If you use an in-network provider:

You won't usually have to pay up front when you visit the doctor — but your doctor could charge you at the time of service. Your in-network doctor's office can call Anthem to find out how much you'll owe for a particular service or whether you've met your annual deductible.

Whenever you visit your in-network doctor:

• Have your Anthem ID card with you
• Know how much you have already paid toward your deductible
• Ask your doctor’s office not to charge you now and tell them you'll pay from your Health Account or Health Care Flexible Spending Account later
• Ask your doctor to call Anthem if your doctor's office wants to charge you at the time of the visit

Here's what will usually happen with an in-network doctor:

If you use an out-of-network provider:

You may have to pay the full amount at the doctor's office. Your doctor's office won't know how much you'll owe for a particular service or whether you've met the annual deductible. Your portion of the bill may be significant, so be careful. You may need to file a claim with Anthem to get reimbursed.

PG&E pays most of the cost of your medical coverage. You pay for your portion of the cost with before-tax contributions deducted from your pay.

Click here to review your 2017 cost of coverage.

Click here for a list of free services.

Click here for the Anthem free mail-order drug list.

Anthem members get three cards:

• The Anthem HAP card that tells your doctor that you're eligible for medical benefits.
• The Express Scripts ID card tells your pharmacy you're eligible for prescription drug benefits.
• The WageWorks Healthcare Card will be loaded with your 2017 Health Account credits and – if you elected the Health Care Flexible Spending Account (FSA) – your FSA contribution.

Filing claims

For 2016 expenses

File claims with WageWorks through March 31, 2017, for 2016 health care expenses incurred through December 31, 2016.

2017 expenses

File claims with WageWorks through March 31, 2018, for 2017 health care expenses incurred through December 31, 2017.

Don’t use your card for prior year expenses

Don’t use your health payment card in 2017 to pay for 2016 expenses. Instead, you’ll need to file a claim to reimburse yourself or to pay your provider.

There are three ways to get reimbursed:

Tip: Don’t wait!

Send your explanation of benefits (EOB) to WageWorks when you get it—even if you paid with your WageWorks card. Sending the EOB right away will help avoid having your payment delayed.

If you need help filing a claim or reimbursement, call the PG&E Benefits Service Center at 1-866-271-8144, and select option 6 for WageWorks.

Your WageWorks account

You can access your WageWorks account directly after logging into Mercer Benefits Central and clicking the WageWorks link. You may also log onto wageworks.com or download the EZ Receipts app to check balances, upload receipts, and file claims.

WageWorks won’t know who you are—so you’ll need to register your account the first time you visit WageWorks outside of Mercer BenefitsCentral. You’ll need to provide the last four digits of your Social Security number just once—when you register your account.

If your spouse or other close family member needs to obtain WageWorks account information on your behalf complete the HIPAA Authorization Release Form and send it to WageWorks.

Want to authorize someone else to contact WageWorks for you?

Does someone at home handle the bills? Do you want to authorize someone else to contact WageWorks on your behalf?

• Log on to your WageWorks account
• Click Profile > Authorized Individuals
• Complete the requested information
• Click Save Changes

Alternatively, you can complete the HIPAA Authorization Release Form and send it to WageWorks.

Using your WageWorks Healthcare Card

You can use the WageWorks Healthcare Card for all health care expenses, including medical, mental health or substance abuse care, dental and vision expenses, and for prescription drugs and select over-the-counter supplies. However, not all small, independent pharmacies have the correct computer system to validate your transaction, in which case you'll need to pay for the prescription using another form of payment.

Ways to get reimbursed

If you elected the Health Care Flexible Spending Account (FSA), the money in your FSA will be used first to reimburse you for any out-of-pocket health care expenses—since the FSA has a "use-it or lose-it" rule. WageWorks administers your FSA and will automatically debit your FSA first to pay for any out-of-pocket medical expenses. If you don’t have enough in your FSA to cover the expenses, WageWorks will then debit your Health Account. Once you receive your Explanation of Benefits (EOB) from Anthem, Delta Dental or VSP, you can use your WageWorks Healthcare Card to pay your health care provider the amount you owe him or her, as long as you have enough in your Health Account or Health Care FSA. You should always save your receipts and EOBs for IRS purposes.

There are three things you need to know about getting reimbursed through WageWorks

• Claims filing deadline
• When you can use the WageWorks health payment debit card
• Deadline for verifying expenses if you use the WageWorks health payment debit card

*If you waive medical coverage during Open Enrollment, you'll have no Health Account as of January 1 of the following year, and you won't get any new credits. However, you'll have until March 31 of the following year to file Health account claims and verify the prior year's expenses incurred while you were enrolled in the Health Account Plan (HAP).

There are three ways to get reimbursed:

Tip: Don’t wait!

Send your explanation of benefits (EOB) to WageWorks when you get it—even if you paid with your WageWorks card. Sending the EOB right away will help avoid having your payment delayed. If you need help filing a claim or reimbursement, call the PG&E Benefits Service Center at 1-866-271-8144, and select option 6 for WageWorks.

Set up your WageWorks account

To set up your account, log on to your Mercer BenefitsCentral account and click on WageWorks link. You’ll be able to go straight to your WageWorks account without creating a username and password.

Alternatively, you can log into wageworks.com or use the EZ Receipts app.

WageWorks won’t know who you are—so you’ll need to register your account the first time you visit WageWorks outside of Mercer BenefitsCentral. You’ll need to provide the last four digits of your Social Security number just once—when you register your account.

If your spouse or other close family member needs to obtain WageWorks account information on your behalf complete the HIPAA Authorization Release Form and send it to WageWorks.

Want to authorize someone else to contact WageWorks for you?

Does someone at home handle the bills? Do you want to authorize someone else to contact WageWorks on your behalf?

• Log in to your WageWorks account
• Click Profile > Authorized Individuals
• Complete the requested information
• Click Save Changes

Alternatively, you can complete the HIPAA Authorization Release Form and send it to WageWorks.

For medical expenses

If you use an in-network provider, you don’t need to file a claim — your doctor will file one with Anthem. Anthem will then pay your doctor amounts it covers under the Health Account Plan (HAP) and send you an Explanation of Benefits (EOB). Once you receive your EOB from Anthem, you can use your WageWorks Healthcare Card to pay your doctor the amount you owe him or her, as long as you have enough in your Health Account or Health Care FSA. You should always save your receipts and EOBs for IRS purposes.

If you use an out-of-network provider, you may need to pay your doctor up front and then file a claim with Anthem. Anthem will then pay your doctor amounts it covers under the HAP and send you an EOB. Once you receive your EOB from Anthem, you can use your WageWorks Healthcare Card to pay your doctor the amount you owe him or her, as long as you have enough in your Health Account or Health Care FSA.

For prescriptions

When you visit the pharmacy you'll need two cards:

• Your Express Scripts ID card tells your pharmacy you're eligible for prescription drug benefits
• Your WageWorks Healthcare Card is loaded with your Health Account credits and — if you elected the Health Care FSA — your annual FSA contribution. However, not all small independent pharmacies have the correct computer system to validate your transaction, in which case you'll need to pay for the prescription using another form of payment

For mental health and preventive substance abuse expenses

After you receive mental health or substance abuse care from a Beacon Health Options (previously ValueOptions) provider, you’ll need to wait a few weeks for Beacon Health Options to process your claim, determine what you owe, and mail you an Explanation of Benefits (EOB) form. Once you receive your EOB from Beacon Health Options, you can use your WageWorks Healthcare Card to pay your health care provider the amount you owe them, as long as you have enough in your Health Account or Health Care FSA. You should always save your receipts and EOBs for IRS purposes.

For dental and vision expenses

You can use your WageWorks Healthcare Card to pay at the time of service, but you may have to submit documentation to WageWorks such as copies of your receipts or Explanation of Benefits (EOB) forms at a later date.

How to ensure your claims are processed correctly

The IRS requires WageWorks to verify all Healthcare card transactions. To ensure your claim is processed correctly, make sure your receipt or explanation of benefits (EOB) has the following five IRS required pieces of information before providing to WageWorks:

IRS Itemized receipt requirements

1. Patients Name
2. Providers Name
3. Date of Service
4. Type of Service
5. Cost you paid or not reimbursed through your benefit plan

Note, if you don’t provide the IRS-required documentation to verify your purchase as an eligible health expense, you may be taxed on the unverified amount.

You can use any pharmacy. To maximize savings, use Express Scripts pharmacies and the mail-order program. You will pay the entire cost of prescriptions if you haven't met your annual deductible. Amounts paid for prescriptions apply to the annual deductible and out-of-pocket maximum. You'll never pay more in a year than your annual out-of-pocket maximum.

Some prescriptions are free

You must use Express Scripts mail order for free drugs.

Maintenance prescriptions

Most, but not all, maintenance prescriptions must use Express Scripts mail order after a maximum of three fills at a retail pharmacy.

Filling a prescription at the pharmacy

You can use any pharmacy for prescriptions, but you’ll have lower costs when you use an Anthem in-network Express Scripts pharmacy.

At an in-network Express Scripts pharmacy, the pharmacist can tell you exactly how much you owe for a particular drug. You can use your WageWorks Healthcare Card to pay for prescriptions and some over-the-counter health care supplies. If you don't have enough in your Health Account (and Health Care Flexible Spending Account (FSA), if you’ve elected it), you'll need to pay out-of-pocket. You can also go to www.express-scripts.com to view your statement.

At an out-of-network pharmacy, you can use your WageWorks Healthcare Card or YSA Visa Debit Card to pay for the entire cost of the prescription. However, not all small, independent pharmacies have the correct computer system to validate your transaction, in which case you’ll need to pay for the prescription using another form of payment. In all instances, if you pay 100% up front, you will then have to file a claim with Express Scripts for reimbursement. Click here for the Express Scripts Prescription Reimbursement / Coordination of Benefits Form. The form can also be obtained by calling Express Scripts at 1-800-718-6590 or by downloading it at www.express-scripts.com.

Want to manage your prescriptions on the go? Use the express scripts app to request refills and renewals, track mail-order prescriptions, get alerts about possible drug interactions and more. Click here for more information.

Filling a prescription for maintenance medications

You must use the Express Scripts mail-order program for certain maintenance medications. You can get up to three fills of the same prescription from a retail pharmacy before you have to switch to mail order. If you don’t switch to mail order after three fills, you’ll have to pay 100% of the cost at the pharmacy — and this does not apply to your deductible or out-of-pocket maximum.

Most narcotics, ADHD drugs, and compound drugs are not part of the mandatory mail-order requirement; you’ll need to purchase these at a retail pharmacy.

Filling a prescription by mail

You can get up to a 90-day supply of medication for each prescription when you use the Express Scripts mail-order program. You must use the Express Scripts mail-order program for certain maintenance medications. You can get up to three fills of the same prescription from a retail pharmacy before you have to switch to mail order. If you don't switch to mail order for those maintenance medications, you'll pay 100% of the cost and nothing will apply to your deductible or out-of-pocket maximum.

The first time you order, you’ll need to complete two Express Scripts forms:

• Mail-order form
• Health, Allergy and Medication Questionnaire (HMQ), which alerts the pharmacists who are filling your mail-order prescriptions of any allergies or medical conditions that might be affected by the prescriptions you’re ordering

You’ll need to mail the completed forms with your original prescription to:

Express Scripts
P.O. Box 747000
Cincinnati, Ohio 45274-7000

To get the Express Scripts mail-order form, Health Assessment Questionnaire, and mail-order envelopes:

• Call Express Scripts Member Services at 1-800-718-6590
• Download them from the Express Scripts website

The Health Care and Dependent Care Flexible Spending Accounts (FSAs) let you set aside before-tax pay to reimburse eligible health and dependent care expenses.

Health and Dependent Care FSA reimbursements

There are two different Flexible Spending Accounts (FSAs). You can elect one or both during Open Enrollment.

You fund the accounts with your own money. Your contributions are deducted from your pay before taxes are calculated—reducing your taxable income and saving you money.

Click here for a list of eligible Health Care FSA expenses, and click here for a list of Dependent Care FSA expenses.

The IRS determines how much you can contribute to these spending accounts. For additional details view Publication 502 for medical and dental expenses and Publication 503 for dependent and child care expenses.

How your Health Care FSA coordinates with your Health Account

Your Health Account — 100% funded by PG&E — gives you health care credits to spend that can roll over from year to year if you don’t use them.

Your Health Care Flexible Spending Account (FSA) — if you’ve elected to contribute your before-tax dollars to help you pay for out-of-pocket medical expenses. Your FSA accounts have a "use it or lose it" rule. However, you can carry over unused balances up to $500 to the next year as long as you're eligible to participate in the Health Care FSA as of January 1 of the next year. To help you avoid forfeiting unused FSA dollars at the end of the year, your Health Care FSA will always pay claims before your Health Account pays claims. When your Health Care FSA is used up, your Health Account will pay claims. No reimbursements will come out of your Health Account until your Health Care FSA is used up, and it’s all handled by WageWorks. For additional information, see Spending Accounts.

To check your FSA or Health Account balance, log on to WageWorks through Mercer BenefitsCentral. Alternatively, you can log into wageworks.com or use the EZ Receipts app.

WageWorks won’t know who you are—so you’ll need to register your account the first time you visit WageWorks outside of Mercer BenefitsCentral. You’ll need to provide the last four digits of your Social Security number just once—when you register your account.

You and your family members each get four free visits a year to a primary care doctor:

• General or family practitioners
• Doctors of internal medicine
• Pediatricians
• Family nurse practitioners
• OB/GYNs
• Non-hospital urgent care facilities

With Anthem’s telemedicine program, LiveHealth Online, Anthem members can use a computer or mobile device to virtually meet with a board-certified doctor anytime, anywhere—including home and work—for consultation when you’re sick, have a rash or even to receive a prescription.

Easily accessible and convenient, LiveHealth Online saves you time and the hassle of driving to a doctor’s office, helping you get the right care at the right time. There are no appointments or long lines to see a doctor, and it’s already part of the Anthem Health Account Plan (HAP). All you have to do is register to get started.

The cost for a virtual doctor appointment is only $4.90, if you are an Anthem HAP member. If you aren’t enrolled in the Anthem HAP, the cost is $49. You can use your Health Account to pay this cost.

Register by going to livehealthonline.com or downloading the LiveHealth Online iPhone or Android apps. When virtually meeting with a doctor at work, you must use cell service to connect. Virtual doctor consultations cannot be accessed through PG&E’s Wi-Fi.

Onsite Locations
Additionally, as part of LiveHealth Online, MedSuite kiosks are available in select PG&E office locations. The onsite kiosk is first-come, first-served and gives Anthem members a quiet place to virtually meet with a doctor through built-in internet and video camera tools.

• Bishop Ranch, 6121 Bollinger Canyon Road, Building Z, Room 2201B
• Concord RMC, 1850 Gateway Blvd, 5th floor, Room 5010
• Fresno Contact Center, 650 O Street, Room 304
• San Jose Contact Center, 111 Almaden Blvd, Room 205B
• Sacramento Contact Center, 2740 Gateway Oaks Drive, Room 135
• San Ramon Valley Conference Center, 3301 Crow Canyon Road, A-Wing 2nd Floor Break Area
• Stockton Contact Center, 3136 Boeing Way, Room 2202

For additional information about Anthem’s telemedicine program, please refer to the LiveHealth Online FAQs, email customersupport@livehealthonline.com or call 1-855-603-7985.

As a reminder, if you have a work-related discomfort or injury, call the 24/7 Nurse Report Line at 1-888-449-7787.

You pay 20% of the cost for all specialist office visits after you meet the annual deductible. Your specialist may charge you up to the full amount of your deductible at the time of service, and you may need to file a claim to get reimbursed. You can visit any provider or specialist of your choice without preauthorization from your primary care doctor.

If you or your loved one has been touched by cancer, you may have questions and need to make some timely decisions. To help you during this time, PG&E provides you and your covered dependents with Optum — a cancer resource that works with the Anthem Health Account Plan (HAP), as well as the Comprehensive Access Plan (CAP) and Network Access Plan (NAP) for employees on long-term disability.

Optum includes experienced cancer nurses who can help you understand your treatment options, answer your questions and help you find the best doctors for your condition. They help simplify the details so you can focus on your health.

Your nurse can help you:

• Tell your spouse, kids and loved ones
• Explain your options and answer questions
• Find additional resources (wigs, financial support)
• Find the best-quality doctors
• Manage your symptoms and side effects
• Understand your medications
• Feel informed so you can make the right decisions for your health

Additionally, your nurse can work with your doctors to make sure all your questions are answered. In turn, your nurse can keep your doctors informed about how you’re feeling.

Optum’s program also includes referrals to Centers of Excellence for rare and complex cancers–additional coordinated care for patients with complex diagnoses, cancer recurrence or those who’d like a second opinion.

If you or one of your dependents is diagnosed with cancer, Anthem will partner with Optum to ensure you have access to the resources you need. PG&E does not have access to your medical records.

No matter where you are in life, we’re making it easier for you to receive the high-quality care you need.

For more information about Optum’s Cancer Support Program, call 1-866-877-5399 Monday through Friday from 7 a.m. – 7 p.m. Pacific time or email cancer_resource_services@optum.com.

Additional Anthem Cancer Support Resources

• Caring for your teeth and gums during cancer treatment
• Cancer Survivorship Kit

Frequently Asked Questions

I received information about Optum’s Cancer Resources program. Does this mean PG&E believes I have cancer?
No, PG&E does not have access to your medical records. However, to ensure you're aware of the resources available through the Health Account Plan (HAP), PG&E will sometimes send you information about all of our available programs.

I received a call from Optum and they were aware of my cancer diagnosis. Does this mean PG&E is also aware that I have cancer?
No, PG&E does not have access to your medical records. If you or one of your Anthem Health Account Plan (HAP) covered dependents is diagnosed with cancer, Anthem partners with Optum to ensure you have access to the quality care you need.

This program is completely optional. If you don’t wish to use Optum’s services, you are not required to do so.

Urgent care is covered as primary care, so you won’t have to pay a deductible. After you’ve used your four free primary care visits for the year, you pay 10% of the cost.

Some hospitals advertise themselves as urgent care centers when in fact, they’re not and they charge higher emergency room rates. This can make a big difference in how much you pay out of your own pocket.

Always check to see if the facility you want to use is really an urgent care center.

Go to anthem.com/ca/pge or access the Anthem BlueCross smartphone app to find an urgent care center near you.

You pay 20% of the cost, subject to the annual deductible. After you visit the emergency room, your HAP plan administrator—Anthem—will process the claim and then send you an Explanation of Benefits (EOB).

If you’re traveling or living outside of your home state, you can use Anthem’s BlueCard Program to access a broader network of doctors and hospitals at discounted rates through other Blue Cross/Blue Shield plans. To locate BlueCard PPO providers:

• Call Anthem Blue Cross Member Services at 1-800-810-2583 (the number is printed on the back of your Anthem ID card for easy reference)
• Visit www.anthem.com/ca/pge

You’ll be able to visit any provider or specialist of your choice without preauthorization from your primary care doctor.

Dependents who live away from home — like college students — can use Anthem’s BlueCard Program to access a broader network of doctors and hospitals at discounted rates through other Blue Cross/Blue Shield plans. To locate BlueCard providers:

• Call Anthem Blue Cross Member Services at 1-800-810-2583 (the number is printed on the back of your Anthem ID card for easy reference)
• Visit www.anthem.com/ca/pge

Beacon Health Options administers all mental health and substance abuse services for Anthem. To preauthorize care, contact:

• A Beacon Health Options care manager at 1-800-562-3588
• An on-site Employee Assistance Program (EAP) counselor during normal business hours, or contact the EAP 24/7 at 1-888-445-4436

Here's what you pay for services:

• Outpatient services: You pay 10% of the cost with no deductible
• Inpatient services: You pay 20% of the cost after you meet the annual deductible

Applied Behavior Analysis services are also provided through Beacon Health Options (at no charge, with no deductible). To obtain prior authorization or pre-certification from Beacon Health Options, please call 1-888-445-4436. During this call, a care manager will request basic information — including, but not limited to — a child's diagnosis, who made the diagnosis, and what the presenting symptoms are (e.g., developmentally delayed skills, problem behaviors).