Medical Benefits for Members Under 65
The table below summarizes the health care benefits available to members or dependents who are under age 65 and/or not Medicare-eligible, and reference to where more details can be found.
Health Care Benefits
Coverage Options
Medical Coverage
Anthem Blue Cross-Administered plans (Eligibility depends on home ZIP code)
  • Network Access Plan (NAP)
  • Comprehensive Access Plan (CAP)
  • Retiree Optional Plan (ROP)
Health Maintenance Organizations (HMOs) / Exclusive Provider Organization (EPO)
(Available if you live within the organization's service territory)
  • Blue Shield HMO (Access+)
  • Health Net HMO
  • Kaiser Permanente EPO – Northern and Southern Regions
Mental Health and Substance Abuse Coverage
(automatically included with medical plan coverage)
For NAP and CAP Plan Members:
  • Coverage provided through the Mental Health and Substance Abuse Program, administered by ValueOptions (VO)
For Retiree Optional Plan (ROP) Members:
  • Coverage provided through Anthem Blue Cross
For Kaiser Members:
  • Coverage provided through Kaiser, except for Inpatient Substance Abuse, which is covered through ValueOptions (VO).
For Members of all other HMOs and EPOs:
  • Mental health coverage provided through the plan. Call the plan's member services number for details. Substance Abuse treatment provided through the Mental Health and Substance Abuse Program administered by ValueOptions (VO), and also through your HMO/EPO.
Prescription Drugs
(included with medical plan)
For Members of Anthem Blue Cross-Administered Plans:
  • Express Scripts (formerly Medco) (retail)
  • Express Scripts Mail Order (formerly Medco By Mail) (mail-order)
For Members of HMOs and EPOs:
  • Drug coverage (retail and mail-order) through individual plan (call the plan's member services number for details).
If You Are Not Medicare-Eligible, But an Enrolled Dependent Is
If any of the dependents you cover are over age 65 and/or Medicare-eligible, they will be enrolled in the over-65 version of the plan you are in, as indicated below, and if available in your area based on your home ZIP code.
If you are enrolled in:
Your Medicare-eligible dependent(s) will be enrolled in:
Blue Shield HMO
Blue Shield Medicare COB HMO
Health Net HMO
Health Net Medicare COB HMO, or
Health Net Seniority Plus (Medicare Advantage HMO)
Kaiser EPO (North and South)
Kaiser Senior Advantage (Medicare Advantage HMO)
Network Access Plan (NAP)
Comprehensive Access Plan (CAP)
Comprehensive Access Plan (CAP)
Comprehensive Access Plan (CAP)
Retiree Optional Medical Plan
Retiree Optional Medical Plan
Kaiser requires your Medicare-eligible dependent(s) to enroll in and assign their Medicare benefits to the Plan's Medicare HMO. Health Net offers an over-65 Medicare Coordination of Benefits (COB) HMO to your Medicare-eligible dependent(s). Health Net Medicare-eligible members also have the option of enrolling in Health Net's Medicare HMO (Seniority Plus). If you enroll in one of these plans, your covered dependents that are eligible for Medicare must fill out and return to Pacific Gas and Electric Company a form that authorizes assignment of their Medicare benefits to the Medicare HMO. If your Medicare-eligible dependent does not have Medicare Part A and B or does not complete the form, he or she cannot enroll in the Medicare HMO and will be switched to the Comprehensive Access Plan (CAP), administered by Anthem Blue Cross. Members of the Blue Shield COB HMO and the Health Net HMO must complete a Medicare Part D enrollment form. If these members do not complete this form, they also will be switched to the CAP. Because members and their enrolled dependents must be covered by the same medical plan carrier, if your dependent is switched to the Comprehensive Access Plan (CAP), you will also be switched to the Anthem Blue Cross plan offered in your area (NAP or CAP), and you will be responsible for that plan's premium.
The Anthem Blue Cross plans require your Medicare-eligible dependent(s) to enroll in the Comprehensive Access Plan. (Note: The MSP is not available to your Medicare-eligible dependents until you turn age 65.)