PG&E's Voluntary Review Process
If you are not satisfied with the claims and appeals process completed with Express Scripts, you may elect to use either PG&E's Voluntary Review Process or elect to bring a civil action. You have 90 days from the date of receipt of the final decision from Express Scripts to elect this voluntary review. Initiation of the Voluntary Review Process does not restrict your ability to bring a civil action against the Plan.
Step 1
The first step of the Voluntary Review Process is to write to the Benefits Department, requesting a review of your appeal. Your appeal should include all pertinent documentation. To expedite processing, you should also include a HIPAA AUTHORIZATION FOR USE AND/OR DISCLOSURE OF PROTECTED HEALTH INFORMATION form. You can access a copy online from the Human Resources Forms section of the PG&E@Work intranet or by calling the PG&E Benefits Service Center at 866-271-8144 (open weekdays from 7:30 a.m. to 5 p.m. Pacific time).
Send your appeal to:
Pacific Gas and Electric Company
Benefits Department
Appeals — Step One
1850 Gateway Blvd., 7th Floor
Concord, CA 94520
The Benefits Department will review your appeal and make a decision within 60 days of the date on which the appeal is received (non-receipt of the HIPAA Authorization form may delay your appeal). There may be special circumstances where an extension of up to 90 days may be required. You will be notified if such an issue occurs. If the Benefits Department denies your claim, you will receive a written response that will include:
  • the reason(s) for the denial;
  • a reference to the Plan provision(s) that apply to the denial; and
  • an explanation of additional appeals procedures.
Step 2
If your appeal is denied, you may then request a second-level review by the Employee Benefit Appeals Committee (EBAC). To do so, you must submit a new appeal in writing within 60 days of the date on which you received the Step One denial. Your appeal should state the reason(s) for your appeal and should include all relevant documentation and information that supports your appeal. Unless there are special circumstances where an extension of up to an additional 90 days may be required, you shall receive the EBAC's decision within 90 days of the EBAC's receipt of the appeal.
Send your appeal to:
Pacific Gas and Electric Company
Benefits Department
EBAC Appeals
1850 Gateway Blvd., 7th Floor
Concord, CA 94520
If the EBAC denies your appeal, you will receive a written response which will include:
  • the specific reason(s) for the denial;
  • a reference to the specific Plan provision(s) on which the denial is based;
  • a statement that you are entitled to receive, upon request and free of charge, reasonable access to, and copies of, all documents, records and other information relevant to your claim for benefits; and
  • a statement of your right to bring a civil action under section 502(a) of ERISA.