ROP at a Glance
This is a summary of the ROP benefits. Please refer to "What the ROP 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 ROP 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.
Retiree Optional Plan (ROP) Administered by Anthem Blue Cross
General
May use provider of choice or network provider; $400 annual deductible per individual, up to family maximum of $1,200; $4,000 annual out-of-pocket maximum per individual, up to family maximum of $8,000. No lifetime maximum; no pre-existing condition exclusions. All plan benefits and out-of-pocket maximums are based on Eligible Expenses only.
Hospital Stay
70% after deductible for semi-private room (private if Medically Necessary); includes intensive care; pre-authorization is required for non-emergency care, except for Medicare-eligible members; $250 penalty for not obtaining required pre-authorization.
Skilled Nursing Facility
70% after deductible after 3 days in hospital; covers semi-private room; excludes custodial care. Pre-authorization is required for both Medicare and non-Medicare members.
Outpatient Hospital Surgery & Emergency Room Care
70% after deductible.
Maternity Care
Covered as any other condition.
Well-Baby Care
70% after deductible.
Office Visits
70% after deductible for office and home visits.
Urgent Care Visits
70% after deductible.
Routine Physical Examinations
70% after deductible.
Immunizations and Injections
70% after deductible.
Eye Examinations
Not covered.
Diagnostic X-rays and Lab Tests
70% after deductible.
Pre-Admission Testing
70% after deductible.
Home Health Care & Home Hospice Care
70% after deductible; requires prior authorization; excludes custodial care.
Inpatient Hospice Care
70% after deductible; requires prior authorization; excludes custodial care.
Outpatient Physical Therapy
70% after deductible.
Outpatient Prescription Drugs
Covered by separate prescription drug plan administered by Express Scripts, Inc. (see the Prescription Drug Coverage section for details).
Mental Health
70% after deductible.
Inpatient and Outpatient Substance Abuse
70% after deductible.
Durable Medical Equipment
70% after deductible.
Chiropractic Care
70% after deductible; 10-visit maximum; maintenance care not covered.
Acupuncture
70% after deductible.
Services Received Outside of the U.S.
Limited to urgent/emergency services only.
Hearing Aids and related expenses
Covered effective January 1, 2014
80% for Medically Necessary only; one hearing aid per ear every three years.
Other Benefits
  • Infertility—70% after deductible; $7,000 lifetime maximum. Balances from prior plans carry forward.
  • Transplant Services—70% after deductible, pre-authorization required for transplant services for non-Medicare members.
  • Hearing aids—70% up to $2,800 annually, through 2013. See new coverage effective January 1, 2014 in the Hearing Aids — Effective January 1, 2014 section.