Medical Coverage
This section describes the medical plans that are offered to eligible retirees and surviving dependents, as well features of those plans such as prescription drug coverage and mental health and substance abuse coverage.
PG&E offers several self-funded plans that are administered by Anthem Blue Cross. Self-funded means that rather than paying insurance premiums to an insurer, PG&E engages a third-party to administer these plans and provides the administrator with funds from PG&E's Retiree Medical Plan trust to pay the actual claims incurred.
HMOs and EPOs are insured plans that are only offered in specific locations. The EPO is offered to non-Medicare-eligible members only, and separate HMO plans are offered for Medicare-eligible and non-Medicare members.
You may also decline PG&E-sponsored medical coverage. If you are a Retiree and decline medical coverage on or after January 1, 2003, you may be eligible to re-enroll during the annual Open Enrollment period for the upcoming calendar year, provided you call the PG&E Benefits Service Center prior to September 1. Note that Surviving Dependents who decline coverage will not be able to re-enroll at a later date. Please see "Cancelling Coverage" in the Health Care Participation section.
Medical plan options and benefits for Medicare-eligible members are different than those for members who are not Medicare-eligible (see "Medical Benefits for Members Under 65" and "Medical Benefits for Medicare-Eligible Members"). For example, if you are Medicare-eligible but one or more of your enrolled dependents is not, you and your dependent(s) may receive different benefits from the medical plan carrier you select.
In addition, there are several different types of plans for Medicare-eligible members. You may choose a secondary plan (e.g., the Comprehensive Access Plan, Retiree Optional Plan, or the Medicare Supplemental Plan), a Medicare Advantage HMO, or a Medicare Coordination of Benefits HMO. It is important that you understand the difference between these plans and how each type of plan works with Medicare to provide your medical benefits.
Additional Informaiton
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).