MSP at a Glance
This is a summary of the PG&E Medicare Supplemental Plan (MSP) benefits. Please see "What the MSP Covers" for more information on covered services and exclusions.
The information in this chart is intended as a summary only. The applicable legal documents will govern actual benefits.
Provisions
PG&E Medicare Supplemental Plan (MSP)
Administered by Anthem Blue Cross
General
Available to all current enrolled Retirees and eligible spouses or registered domestic partners who are 65 or older or who have Medicare due to disability (if retiree elects Medicare Supplemental Plan and spouse/domestic partner is not eligible for Medicare, spouse/domestic partner will be enrolled in appropriate PG&E medical plan administered by Anthem Blue Cross); worldwide coverage for urgent/emergency care; there are two $100 annual individual deductibles — a medical deductible and a drug deductible; $10,000 lifetime maximum (up to $1,000 restored each year) for medical; $10,000 lifetime maximum for prescription drugs (up to $1,000 restored each year).
Hospital Stay
After deductible, 80% of eligible hospital expenses not covered by Medicare.
Skilled Nursing Facility
After deductible, 80% of member copay amount per Medicare from 21st to 100th day of confinement; custodial care not covered.
Outpatient Hospital and Emergency Room Care
After deductible, 80% of eligible expenses not covered by Medicare.
Office Visits
After deductible, 80% of eligible expenses not covered by Medicare.
Urgent Care Visits
After deductible, 80% of eligible expenses not covered by Medicare.
Routine Physical Examinations
Not covered.
Immunizations and Injections
Not covered.
Eye Examinations
Not covered.
X-rays and Lab Tests
After deductible, 80% of eligible expenses not covered by Medicare.
Pre-Admission Testing
After deductible, 80% of eligible expenses not covered by Medicare.
Durable Medical Equipment
After deductible, 80% of eligible expenses not covered by Medicare.
Home Health Care & Home Hospice Care
After deductible, 80% of eligible expenses not covered by Medicare.
Inpatient Hospice Care
After deductible, 80% of eligible expenses not covered by Medicare.
Outpatient Physical Therapy
After deductible, 80% of eligible expenses not covered by Medicare.
Outpatient Prescription Drugs
After separate, $100 individual deductible, 80% of eligible expenses not covered by Medicare; prescription drug program administered by Express Scripts, Inc. Not linked to medical plan. Separate $10,000 lifetime maximum and separate annual restoral.
Mental Health:
Inpatient Care
After deductible, 80% of eligible expenses not covered by Medicare; physician services not covered.
Outpatient Care
Not covered.
Substance Abuse
Not covered.
Chiropractic Care
After deductible, 80% of eligible expenses not covered by Medicare. Services must be Medically Necessary.
Acupuncture
Not covered.
All plan benefits and out-of-pocket maximums are limited to Eligible Expenses.