New Contact for Benefits Administration

Transcription

1 New Contact for Benefits Administration Effective July 24, 2015, Pacific Gas and Electric Company (PG&E) introduced a new partner for benefits administration. The following print version of content from the Summary of Benefits Handbook (the summary plan description ( SPD )) includes references to the old benefits administration team. (The SPD website has been updated, but not the print version of the SPD.) Where the following pages refer to the HR Service Center, you should use the following contacts, instead of the HR Service Center: PG&E Benefits Service Center at (open weekdays from 7:30 a.m. to 5 p.m. Pacific time) Mercer BenefitsCentral, accessible via: o PG&E@Work For Me (if on the PG&E network) or o mypgebenefits.com (for those outside the network). Other Resources In addition to the PG&E Benefits Service Center and Mercer BenefitsCentral, you have two other important benefits and human resource contacts that are not changing: PG&E Pension Call Center Xerox is still providing benefits administration for the retirement plans. Contact them online at or call Monday through Friday from 7:30 a.m. to 3:30 p.m. and. HR Service Center While Mercer administers most benefits other than retirement, the HR Service Center will still help you with questions about your job title, classification or changing your name or contact information. Contact them at hrbenefitsquestions@exchange.pge.com, or call Monday through Friday from 7:30 a.m. to 5 p.m. Pacific time. PG&E refers to Pacific Gas and Electric Company, a subsidiary of PG&E Corporation Pacific Gas and Electric Company. All rights reserved.

2 This is the 2013 edition of your Summary of Benefits Handbook for Retirees and Surviving Dependents, and describes the benefits effective January 1, The Handbook contains valuable information about the following benefit programs (some that are negotiated and some that are not negotiated) that the Company offers to you and your eligible dependents. Health care plans, including medical coverage, prescription drug benefits and mental health and substance abuse benefits. Life and accident insurance. 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. Retirement benefits including the Pacific Gas and Electric Company Retirement Plan, Retiree Medical Savings Account and the PG&E Corporation Retirement Savings Plans. Other benefits, including smoking cessation for retirees enrolled in a Company medical plan and discounts on gas and electric services for your home. The Benefits Available The Company offers certain retirees and their surviving dependents certain benefits that give you choices and may require you to make election decisions. Other benefits do not require election or enrollment decisions; you are automatically covered if you are an eligible participant. For details on the various plan provisions, see individual plan sections in this Handbook as well as: The What to Do section provides checklists of things you need to do when certain events occur or you reach certain milestones; The Health Care Participation section for health care plan enrollment information; Whether you are about to retire and choosing your retiree benefits for the first time or you are considering a change to your existing retiree benefits elections, you should evaluate your options with care. Be sure to consider your future as well as your present needs when making your benefit decisions. Questions? If you have any questions about your benefits that are not answered by this Handbook or other benefit plan documents, you can contact the HR Service Center at or toll-free at You can also send an to the HR Service Center at hrbenefitsquestions@exchange.pge.com. Benefits Effective January 1,

3 Contents Welcome!... 1 About This Handbook Benefits at a Glance Medical Coverage at a Glance NAP Medical at a Glance CAP Medical at a Glance In-Area Health Savings Account (HSA) Medical Plan at a Glance Out-of-Area Health Savings Account (HSA) Medical Plan at a Glance Retiree Optional Plan (ROP) Medical at a Glance Blue Shield HMO Medical at a Glance Health Net HMO Medical at a Glance Kaiser Permanente EPO Medical at a Glance Medicare Supplemental Plan (MSP) Medical Coverage at a Glance Medicare HMOs Life and Accident Insurance at a Glance Retirement Plans at a Glance Life Balance Benefits at a Glance What to Do Age-Related Events Under Age At Age At Age When Your Spouse or Registered Domestic Partner Turns Family Events If You Get Married or Establish a Registered Domestic Partnership If You Have New Children In the Case of Dissolution of Marriage or Termination of a Registered Domestic Partnership In Case of Death What Your Family Needs to Do in the Event of Your Death If Your Spouse or Another Dependent Dies Other Events If You Move If Your Children Become Ineligible for Coverage Changing Coverage During the Year (Change-in-Status Events) Health Care Benefits Health Care Participation Eligible Retirees Eligible Dependents Qualified Medical Child Support Orders Disabled Dependents Ineligible Dependents Penalties for Covering Ineligible Dependents Eligible Survivors of Retirees If a Surviving Dependent Dies Benefits Effective January 1, 2013

4 Cost of Coverage Retiree Medical Employer Contribution (RMEC) Program Retiree Premium Offset Account (RPOA) for RMEC Retirees Methods of Payment Non-Payment of Premium Contribution Retiree Medical Savings Account (RMSA) Enrollment and When Coverage Begins Changing Your Coverage Open Enrollment Mid-Year Health Care Enrollment Changes Cancelling Coverage Timeline for Enrollment If You Have Other Coverage Which Plan Is Primary for You? Which Plan Is Primary for Your Children? Coordination with Medicare Reductions/Exclusions for Duplicate Coverage Subrogation and Reimbursement When Coverage Ends Extended Benefits When Coverage Ends COBRA and Conversion to an Individual Medical Policy COBRA Coverage Under the Retiree Medical Plan Appeals Conversion to an Individual Medical Policy HIPAA Conversion Plan If Eligibility Is Denied Medical Coverage The Options Available PG&E s Plans Administered by Anthem Blue Cross Health Maintenance Organizations (HMOs) and Exclusive Provider Organizations (EPOs) Medical Benefits for Members Under Medical Benefits for Medicare-Eligible Members PG&E s Medicare Plan Options General Information Medicare Medicare Part A Medicare Part B Medicare Part D When You Become Medicare-Eligible Other Things You Need to Know When You Become Medicare-Eligible Network Access Plan (NAP) NAP at a Glance How the NAP Works Network Providers Non-Network Providers Deductibles Benefits Effective January 1,

5 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 (for Non-Medicare Members) What the NAP Covers Acupuncture Ambulance Services Chiropractic Care Hearing Aids Effective January 1, 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 Transportation and Lodging Skilled Nursing Facility Other Covered Services and Supplies What the NAP Doesn t Cover Third-Party Exclusion Comprehensive Access Plan (CAP) CAP at a Glance How the 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 (for Non-Medicare Members) What the CAP Covers Acupuncture Ambulance Services Chiropractic Care Hearing Aids Effective January 1, Home Health Care and Hospice Care Hospital Care Inpatient Hospital Care Outpatient Organ and Tissue Transplants Prescription Drugs Benefits Effective January 1, 2013

6 Professional Services Psychiatric Care and Substance Abuse Treatment Skilled Nursing Facility Transportation and Lodging Other Covered Services and Supplies What the CAP Doesn t Cover Third-Party Exclusion Retiree Optional Plan (ROP) ROP at a Glance How the Retiree Optional Plan (ROP) 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 (for Non-Medicare Members) What the ROP Covers Acupuncture Ambulance Services Chiropractic Care Hearing Aids Effective January 1, Home Health Care and Hospice Care Hospital Care Inpatient Hospital Care Outpatient Mental Health Care Organ and Tissue Transplants Prescription Drugs Professional Services Psychiatric Care and Substance Abuse Treatment Skilled Nursing Facility Substance Abuse Transportation and Lodging Other Covered Services and Supplies What the ROP Does Not Cover Third-Party Exclusion Medicare Supplemental Plan (MSP) MSP at a Glance Eligibility How the MSP Works What the MSP Covers Services and Supplies Emergency Care Outpatient Prescription Drug Coverage Skilled Nursing Facility Benefits Effective January 1,

7 Home Health Care Hospice Care Mental Health Conditions What the MSP Does Not 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 Non-Medicare HMOs and the Kaiser EPO How HMOs and the Kaiser EPO Work Primary Care Physicians (PCPs) Service Areas Available HMOs/EPOs Summaries of Benefits (Non-Medicare) Blue Shield HMO (Access+) Health Net HMO Kaiser Permanente EPO North and South Additional Coverage Rules Claims, Appeals and Complaints Claims Appeals Complaints Process for HMOs Medicare Health Maintenance Organizations (HMOs) HMO Plan Summaries of Benefits for Medicare-Eligible Members Blue Shield Medicare COB HMO Health Net Medicare COB HMO Health Net Seniority Plus Kaiser Senior Advantage Northern and Southern California HMO (Medicare) Claims, Appeals and Complaints Eligibility & Participation Claims Mental Health and Substance Abuse Coverage 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 Benefits Effective January 1, 2013

8 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 and Kaiser EPO Members Deductibles and Limits for HMO and Kaiser EPO Members Coinsurance and Copayments for HMO and Kaiser EPO Members How the Program Works for HMO and Kaiser EPO Members What the Program Covers for HMO and Kaiser EPO Members For Members of All Medical Plans Medical Management and Authorization Programs Medically Necessary What the Program Does Not Cover More about the Program Claims and Appeals Process for ValueOptions (VO) Prescription Drug Coverage Plan Benefits Generic Incentive Provision Eligibility How the Plan Works Retail Pharmacy Service Express Scripts Mail-Order Pharmacy 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 Postretirement Life and Accident Insurance Plans Life Insurance Eligibility, Enrollment, and Cost Imputed Income from Your Life Insurance Coverage How Your Benefit Is Paid Your Beneficiary Accelerated Benefit Option (ABO) Assignment of Benefits When Coverage Ends Converting Your Supplemental and Dependent Life Insurance Coverage to an Individual Policy Claims and Appeals Claims Relating to a Benefit Claims Relating to Eligibility Accidental Death & Dismemberment Insurance Eligibility, Enrollment, and Cost How Your Benefit Is Paid Benefits Effective January 1,

9 Beneficiary Designation Claims and Appeals Claims Relating to a Benefit Claims Relating to Eligibility State Legal Notices Retirement Benefits Retirement Plan If You Are a Current Employee Thinking About Retirement Plan Highlights for Retirees and Survivors Pension Checks Payment Options Other Retirement Benefit Provisions Other Important Plan Information Claims and Appeals The Pension Benefit Guaranty Corporation Retirement Savings Plan Participating in the Plan Beneficiary Designation Investing PG&E Corporation Stock Fund Dividends Monitoring and Making Changes to Your Investments Financial Engines Fidelity Education and Modeling Tools Distributions After Your Employment Has Ended What Happens If You Leave PG&E or Retire If You Die If You Get Divorced If You Get Rehired Additional Plan Information Significant Accounting Policies and Investment Disclosure Fees and Expenses Plan Administration and the Corporation s Power and Duties Participant Account Activity and Plan Service Provider Claims and Appeals Procedures Borrowing, Pledging, and Assigning Interests in the Plan Future of the Plan Qualified Domestic Relations Orders (QDROs) Facility of Payment Other Benefits Retiree Discount Smoking Cessation Program Rules, Regulations & Administrative Information Plan Amendment and Termination Your Rights Under ERISA Health Information Privacy and Data Security Benefits Effective January 1, 2013

10 Forfeiture of Unclaimed Benefit Payments Facility of Payment Administrative Information The Pacific Gas and Electric Company Health Care Plan for Retirees and Surviving Dependents The Pacific Gas and Electric Company Postretirement Life Insurance Plan The Pacific Gas and Electric Company Retirement Plan PG&E Corporation Retirement Savings Plan and Retirement Savings Plan for Union- Represented Employees Contacts Benefits Effective January 1,

11 10 Benefits Effective January 1, 2013