Health Care Benefits
"Company" Defined
Throughout this section, unless otherwise stated, reference to "Company" or "PG&E" means Pacific Gas and Electric Company. The plans and benefits described in this handbook are also applicable to employees who terminate at or after age 55 ("retirees") and surviving dependents of PG&E Corporation and its designated subsidiaries, but only to the extent that such entities are participating employers with respect to the described plans or programs and such retirees and surviving dependents meet the eligibility requirements of the plans or programs.
The Company gives you a choice of benefits so you can elect the coverage that best meets your needs. This Handbook describes the available medical (including mental health and prescription drugs) coverage provided pursuant to the Pacific Gas and Electric Company Health Care Plan for Retirees and Surviving Dependents (as used in this section, "the Plan.")
This section is organized into subsections and chapters, to help you find the information you want. These are:
  • Health care participation,
  • Medical coverage, including the chapters:
    • Network Access Plan (NAP),
    • Comprehensive Access Plan (CAP),
    • Retiree Optional Plan (ROP),
    • Medicare Supplemental Plan (MSP)
    • NAP, CAP, ROP, and MSP Definitions,
    • Claims and Appeals Process (for NAP, CAP, ROP, and MSP),
    • Non-Medicare Health Maintenance Organizations (HMOs),
    • Medicare Health Maintenance Organizations (HMOs),
    • Mental Health and Substance Abuse, and
    • Prescription Drugs.
Additional Information
In addition to the information in this section, there is also important information about your benefits in other parts of this Handbook. Be sure to review the About This Handbook section, the Benefits at a Glance section, the What to Do… section, and the Rules, Regulations & Administrative Information section.
Information about the In-Area HSA Medical Plan and the Out-of-Area HSA Medical Plan is included in a separate Summary Plan Description (SPD). You may request a copy at any time by contacting the PG&E Benefits Service Center at 866-271-8144 (open weekdays from 7:30 a.m. to 5 p.m. Pacific time).
Responsibility for Your Health Care
While the Company has contracted with reputable health care plans to provide health care services, neither the Company nor the Plan can ensure the quality of care you receive. The health care vendors contract with the providers in their networks; the Company does not contract with any of the network doctors, hospitals or other providers directly.
Health plan participants always have a choice in the services they receive and who provides those services, regardless of what the health care plan covers or pays. Members of HMOs always have the right to change primary care physicians, subject to the limitations outlined in the HMOs' Evidences of Coverage (EOCs). To see the EOC for your health care plan, contact the medical plan vendor.
Plan Documents and Administration
The plan document for The Pacific Gas and Electric Company Health Care Plan for Retirees and Surviving Dependents (the "Health Care Plan") incorporates the terms of this Summary of Benefits Handbook which pertain to the Health Care Plan, the documents that are Summaries of Material Modifications to the Health Care Plan, which may include Open Enrollment guides, and the Health Maintenance Organization Evidences of Coverage. If a conflict exists between these Health Care Plan documents and any other communications or documents, the terms of these Health Care Plan documents shall govern the operation of the Health Care Plan.
The Employee Benefit Committee of PG&E Corporation is the Plan Administrator of the Health Care Plan and has the discretionary authority to interpret and construe the terms of the Health Care Plan, to resolve any conflicts or discrepancies between documents and to establish rules which are necessary or desirable for the administration of the Health Care Plan.