life:
Mental Health Support
Get the help you need with a full range of behavioral health services through Optum®.
Your mental well-being matters. The High Option Plan gives you access to virtual and in-person mental health services through trusted partners.
Medicare Coordination with the NALC High Option Plan
If you're enrolled in Medicare Parts A and B, the NALC High Option Plan offers enhanced coverage with little to no out-of-pocket costs for most medical services. You’ll also get access to exclusive options that maximize your benefits.
Medicare A & B Coordination
When Original Medicare is your primary payor and NALC HBP is secondary, your deductibles, copays, and coinsurance are waived for covered services—except prescriptions—when using a Medicare provider.
Aetna Medicare Advantage Plan (Part C)
Eligible retirees can opt into our Aetna Medicare Advantage option with no added premium. You’ll receive:
- $75/month Part B premium reduction
- No copays or deductibles for covered services
- Dental, vision, transportation, meals, and SilverSneakers®
SilverScript PDP (Part D)
Get enhanced prescription coverage and:
- Lower Medicare drug costs
- 2025 out-of-pocket max for prescriptions - $2,000
- 2026 out-of-pocket max for prescriptions - $2,100
- Receive up to $600 per enroll in premium reimbursement from the NALC Health Benefit Plan, administered by HealthEquity®.
FAQs About NALC Postal High Option Plan
In-network providers (PPO) offer lower costs and predictable copays. Out-of-network care is covered, but you’ll pay more—typically 35% after deductible.
Yes. If you’re enrolled in Medicare Parts A & B, you’ll pay little to no out-of-pocket for most services. You will also qualify for the Plan's Aetna Medicare Advantage policy.
Use Optum’s provider directory to find a mental health or substance use disorder provider. You can also call 877-468-1016 to speak with a rep 24/7.
An annual physical, screenings, and routine immunizations are all covered at 100% when you use in-network (PPO) providers. For additional information, please refer to High Option Section 5(a) of our official Plan brochure.