Retiree Medical Home

Eligibility and Enrollment

Want PG&E-sponsored retiree medical coverage? You need to elect it. You’re not automatically enrolled.

Your employee coverage will end on the last day of the month in which you retire. If you’re eligible for PG&E-sponsored retiree medical coverage and you meet the enrollment deadlines, retiree medical coverage typically will start on the first of the month after you retire.

You’re eligible to elect PGE-sponsored retiree medical coverage for yourself and your eligible dependents if you’re at least age 55 on your last day of employment and:

Retiree Med Eligibility

CALIFORNIA RESIDENTS MUST HAVE MINIMUM ESSENTIAL COVERAGE

Planning to opt out of PG&E-sponsored retiree medical coverage? You can opt out of PG&E-sponsored retiree medical coverage when you retire—and enroll later, during a future Open Enrollment.

If you’re not eligible for Medicare when you opt out of PG&E-sponsored coverage, make sure you have other medical coverage that meets California’s minimum essential coverage requirements. Medicare satisfies those requirements.

If you don’t have minimum essential coverage, you could be subject to a state tax penalty. If your state doesn’t require minimum essential coverage, there’s no tax penalty.

Massachusetts, New Jersey, Vermont, Rhode Island and Washington, D.C. also require minimum essential coverage.

ELIGIBLE CHILDREN

You can enroll your children up to age 26 as long as they’re not eligible for coverage under another employer-sponsored health plan (except for a plan of their other parent). You’ll need to provide verification of your dependents’ eligibility to the PG&E Benefits Service Center.

To enroll a Medicare-eligible dependent, you’ll need to call the PG&E Benefits Service Center. Listen for the Initiate or Enroll Retiree Medical Benefits option. You can’t enroll online.

Is your dependent child disabled?

If your child is disabled, under age 26 and currently enrolled in a PG&E-sponsored medical plan, you’ll need to get your child medically certified as disabled before he or she reaches age 26 to continue coverage from age 26 onward. You’ll need to get the certification directly from your medical plan.

You can cover disabled dependents age 26 or older only if they meet both of these conditions:

They were already enrolled in a PG&E-sponsored plan when they turned 26

AND

They were medically certified as disabled by a PG&E-sponsored medical plan before they turned 26

You may not cover disabled dependents age 26 or older if they fail to meet either one of these conditions.

ENROLLING WHEN YOU RETIRE: REPORT YOUR INTENT TO RETIRE

Your employee coverage will end on the last day of the month in which you retire. If you’re eligible for PG&E-sponsored retiree medical coverage, you’ll need to enroll if you want the coverage when you first retire.

Before you can enroll for PG&E-sponsored retiree medical coverage, you MUST report your Intent to Retire to the PG&E Benefits Service Center.

Retiree Med Eligibility

To report your Intent to Retire:

Log in to your myPlans Connect account and select the Intent to Retire Life Event:

At work, go to PG&E@ Work for Me and click About Me > My Benefits > myPlans Connect. You’ll be automatically logged in to your account.

From any computer or mobile device, go to mypgebenefits.com and click Log In under Manage Your Benefits.
OR
Call 1-866-271-8144. Representatives are available 7:30 a.m. to 5 p.m. Pacific time, Monday through Friday, except holidays.

ENROLLING WHEN YOU RETIRE: IF YOU AND ALL DEPENDENTS ARE UNDER 65

Follow these steps if you and all of your dependents will NOT be eligible for Medicare when you retire.

Enroll Under 65

ENROLLING WHEN YOU RETIRE: IF YOU OR ANY DEPENDENTS ARE 65+

Follow these steps if you or ANY dependents will be eligible for Medicare when you retire.

Enroll 65+

Enroll 65

ENROLLING 31 DAYS AFTER YOU RETIRE?

If you enroll for PG&E-sponsored retiree medical coverage within 31 days after your retirement date:

  • Your coverage will be retroactive to the first of the month on or after your retirement date.
  • You’ll be responsible for paying premiums back to the start of your retiree coverage. This could be costly.
LATE? NOT ENROLLING WHEN YOU RETIRE?

If you’re late or you don’t enroll, you’ll have no PG&E-sponsored retiree medical coverage when you retire. If you don’t enroll, you’ll be considered to have waived coverage. Here’s what will happen:

  • Your employee medical coverage will end on the last day of the month in which you retire.
  • You’ll be responsible for any medical costs you have after you retire.
  • Your next opportunity to enroll for PG&E-sponsored retiree medical coverage will be the next Open Enrollment.
  • Coverage you elect during Open Enrollment will start January 1.
  • Should you die before you enroll for PG&E-sponsored retiree medical coverage, your spouse or surviving dependents will not be eligible to enroll for PG&E-sponsored survivor coverage.

Late Enrollment

If you’re a California resident, make sure you have minimum essential coverage if you’re not eligible for Medicare. Otherwise, you could be subject to a state tax penalty. Massachusetts, New Jersey, Vermont, Rhode Island and Washington, D.C. also require minimum essential coverage.

HOW TO ENROLL WHEN YOU RETIRE

How Enroll When Retire

Adding a dependent? You’ll need to provide your dependent’s name, birth date and Social Security number when you enroll, and you’ll need to provide verification of your dependents’ eligibility to the PG&E Benefits Service Center. To enroll a Medicare-eligible dependent, you’ll need to call the PG&E Benefits Service Center. You can’t do this online.

SPECIAL RULES FOR KAISER SENIOR ADVANTAGE AND MEDICARE HMOs

Medicare Advantage and Medicare Coordination of Benefits (COB) HMOs have earlier enrollment deadlines and special rules.

First, report your Intent to Retire to the PG&E Benefits Service Center. Then, follow these steps:

Medicare HMO Enrollment

Kaiser Coverage

Kaiser Coverage

Example Medicare HMO Enrollment Timeline

What if you’re late enrolling in a Medicare HMO?

You won’t have coverage in your Medicare HMO. You’ll have to wait until the next Open Enrollment to elect the plan you want for the following year.

If you try to elect a Medicare HMO within 31 days after your retirement date, you’ll be automatically enrolled in the Anthem Comprehensive Access Plan (CAP), and you’ll be responsible for monthly premium contributions for that plan.

If you try to elect a Medicare HMO—or any plan—32 or more days after your retirement date, you won’t have any PG&E-sponsored retiree medical coverage when you retire because you’ll have missed all the deadlines. Make sure you’re at least enrolled in Medicare Parts A and B to avoid potential tax penalties if you’re a California resident.

HOW TO ENROLL DURING OPEN ENROLLMENT

Be sure to read the Open Enrollment guide that will be mailed to your home each year during Open Enrollment. It will show the Open Enrollment deadline for the year, and will explain any changes to the plans for the coming year

Enroll online
Log in to your myPlans Connect account

OR

Enroll by phone

You must call the PG&E Benefits Service Center if you want to add or drop a Medicare-eligible dependent: 1-866-271-8144.

Representatives are available Monday–Friday, 7:30 a.m.–5 p.m. Pacific time.

Adding a dependent? You’ll need to provide your dependent’s name, birth date and Social Security number when you enroll, and you’ll need to provide verification of your dependents’ eligibility to the PG&E Benefits Service Center.

CHANGING COVERAGE IF YOUR LIFE CHANGES

Getting married or divorced? Big changes like these are life events. Chances are, you’ll want to change your benefits coverage, too—like adding or dropping a dependent.

Already enrolled?

You have 31 days from the date of your life event to make allowable midyear changes to your coverage (180 days from the birth or adoption of a child). For details on allowable changes, see your Summary of Benefits Handbook.

Not enrolled?

If you’re not enrolled when you experience a life event, you’ll need to wait until the next Open Enrollment period to elect coverage. The only exception is if your spouse is a PG&E employee and you have dependent coverage through your spouse’s active employee Health Account Plan (HAP). If you lose your dependent coverage when your spouse retires or loses eligibility for PG&E-sponsored employee coverage, you’ll be able to elect PG&E-sponsored retiree medical coverage.

Moving?

You can switch to another plan midyear only if you’re enrolled in a plan with a defined service area and you move out of that plan’s service area. Special rules apply if you’re switching in or out of a Medicare Advantage or Medicare COB HMO. Check the current Benefits Enrollment Guide for details and current deadlines.

Did your doctor leave your plan?

You can’t change medical plans if any of your primary care physicians (PCPs), specialists, medical groups, Independent Practice Associations (IPAs), hospitals or other providers leave your medical plan. Instead, you’ll need to use other providers in your plan’s network. You can elect a different plan during the next Open Enrollment.

OTHER ENROLLMENT RULES

Make sure you understand the following enrollment rules to avoid penalties.

When you can’t re-enroll

The following people can’t ever re-enroll for PG&E-sponsored retiree or survivor medical coverage:

  • Retirees who dropped coverage before January 1, 2003
  • Surviving spouses or dependents who dropped PG&E-sponsored retiree medical coverage at any time*

*If a surviving spouse or dependent is also a PG&E retiree eligible for PG&E-sponsored retiree medical coverage, he or she will be able to re-enroll in a PG&E-sponsored retiree medical plan—as a retiree.

Miss a payment? Enroll an ineligible dependent?

Your coverage may be canceled. You’re responsible for:

  • Paying your required monthly premium contribution on time
  • Making sure your enrolled dependents are eligible for coverage
  • Paying any required restitution for covering ineligible dependents (you'll be billed for required restitution)

You have 31 days to drop ineligible dependents

You must drop ineligible dependents from coverage within 31 days of the date they become ineligible.

If you cover an ineligible dependent, you’ll be required to make restitution to the Participating Employer for health care coverage—up to two full years’ of the cost of coverage. Knowingly covering an ineligible dependent is considered fraud.

To drop ineligible dependents, call the PG&E Benefits Service Center at 1-866-271-8144 or log in to your myPlans Connect account.

Surviving dependents who become ineligible should call the PG&E Benefits Service Center right away to avoid penalties: 1-866-271-8144.