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2014 Benefit ChangesConference Call for ESC Represented Employees

November 19, 2013

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Agenda

• New Medical Plan for 2014– New Resources - where to get more information– What’s changing?– New Plan Design for 2014

• Question and Answer Period

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New ResourcesProvant – Your One-Stop Shop for Health and Wellness QuestionsTalk to a health advocate for:• Billing Questions• New Health Account Plan questions• Dental or Vision Plan Questions• Questions about health screenings, health accounts

PROVANTPhone support:

866-271-8144, M-F, 5am-5pm. Pacific TimeEmail support:

PGEsupport@provanthealth.com

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New ResourcesNew Website: www.mypgebenefits.com

• Details on the new Anthem and Kaiser HAP for 2014

• Accessed from any computer with internet access

• What to expect at the doctor and pharmacy on your first visit in 2014

• How to use your different cards• Where to get more information as

you use the plans

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What Isn’t Changing? What Is?

Dental Delta Dental New coverage for dental implants

Vision VSP Discounts on non-covered services are different

Medical Monthly Premium New Health Account Plan in effect for both Kaiser and Anthem: two provider networks-same plan design

Hearing Aids covered for all employees and retirees

What’s Changing?

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What’s Changing?Rules for Covering Children

• Children can be covered under your PG&E medical, dental and vision plan until their 26th Birthday

• They no longer have to be • students• unmarried• your tax dependent

• They can be employed and be offered benefits (New)

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New Medical Plan for 2014

The Health Account• All active employees enrolled in Anthem or Kaiser will

have a Health Account • Both the Anthem and Kaiser PG&E plans for active

employees will be called the Health Account Plan, or HAP

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New Medical Plan for 2014The Health Account

• You automatically get: • $ 750 • $1,500

• If you take a health screening: • $ 250 • $ 500

• If you test tobacco-free or complete PG&E’s tobacco cessation program: • $ 250 • $ 500

• Total • $ 1,250 • $ 2,500• You automatically get: • $ 500 • $ 1,000

• If you take a health screening: • $ 250 • $ 500

• If you test tobacco-free or complete PG&E’s tobacco cessation program: • $ 250 • $ 500

• Yearly Total • $ 1,000 • $ 2,000

2015 through 2020

2014Health Account Deposits Single Coverage Family Coverage

Remember: If you don’t use all your credits in one year, they roll over

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New Medical Plan for 2014Earning Health Account Credits• Health Screening consists of four tests:

• Weight/Height to get BMI• Blood Pressure• Glucose Level (non-fasting)• Cholesterol Level

• Tobacco use test is optional and done with an oral swab

• Tobacco users can skip the tobacco use test and complete a tobacco cessation course with Provant to earn credits

Employees with family coverage will earn credits for their entire family – their dependents do not need to do a screening to earn credits

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New Medical Plan for 2014

Health Screenings and Tobacco Use Test• Three ways to get a Health Screening/Tobacco

Test• On-site event: enroll online at

www.provantevents.com/pge or call Provant • Concierge: call Provant at 1-866-271-8144 to

schedule at your home or office • Take a form to your doctor: doctor’s offices

don’t do tobacco screenings; you’ll need to walk into any on-site screening – no appointment needed. Download the screening form from www.mypgebenefits.com

• Check for your results at www.provantonline.com• Have until Sept. 30, 2014 to earn credits for 2014

plan year

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New Medical Plan for 2014How the Health Account Plan (HAP) WorksUsing Health Account Credits• Pay for plan deductibles and other out-of-pocket expenses• Credits can be used for:

– medical, dental and/or vision expenses – for you or your family members – unused credits roll over year after year and can be used for PG&E

Retiree Medical Plan expenses• You can still contribute to a Health Care Flexible Spending Account

(FSA)

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New Medical Plan for 2014How the Health Account Plan (HAP) WorksUsing Health Care Flexible Spending Account • NEW! Can roll over $500 from one year to next, amounts above $500

left in account at end of year are still a “use-it-or-lose-it” • Will work with the Health Account• Administrators:

– Your Spending Account (for Anthem Blue Cross members)– Kaiser (for Kaiser members)

• Will automatically use the Health Care Flexible Spending Account first

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Use card to pay expenses for: • Medical • Mental health • Pharmacy• Dental• Vision

Use card to pay expenses for:• Kaiser pharmacy

Kaiser medical expenses and mental health expenses automatically taken out of your account after your visit to Kaiser

Submit claims to pay for• Dental• Vision

How the Plan Works – Health Account Debit Cards

YSA (Anthem HAP)

Kaiser HAP

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New Medical Plan for 2014How the Health Account Plan (HAP) Works• 4 free primary care visits per year for every covered

family member• First choice for everything from chronic disease

management, physicals, everyday ailments• Choose a family doctor who knows you and cares

about your “whole person” health• Primary Care Doctors

• General or family practitioners (including nurses)• Internal Medicine doctors• Pediatricians• OB/GYNs• Urgent care

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New Medical Plan for 2014Other Free Services• Some free preventive screening services (e.g., mammograms,

pap smears, colonoscopies, immunizations)• Some free prescription drugs for preventive care and chronic

conditions (e.g., insulin for diabetes)• Free maternity and well-baby office visits to age two

Go to www.mypgebenefits.com for lists of which preventive services and prescription drugs are free

Tip: free doctor visits may include additional tests or services performed during your visit – these are covered, but may not be free

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New Medical Plan for 2014A few terms to understand …Annual Deductible

For services that aren’t free, amount you’re responsible to pay for first before the plan will start to pay

Co-insuranceYou pay a percent of the cost of a medical service

Out-of-Pocket MaximumThe limit on the amount you have to pay every year for covered services

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New Medical Plan for 2014How the Health Account Plan (HAP) WorksAnnual Deductible• If you have single coverage, annual deductible is $1,000• If you have family coverage, annual deductible is $1,000 per

person but no more than $2,000 for your entire family

Remember: if you earn all your Health Account credits, you’ll have enough to pay your whole deductible from your Health Account

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New Medical Plan for 2014How the Health Account Plan (HAP) WorksCoinsurance• You’ll be responsible for either 10% or 20% of the covered

cost and the HAP will pay the other 90% or 80% respectively. • There are no copayments under the HAP, so instead of paying

a flat $10 or $20 copayment at the time of service, you’ll pay 10% or 20% for services that are not free

• But, your expense is limited by the Out of Pocket Maximum….

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New Medical Plan for 2014How the Health Account Plan (HAP) WorksOut-of-Pocket Maximum

• Limits how much you are responsible for paying every year• Once out-of-pocket maximum is reached, all covered services are

free for the rest of the year• Includes all money you spend on covered medical services,

prescription drugs and mental health services• Includes credits you used from your Health Account for medical

expenses• Includes deductible and co-insurance

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New Medical Plan for 2014How the Health Account Plan (HAP) WorksOut-of-Pocket Maximum

• If you have single coverage, the annual out-of-pocket maximum is $2,400

• If you have family coverage, the annual out-of-pocket maximum is $2,400 per person but no more than $4,800 for your entire family

Single Coverage Family Coverage

Your Maximum 2014 Health Account Credits: $1,250 $2,500

Your Annual Out-of-Pocket Maximum: (includes annual deductible)

– $2,400 – $4,800 at the most

Your 2014 Effective Out-of-Pocket Maximum: <$1,150> <$2,300 at the most>

All covered expenses paid at 100% for the rest of the calendar year

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How the Plan Works – Coinsurance MEDICAL SERVICES

• Primary care office visits after first four free visits

• Outpatient mental health visits10% with no deductible

• Therapies – 1st five visits (i.e., acupuncture, chiropractic, outpatient physical therapy, occupational therapy)

10% after deductible

• Specialists• Laboratory/X-ray• Therapies – additional visits after five (i.e.,

acupuncture, chiropractic, outpatient physical therapy, occupational therapy)

• Hospital care• Emergency room

20% after deductible

PRESCRIPTION DRUGS

Retail Pharmacy – must first meet deductible • 15% generic • 25% brand

Mail-Order – must first meet deductible • 10% generic• 20% brand

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New Medical Plan for 2014Things to note about pharmacy• Express Scripts will continue to be the pharmacy provider for Anthem

Blue Cross; Kaiser provides pharmacy benefits for its members• Free medications for Anthem HAP must be obtained from Express

Scripts mail order• Free medication from Kaiser can be from any Kaiser pharmacy or

mail order• Anthem HAP members will have mandatory mail order for many

maintenance drugs – drugs you take on a long-term basis– In 2014, can get three fills at a retail pharmacy, then must get the drugs

through Express Scripts mail order, or pay 100% of the cost– Can sign up now with Express Scripts mail order if currently enrolled in

Anthem – Most narcotics, ADHD drugs and compound drugs are not included – you

will continue to have coverage for these at a retail pharmacy

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What do you need to do now?• Schedule a Health Screening to maximize your

Health Account credits for 2014• If you want a flexible spending account, enroll by

November 21, 2013• Review Health Account Plan User Guide that will

be sent to you in late December• Visit www.mypgebenefits.com for more

information on the new Health Account Plan• Contact Provant with detailed questions

866-271-8144, M-F, 5am-5pm, Pacific TimePGEsupport@provanthealth.com

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Question & Answer

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Thank YouQuestions?Log onto www.mypgebenefits.com for more informationEmail PGEsupport@provanthealth.comOr call Provant at 1-866-271-8144 for medical plan questions