Plan Maximums
Out-of-Pocket Maximums
The Plan has an out-of-pocket maximum that limits the amounts you pay for covered services. The out-of-pocket maximum is the maximum amount you pay each calendar year for covered expenses, including deductibles, copayments and coinsurance.
 
Network Providers
Non-Network Providers
Per Person
$750
$1,000
Family
$1,500
$2,000
Charges for non-covered services, charges above Customary and Reasonable Charges (Eligible Expenses), and penalties for not obtaining pre-authorization do not apply toward the annual out-of-pocket maximum.
Lifetime Maximums
The Plan does not have an overall lifetime maximum benefit, but there are lifetime maximums for the following services or supplies:
Service or Supply
Lifetime Maximum
Infertility Treatments
$7,000 combined for all PG&E self-insured medical plans administered by Anthem Blue Cross or prior claims administrators.
Reimbursement for Travel and Lodging Expenses incurred in connection with Organ Transplants
Transportation and lodging expenses for the transplant recipient and companion(s)
$10,000 combined for all travel expenses (IRS limit).
Reimbursement for Travel and Lodging Expenses incurred in connection with Bariatric/Transgender Surgery
$3,000 combined for all travel expenses.