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About this Handbook
This version is for eligible union-represented employees
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What If...
Benefits at a Glance
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Health Care
Benefits
Medical Plan Chooser
Health Care Participation
Medical Coverage
Network Access Plan (NAP)
Comprehensive Asscess Plan (CAP)
Definitions for NAP, CAP and HSA
Claims and Appeals
In-Area Health Savings Account (HSA) Plan
Out-of-Area Health Savings Account (HSA) Plan
Health Maintenance Organizations (HMOs)
Medical Coverage for Medicare-Eligible Participants
Mental Health and Substance Abuse
Prescription Drug Coverage
Dental Coverage
Vision Coverage
Reimbursement
Accounts
Disability
Coverage
Life & Accident
Insurance
Retirement
Benefits
Time Off
& Leaves
Work/Life
Benefits
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Benefits Handbook Home
About this Handbook
Benefits at a Glance
What Happens...
Health Care Benefits
Reimbursement Accounts
Disability Coverage
Life & Accident Insurance
Retirement Benefits
Time Off & Leaves
Work/Life Benefits
Rules, Regulations & Administrative Information
Contacts
Health Care Benefits
Medical Plan Chooser
Health Care Participation
Medical Coverage
Mental Health and Substance Abuse Coverage
Prescription Drug Coverage
Dental Coverage
Vision Coverage
Medical Coverage
Network Access Plan (NAP)
Comprehensive Asscess Plan (CAP)
Definitions for NAP, CAP and HSA
Claims and Appeals
In-Area Health Savings Account (HSA) Plan
Out-of-Area Health Savings Account (HSA) Plan
Health Maintenance Organizations (HMOs)
Medical Coverage for Medicare-Eligible Participants
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Welcome!
About this Handbook
Benefits at a Glance
Health Care Eligibility at a Glance
Enrollment Options at a Glance
Health Care Coverage at a Glance
NAP Medical at a Glance
CAP Medical at a Glance
In-Area HSA Medical at a Glance
Out-of-Area HSA Medical at a Glance
Blue Shield HMO Medical at a Glance
Health Net HMO Medical at a Glance
Kaiser Permanente HMO Medical at a Glance
EAP and Mental Health/Substance Abuse Benefits at a Glance
Prescription Drug Plan at a Glance
Dental Coverage at a Glance
Vision Coverage at a Glance
Reimbursement Accounts at a Glance
Disability Coverage at a Glance
Life and Accident Insurance at a Glance
Retirement Plans at a Glance
Time Off Benefits at a Glance
Work/Life Benefits at a Glance
What If.
Work Events
I Join PG&E
I Transfer from Management or Administrative & Technical Positions
I Reach Regular Status
I Take an Unpaid Leave of Absence
I Leave PG&E
I Retire
Family Events
I Get Married or Enter into a Registered Domestic Partnership
I Become Divorced, Legally Separated, or End a Registered Domestic Partnership
I Have or Adopt a Child or Become a Foster Parent or a Legal Guardian
I Move
I Lose Other Coverage, After Declining Company Coverage
My Spouse or Registered Domestic Partner Retires
Health Events
I Am Injured or Sick and Absent from Work
I Am Disabled Long-Term and Go on LTD
I Become Terminally Ill or Die While an Active Employee
Other Events
I Enroll for Benefits Each Year
I Need to Make a Mid-Year Change
Other Rules
Change in Status Events
Timeline for Health and Welfare Benefit Enrollment
Health Care Benefits
PG&E Medical Plan Chooser
Health Care Participation
Eligible Dependents
Ineligible Dependents
If Eligibility Is Denied
Cost of Coverage
Contributions for Full-Time Employees
Contributions for Part-Time Employees
Contributions for Employees on Leaves of Absence
Contributions for Employees on Long-Term Disability
Medicaid and the Children's Health Insurance Program (CHIP) Offer Free or Low-Cost Health Coverage to Children and Families
Enrollment
New Hire Enrollment
Annual Open Enrollment
Declining Medical, Dental and/or Vision Coverage
Changing Your Coverage
HIPAA Special Enrollment Periods
If You Have Other Coverage
Which Plan Is Primary for You?
Which Plan Is Primary for Your Children?
Coordination with Medicare
Medicare and Active Employment
Reductions/Exclusions for Duplicate Coverage
Subrogation and Reimbursement
When Coverage Ends
Your Dependents
Extended Benefits When Coverage Ends
Continuing Coverage Under COBRA
Eligibility
When COBRA Coverage Ends
Cost of COBRA Continuation Coverage
How to Obtain COBRA Continuation Coverage
Review of COBRA Determination of Ineligibility
If Your COBRA Coverage Ends
Conversion to an Individual Medical Policy
Medical Coverage
The Network Access Plan (NAP)
NAP at a Glance
How the NAP Plan Works
Network Providers
Non-Network Providers
Deductibles
Plan Maximums
Copayments and Benefit Percentages
How Benefits Are Determined
Medical Management Programs
Utilization Review Program
Authorization Program
Medical Necessity Review Process
Personal Case Management
What NAP Covers
Acupuncture
Ambulance Services
Chiropractic Care
Home Health Care and Hospice Care
Hospital Care -- Inpatient
Hospital Care - Outpatient
Organ and Tissue Transplants
Prescription Drugs
Professional Services
Psychiatric Care and Substance Abuse Treatment
Skilled Nursing Facility
Other Covered Services and Supplies
What NAP Doesn't Cover
Third Party Exclusion
Comprehensive Access Plan (CAP)
CAP at a Glance
How CAP Works
Deductibles and Maximums
Copayments and Benefit Percentages
How Benefits Are Determined
Medical Management Programs
Utilization Review Program
Authorization Program
Medical Necessity Review Process
Personal Case Management
What CAP Covers
Acupuncture
Ambulance Services
Chiropractic Care
Home Health Care and Hospice Care
Hospital Care - Inpatient
Hospital Care - Outpatient
Organ and Tissue Transplants
Prescription Drugs
Professional Services
Psychiatric Care and Substance Abuse Treatment
Skilled Nursing Facility
Other Covered Services and Supplies
What CAP Doesn't Cover
Third Party Exclusion
Definitions
Claims and Appeals Process
Filing a Claim for Benefits
Required Information
Payment of Benefits for Non-Network Benefits
Benefit Determinations (Before an Appeal Is Filed)
To Resolve a Problem
Appeals
How to Appeal a Claim Decision - Non-Urgent
PG&E's Voluntary Review Process
In-Area Health Savings Account (HSA) Medical Plan
Eligibility
In-Area HSA Medical Plan at a Glance
How the In-Area HSA Medical Plan Works
Network Providers
Non-Network Providers
Deductibles
Plan Maximums
Benefit Percentages
Preventive Health Guidelines
How Benefits Are Determined
Medically Necessary Services
Medical Management Programs
Utilization Review Program
Authorization Program
Medical Necessity Review Process
Personal Case Management
What the In-Area HSA Medical Plan Covers
Acupuncture
Ambulance Services
Bariatric Surgery
Chiropractic Care
Home Health Care and Hospice Care
Hospital Care - Inpatient
Hospital Care - Outpatient
Organ and Tissue Transplants
Prescription Drugs
Professional Services
Psychiatric Care and Substance Abuse Treatment
Skilled Nursing Facility
Other Covered Services and Supplies
What the In-Area HSA Medical Plan Does Not Cover
What Outpatient Prescription Drugs the Plan Does Not Cover
Third Party Exclusion
Claims and Appeals Process for Medical Benefits
Filing a Claim for Benefits
Payment of Benefits for Non-Network Benefits
Benefit Determinations (Before an Appeal Is Filed)
To Resolve a Problem
Appeals
PG&E's Voluntary Review Process
Claims and Appeals for Outpatient Prescription Drug Benefits
Out-of-Area Health Savings Account (HSA) Medical Plan
Eligibility
Out-of-Area HSA Medical Plan at a Glance
How the Out-of-Area HSA Medical Plan Works
Deductibles and Maximums
Benefit Percentages
Preventive Health Guidelines
How Benefits Are Determined
Medically Necessary Services
Medical Management Programs
Utilization Review Program
Authorization Program
Medical Necessity Review Process
Personal Case Management
What the Out-of-Area HSA Medical Plan Covers
Acupuncture
Ambulance Services
Bariatric Surgery
Chiropractic Care
Home Health Care and Hospice Care
Hospital Care - Inpatient
Hospital Care - Outpatient
Organ and Tissue Transplants
Prescription Drugs
Professional Services
Psychiatric Care and Substance Abuse Treatment
Skilled Nursing Facility
Other Covered Services and Supplies
What the Out-of-Area HSA Medical Plan Does Not Cover
What Outpatient Prescription Drugs the Plan Does Not Cover
Third Party Exclusion
Claims and Appeals Process for Medical Benefits
Filing a Claim for Benefits
Payment of Benefits for Non-Network Benefits
Benefit Determinations (Before an Appeal Is Filed)
To Resolve a Problem
Appeals
PG&E's Voluntary Review Process
Claims and Appeals for Outpatient Prescription Drug Benefits
Health Maintenance Organizations (HMOs)
How HMOs Work
Primary Care Physicians (PCPs)
HMO Service Areas
Available HMOs
HMO Summaries of Benefits (Non-Medicare)
Blue Shield HMO (Access+)
Health Net HMO
Kaiser Permanente HMO - North and South
Additional Coverage Rules
Claims, Appeals and Complaints
Claims
Appeals
Complaints
Medical Coverage for Medicare-Eligible Participants
Medicare Parts A, B and D
Plan Options for LTD Employees/Dependents Eligible for Medicare
Comprehensive Access Plan
Medicare Coordination of Benefits (COB) HMO Plans
Medicare Advantage HMOs
Members and Dependents with Different Medicare Status
Summaries of HMO Benefits for Members on Medicare
Blue Shield Medicare COB HMO
Health Net Medicare COB HMO
Health Net Seniority Plus (Medicare Advantage HMO)
Kaiser Permanente Senior Advantage - North and South (Medicare Advantage HMO)
Other Coverage Rules
Mental Health and Substance Abuse Coverage
EAP and Mental Health and Substance Abuse at a Glance
Employee Assistance Program
Eligibility and Cost
Confidentiality
How to Use the Program
What the Program Covers
Grievance and Arbitration Procedures
Eligibility
How Benefits Are Provided
For NAP Members
Coinsurance and Copayments for NAP Members
How the Program Works for NAP Members
What the Program Covers for NAP Members
For CAP Members
Deductibles and Limits for CAP Members
Coinsurance and Copayments for CAP Members
How the Program Works for CAP Members
What the Program Covers for CAP Members
For HMO Members
Deductibles and Limits for HMO Members
Coinsurance and Copayments for HMO Members
How the Program Works for HMO Members
What the Program Covers for HMO Members
For Members of All Medical Plans (except HSA Medical Plan)
Medical Management and Authorization Programs
Medically Necessary
What the Program Does Not Cover
More about the Program
Claims and Appeals Process for ValueOptions
Prescription Drug Coverage
Plan Benefits
Generic Incentive Provision
Eligibility
How the Plan Works
Retail Pharmacy Service
Medco By Mail
What the Plan Covers
What the Plan Does Not Cover
Coordination of Benefits
Claims and Appeals
Claims and Inquiries
Appeals
PG&E's Voluntary Review Process
Dental Coverage
Dental Coverage at a Glance
How Dental Coverage Works
Non-Participating Dentists
Predetermination of Costs
What's Covered
Plan Limitations
What's Not Covered
Claims and Appeals
Claims and Inquiries
Complaints and Appeals
Vision Coverage
How the Plan Works
Non-VSP Providers
Benefits with VSP Providers
Benefits with Non-VSP Providers
What the Plan Does Not Cover
Value-Added Discounts from VSP Doctors
Claims and Appeals
Claims
Complaints and Appeals
PG&E's Voluntary Review Process
Reimbursement Accounts
Reimbursement Accounts at a Glance
How this Section Is Organized
How HCRAs and DCRAs Work
Eligibility, Enrollment and Administration
Setting Up Your Reimbursement Accounts
Putting Money into Your Reimbursement Accounts
Health Care Reimbursement Account
Deadline for Submitting Health Care Claims
Dependent Care Reimbursement Account
Deadline for Submitting Dependent Care Claims
When Reimbursements Are Available
Reimbursement Account Limitations
Questions About Claims for Reimbursement
Health Care Reimbursement Account (HCRA)
Eligible Expenses
Ineligible Expenses
Partial Prepayments
Claims and Appeals
Dependent Care Reimbursement Account (DCRA)
Whose Expenses Are Eligible?
Eligible Expenses
Ineligible Expenses
Tax Credits
Health Savings Account (HSA)
Eligibility, Enrollment and Administration
Putting Money into Your HSA
Income Taxes and Your HSA
Investment Options
Withdrawals/Reimbursements
Eligible Expenses
Ineligible Expenses
Claims and Appeals
What Happens.
If You Take a Leave of Absence Without Pay
If You Are on Long-Term Disability or Workers' Compensation
If You Retire or Leave the Company
If You Have Multiple Accounts
Sick Leave & Disability
The Coverage Available
Eligibility, Enrollment and Cost
Sick Leave
Earning Sick Leave
Family Sick Leave
Sick Leave Bonus Vacation Award
Using Sick Leave
Terminated Employees
Long-Term Disability (LTD) Plan
How Disability Is Determined
What the LTD Plan Does Not Cover
What Happens to Your Other Benefits
Plan I
Plan II
Plan III
Claims and Appeals - Plans I, II and III
Workers' Compensation
Procedures in the Event of an Industrial Injury or Illness
Supplemental Benefits for Industrial Injury Plan
When Benefits Begin
How Much the Plan Pays
When Benefits End
Claims and Appeals
Life and Accident Insurance Plans
Group Life Insurance
Eligibility, Enrollment, and Cost
Imputed Income from Your Life Insurance Coverage
How Your Benefit Is Paid
Accelerated Benefit Option (ABO)
Assignment of Benefits
Changing the Level of Your Coverage
What Happens.
When Coverage Ends
Converting Your Coverage to an Individual Policy
Claims and Appeals for Group Life
Claims Relating to a Benefit
Claims Relating to Eligibility
State Legal Notices for Group Life Coverage
Business Travel Insurance (BTI)
Eligibility
How Business Travel Insurance Works
Amount of Coverage
BTI Benefits
Limitations and Exclusions
Claims Information
Claims Review Procedure
Retirement Benefits
Retirement Plan
Retirement Plan at a Glance
Participating in the Plan
How the Retirement Plan Works
Your Pension Benefit
Credited Service
Breaks in Service
Loss or Reduction of Benefits
When Benefits Are Payable
Early Retirement Benefits
Deferred Retirement Benefits
Mandatory Distributions
Payment Options
Single Life Pension
Joint Pension
Past Employee Contributions to the Retirement Plan
Changing Your Election
What Happens.
If You Leave the Company Before You Are Eligible to Retire
If You Transfer to or from a Non-Union Position
If You Get Divorced
If You Die Before You Retire
Claims and Appeals
The Pension Benefit Guaranty Corporation
Retirement Savings Plan
Financial EnginesR
Retiree Medical Coverage
Your Medical Plan Options
Eligibility
Surviving Dependents
Changing Your Coverage
Cost of Retiree Medical Coverage
How the RMSA Works
Postretirement Life Insurance
Amount of Coverage
Time Off and Leaves
Time Off and Leaves at a Glance
Vacation Program
Earning Vacation
Illness While on Vacation
Service Anniversary Days
How to Schedule or Defer Your Vacation
Work In-Lieu of Vacation
Excess Vacation Payout
Voluntary Vacation Transfer
Vacation Pay Upon Termination
Re-employment with the Company
Paid Holidays
When a Holiday Falls on a Weekend or Non-Workday
Work Performed on a Holiday
Floating Holidays
Part-Time Employees
Leaves of Absence
Determination for Eligibility and Entitlements under FMLA/CFRA Leave
Types of Leave
Union Business Leave
Other Time Off
Jury Duty
Funerals
Adoption
Voting
Family School Partnership Act (FSPA)
Victims of Domestic Violence Act (VDVA)
Victims of Crime Act (VCA)
Civil Air Patrol Leave
Work/Life Benefits
Adoption Expense Reimbursement Program
Eligibility
What the Program Covers
How to Apply
Claims and Appeals
Antiviral Program Plan
Eligibility, Participation and Cost
Claims and Appeals
Commuter Transit Program
Eligibility
Benefits
Forfeitures
Employee Discount
Requesting the Discount and Change of Residence
Legal/Financial Solutions (ValueOptions)
Eligibility
Cost
How to Use Legal/Financial Solutions
PG&E Children's Center
Eligibility and Enrollment
Claims and Appeals
Tuition Refund Program
Eligibility
Tuition Refund Application
Course Approval Criteria
Excluded Programs and Courses of Study
Tuition Costs Covered
Tuition Costs Not Covered
What the Program Will Pay
Wellness Program
Fitness
Smoking Cessation
Work/Life Program
Rules, Regulations & Administrative Information
Plan Amendment and Termination
Your Rights Under ERISA
Health Information Privacy and Data Security
Forfeiture of Unclaimed Benefit Payments
Facility of Payment
Administrative Information
The Health and Welfare Benefits Pre-Tax Plan
The Pacific Gas and Electric Company Health Care Plan for Active Employees
The Pacific Gas and Electric Company Health Care Reimbursement Account Plan
The Long-Term Disability Plan
The PG&E Corporation Disability Plan
The Supplemental Benefits for Industrial Injury Plan
The Pacific Gas and Electric Company Group Life Insurance Plan
The PG&E Corporation Business Travel Insurance Plan
The Pacific Gas and Electric Company Retirement Plan
The Pacific Gas and Electric Company Antiviral Program Plan
The Pacific Gas and Electric Company Children's Center Program
Contacts
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