Retiree Medical Home

Eligibility and Enrollment

Want PG&E-sponsored retiree medical coverage? You need to elect it. You’re not automatically enrolled in retiree medical coverage, and your employee coverage will end when you retire.

You can elect PGE-sponsored retiree medical coverage for yourself and your eligible dependents if:

YOU MUST HAVE MINIMUM ESSENTIAL COVERAGE

Don’t want PG&E-sponsored retiree medical coverage? Make sure you have minimum essential 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 the federal government’s minimum essential coverage requirements. Medicare satisfies those requirements.

If you don’t have minimum essential coverage, you could be subject to a tax penalty.

ENROLLING 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.

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

Your employee coverage will end when you retire. You’ll need to enroll in PG&E-sponsored retiree medical coverage if you want retiree medical coverage.

Here’s a snapshot of what you need to do and when you need to do it:

Under 65 and not disabled?

WHAT

Elect your PG&E-sponsored retiree medical coverage

WHEN

  • As early as 90 days before your retirement date
  • No later than 31 days after your retirement date

Are any covered dependents eligible for Medicare?

  • Make sure they enroll in Medicare Part B
  • 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)
  • At least 90 days before your retirement date
  • When you enroll in retiree medical coverage
Age 65—or under age 65 but disabled and eligible for Medicare?

WHAT

1. Elect your PG&E-sponsored retiree medical coverage*

WHEN

Most plans:

  • As early as 90 days before your retirement date
  • No later than 31 days after your retirement date

Medicare HMOs:

Completed Medicare HMO enrollment forms must be postmarked at least 45 days before your retirement date and mailed directly to the plan

2. Make sure you and all Medicare-eligible family members enroll in Medicare Parts A and B

You must enroll by phone if you or any dependent is eligible for Medicare (listen for the Initiate or Enroll Retiree Medical Benefits option)

At least 90 days before age 65 or as soon as eligible due to disability

At least 90 days before you retire if you’re already eligible for Medicare due to age or disability

Your PG&E-sponsored retiree medical coverage can start on your retirement date—even if you delay your pension.

ENROLLING WITHIN 31 DAYS AFTER YOU RETIRE

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

  • For most plans, your coverage will be retroactive to your retirement date. You’ll be responsible for paying premiums back to your retirement date.
  • For Medicare Advantage and Medicare Coordination of Benefits (COB) plans, you can’t get retroactive coverage. You’ll need to wait until the next Open Enrollment to elect the plan you want for the following year.
LATE? NOT ENROLLING WHEN YOU RETIRE?

If you’re late or you don’t enroll, you’ll have no coverage until the next Open Enrollment. Then, you’ll be able to elect coverage for the following year.

You can decline coverage when you retire—and enroll later.

  • Your employee medical coverage will end on your retirement date.
  • You’ll be responsible for any medical costs you have after you retire.
  • Your next opportunity to enroll will be the next Open Enrollment.
  • Coverage you elect during Open Enrollment will start January 1.

Make sure you have minimum essential coverage if you’re not eligible for Medicare. Otherwise, you could be subject to a tax penalty.

HOW TO ENROLL WHEN YOU RETIRE

There are two ways to enroll when you retire:

Enroll online
You can enroll online if no one in your family is eligible for Medicare.
Log in to your Mercer BenefitsCentral account and go to: Menu > My Account > Life Events > Changes at Work > Intent to Retire

OR

Enroll by phone
You must enroll by phone if you or any dependent is eligible for Medicare.
Call the PG&E Benefits Service Center: 1-866-271-8144
Listen for the Initiate or Enroll Retiree Medical Benefits option
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. To enroll a Medicare-eligible dependent, you’ll need to call the PG&E Benefits Service Center.

How to enroll in a Medicare Advantage or Medicare Coordination of Benefits (COB) HMO

  1. You and any dependents eligible for Medicare will need to enroll in Medicare Parts A and B.
  2. Elect your PG&E-sponsored Medicare Advantage or Medicare COB HMO by calling the PG&E Benefits Service Center at 1-866-271-8144. Representatives are available Monday–Friday, 7:30 a.m.–5 p.m. Pacific time.
  3. Complete and mail or fax your plan’s Medicare HMO enrollment form directly to that plan at least 45 days BEFORE your retirement date.
Current Kaiser members

Want to continue with Kaiser?

  1. Complete the Kaiser Senior Advantage enrollment form enclosed in your retiree medical packet.
  2. Mail the form to Kaiser at the address on the form—postmarked at least 45 days BEFORE your retirement date.

Want to switch out of Kaiser?

  1. Call the PG&E Benefits Service Center immediately for information about available plans and to request the appropriate enrollment form(s) for the plan you want to elect. Listen for the Initiate or Enroll Retiree Medical Benefits option.
  2. Mail your completed form(s) directly to the plan—postmarked at least 45 days BEFORE your retirement date.
Everyone else

Want to elect a Medicare Advantage or Medicare COB HMO?

  1. Call the PG&E Benefits Service Center immediately for information about available plans and to request the appropriate enrollment form(s) for the plan you want to elect. Listen for the Initiate or Enroll Retiree Medical Benefits option.
  2. Mail or fax your completed form(s) directly to the plan—postmarked at least 45 days BEFORE your retirement date.

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

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

If you try to elect 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. For details, See You Must Have Minimum Essential Coverage.

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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 Mercer BenefitsCentral 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 at spd.mypgebenefits.com.

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.

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.

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

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 Mercer BenefitsCentral account.

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