The Pacific Gas and Electric Company Health Care Plan for Retirees and Surviving Dependents
Name and Address of Employer
The Pacific Gas and Electric Company Health Care Plan For Retirees and Surviving Dependents is sponsored by:
Pacific Gas and Electric Company
1850 Gateway Boulevard, 7th Floor
Concord, CA 94520
Employer Identification Number
The Internal Revenue Service has assigned this ID number to the Plan sponsor:
Pacific Gas and Electric Company: 94-0742640
Participating Employers
The Pacific Gas and Electric Company
PG&E Corporation
PG&E Corporation Support Services, Inc.
PG&E Corporation Support Services II, Inc.
Plan Name
The Pacific Gas and Electric Company Health Care Plan for Retirees and Surviving Dependents
Plan Number
535
Plan Type
Plan Year
1/1–12/31
Plan Administrators
(Referred to collectively as "Plan Administrator")
The Plan Administrator for the Plan is:
The Employee Benefit Committee (EBC) of PG&E Corporation
c/o Pacific Gas and Electric Company
Benefits Department
1850 Gateway Boulevard, 7th Floor
Concord, CA 94520
The Plan Administrator for the Plan, with respect to appeals regarding claims decisions only is:
The Employee Benefit Appeals Committee (EBAC) of Pacific Gas and Electric Company
c/o Benefits Department
1850 Gateway Boulevard, 7th Floor
Concord, CA 94520
Plan Trustee, Insurance Issuer and/or Third-Party Administrator
Discretionary Authority
The Plan Administrator has oversight responsibility for the administration of the Plan which includes maintaining records, and making rules, computations, interpretations and decisions that may be necessary for administration of the Plans. The Plan Administrator has the discretionary authority to interpret, construe, and define the terms of the Plan and may advise the Plans' Claims Administrators of such interpretations, constructions and definitions.
Notwithstanding the foregoing, the insured plans (HMOs and Employee Assistance Plan) have the authority to interpret and construe the terms of their contracts and Evidences of Coverage and to resolve claims for benefits. See Funding for additional information.
Agent for the Service of Legal Process
If you wish to take legal action after exhausting the applicable claims and appeals procedures, a lawsuit may be served on the ERISA Plan Administrator. Service should be directed to:
Linda Y.H. Cheng
Vice President, Corporate Governance and Corporate Secretary
Pacific Gas and Electric Company
77 Beale Street
Mail Code B24W
San Francisco, CA 94105
Other Administrative Information
ERISA divides employee benefit plans into two broad categories: welfare plans and pension plans.
Your Pacific Gas and Electric Company Health Care Plan for Retirees and Surviving Dependents Plan is a "welfare" plan.
Funding
The Comprehensive Access Plan, the Network Access Plan, the Retiree Optional Plan, the HSA Medical Plan, the Kaiser EPO, the PG&E Medicare Supplemental Plan, the Prescription Drug Plan, and the Mental Health and Substance Abuse Program are all "self-insured." This means the Company is responsible for the overall design and administration of the plans and the Company is financially responsible for the payment of the actual costs of the benefit claims. The cost of the benefit claims are paid directly from the Company's general assets, after the claims are incurred.
Benefits from the Health Maintenance Organizations (HMOs) are provided pursuant to contracts with each plan. These organizations agree to provide covered services to enrolled Retirees and Surviving Dependents and their dependents in exchange for monthly premiums. The HMOs (not the Company) are financially responsible for the payment of benefits.
Manufacturer rebates are earned upon participant purchase of certain prescription drugs. The value of these rebates is based on the contract that Pacific Gas and Electric Company, as Plan sponsor, has with Express Scripts, Inc. These rebates are received from Express Scripts, Inc. approximately six months after the purchase of a drug and are deposited back to the trust holding the Plan assets for Retirees or employees on long-term disability or back to the Company for active employees. The cost of the Plan is reduced by the value of the rebates.
Retirees and Surviving Dependents pay a portion of the costs, generally through post-tax contributions. The applicable Retiree and Surviving Dependent contribution is established annually.
Plan Directory
The plan directory includes, in alphabetical order, the programs that make up The Pacific Gas and Electric Company Health Care Plan for Retirees and Surviving Dependents. The Company contracts with various health care organizations to administer claims for the self-funded health plans. These organizations are called third-party administrators.
Plan Name
Plan Type
Trustee, Insurance Issuer and/or Third-Party Administrator
Blue Shield HMO and Blue Shield COB HMO
hospitalization and medical benefits
Insurance Issuer:
Blue Shield of California
P.O. Box 272540
Chico, CA 95927-2540
Comprehensive Access Plan (CAP), Network Access Plan (NAP), Retiree Optional Plan (ROP), PG&E Medicare Supplemental Plan (MSP), and Health Savings Account Medical Plan (HSA Medical Plan)
hospitalization and medical benefits
Third-Party Administrator:
Anthem Blue Cross
PO Box 60007
Los Angeles, CA 90060-0007
Health Net HMO, Health Net COB HMO, and Health Net Seniority Plus (Medicare Advantage HMO)
hospitalization and medical benefits
Insurance Issuer:
Health Net
P. O. Box 9103
Van Nuys, CA 91409
Kaiser Permanente Exclusive Provider Organization Plan
hospitalization and medical benefits
Third-Party Administrator:
Kaiser Permanente Insurance Company
Kaiser Permanente Health Plan and Kaiser Senior Advantage (Medicare Advantage HMO) – Northern and Southern Regions
hospitalization and medical benefits
Insurance Issuer:
Kaiser Permanente Health Plan, Inc.
1950 Franklin Street
Oakland, CA 94612
Mental Health and Substance Abuse Program
hospitalization and medical benefits
Third-Party Administrator:
ValueOptions
P. O. Box 1290
Latham, NY 12110
Prescription Drug Plan
prescription drug benefits
Third-Party Administrator:
Express Scripts, Inc.
P. O. Box 17411
Lexington, KY 40512
Smokeless®
Through December 31, 2013
tobacco cessation program
Third-Party Administrator:
American Institute for Preventive Medicine
30445 Northwestern Highway
Suite 350
Farmington Hills, Michigan 48334
Provant Health Solutions
Effective January 1, 2014
tobacco cessation program
Third-Party Administrator:
Provant Health Solutions
420 Ladd Street
East Greenwich, RI 02818