NAP at a Glance
This is a summary of the Network Access Plan (NAP) benefits. Please refer to "What the NAP Covers" for more information on covered services and exclusions.
The information in this chart is intended to be a summary of the benefits provided by the NAP as of January 1, 2013. The information contained in the applicable service provider agreement between The Pacific Gas and Electric Company and Anthem Blue Cross shall govern in case of conflict between this chart and the service provider agreement. Please refer to the most recent information about your medical plan benefit options, which are updated annually in the Open Enrollment materials.
Network Access Plan (NAP) Administered by Anthem Blue Cross
Provisions
Network
Non-Network
General
Care provided by network providers.
Annual Deductible:
  • $120/person; $240/two people; $320/three or more people
Annual out-of-pocket maximum (includes deductible):
  • $750/person, no more than $1,500/family
  • No lifetime benefits maximum
  • No pre-existing condition exclusions.
Care provided by non-network providers.
Annual Deductible:
  • $240/person; $480 /two people; $680/three or more people
Annual out-of-pocket maximum (includes deductible):
  • $1,000/person, no more than $2,000/family
No lifetime benefits maximum.
No pre-existing condition exclusions.
  • All plan benefits and out-of-pocket maximums are based on Eligible Expenses only. For the definition of "Eligible Expenses," see the Definitions section.
  • Network benefits and limits may not be combined with non-network benefits and limits
Hospital Stay
100% after $100 copay; pre-authorization required for non-emergency care, $300 penalty if not obtained; covers semi-private room (private if Medically Necessary); includes intensive care.
70%; pre-authorization required for non-emergency care, $300 penalty if not obtained; covers semi-private room (private if Medically Necessary); includes intensive care.
Skilled Nursing Facility
(For more information on custodial care, see "What the NAP Doesn't Cover")
90% for semi-private room after 3 days in hospital; pre-authorization required, $300 penalty if not obtained. Excludes custodial care.
70% for semi-private room after 3 days in hospital; pre-authorization required, $300 penalty if not obtained. Excludes custodial care.
Emergency Room
$35 copay/visit for medical emergencies; waived if admitted. Lab/X-ray covered separately.
$35 copay/visit for medical emergencies; waived if admitted. Lab/X-ray covered separately.
Outpatient Hospital Care
$35 copay/visit for medical emergencies; waived if admitted. Lab/X-ray covered separately
70% for outpatient surgery.
Maternity Care
Covered as any other condition. Pre-authorization required for delivery stays beyond 48 hours for normal delivery (96 hours for cesarean section); $300 penalty if not obtained.
Covered as any other condition. Pre-authorization required for delivery stays beyond 48 hours for normal delivery (96 hours for cesarean section); $300 penalty if not obtained.
Well-Baby Care
Covered as any other condition.
Covered as any other condition.
Office Visits
  • Primary care - $10 copay/visit
  • Specialist (including OB/GYN) –$20copay/visit.
70%
Urgent Care Visits
  • Primary care - $10 copay/visit
  • Specialist (including OB/GYN) –$20 copay/visit.
70%
Routine Physical Examinations
  • Primary care –$10 copay/visit
  • Specialist –$20copay/visit lab/X-ray covered separately.
70%
Immunizations and Injections
95%
70%
Eye Examinations
Not covered.
Not covered.
X-rays and Lab Tests
90%
70%
Pre-Admission Testing
95%
70%
Home Health Care and Home Hospice Care
(For more information on custodial care, see "What the NAP Doesn't Cover")
90%; requires prior authorization; $300 penalty if not obtained. Excludes custodial care.
70%; requires prior authorization; $300 penalty if not obtained. Excludes custodial care.
Outpatient Physical Therapy
80%
70%
Outpatient Prescription Drugs
Covered by separate drug plan administered by Express Scripts. See the Prescription Drug Coverage section.
Covered by separate drug plan administered by Express Scripts. See the Prescription Drug Coverage section
Inpatient and Outpatient Mental Health Care
Covered by separate Mental Health Program administered by ValueOptions. See the Mental Health and Substance Abuse Coverage section.
Covered by separate Mental Health Program administered by ValueOptions. See the Mental Health and Substance Abuse Coverage section.
Inpatient and Outpatient Substance Abuse Care
Covered by separate Substance Abuse Program administered by ValueOptions. See the Mental Health and Substance Abuse Coverage section.
Covered by separate Substance Abuse Program administered by ValueOptions. See the Mental Health and Substance Abuse Coverage section.
Durable Medical Equipment
80%; pre-authorization required for purchase or cumulative rental over $1,000; $300 penalty if not obtained.
70%; pre-authorization required for purchase or cumulative rental over $1,000; $300 penalty if not obtained.
Chiropractic Care
80% for care approved by American Specialty Health Network (ASHN) using network provider. See "Chiropractic Care" under "What the NAP Covers."
70% for up to 15 visits for Medically Necessary care.
Acupuncture
80% for up to 20 visits per year from licensed acupuncturist or M.D.
70% for up to 15 visits per year from licensed acupuncturist or M.D.
Hearing Aids and related expenses
Covered effective January 1, 2014
80% for Medically Necessary only; one hearing aid per ear every three years
80% for Medically Necessary only; one hearing aid per ear every three years
Services Received Outside of the US
Limited to urgent/emergency services only
Limited to urgent/emergency services only
Other Benefits
Infertility Treatment—Paid according to type of benefit; $7,000 lifetime maximum. Balances from prior plans carry forward.
Transplant Services—100% when performed at a Center of Medical Excellence (CME); 70% when performed at a non-CME, Network facility; pre-authorization required.
Infertility Treatment—Paid according to type of benefit; $7,000 lifetime maximum. Balances from prior plans carry forward.
Transplant Services—Not covered.