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 2023 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 Optum Financial payment card will be loaded with your annual Health Account credits and – if you elected the Health Care Flexible Spending Account (FSA) – your FSA contribution.

Filing claims

You can file Health Account claims for reimbursement anytime. Generally, the annual March 31 Health Account deadline for prior-year expenses no longer applies to Health Account claims – provided you:

Filing claims versus verifying expenses

When you file a claim, you're submitting a request for reimbursement for an expense you paid out of pocket. Watch the Reimbursements with Anthem video to learn how to file a claim.

When you verify an expense, you're submitting paperwork that proves your expense was eligible – usually an Explanation of Benefits (EOB) or itemized receipt showing the date and amount of service, the provider’s name, patient’s name and the service provided.

If you use your Optum Financial payment card, you have until March 31 of the year after you use your card to verify your expense, if requested.

Special deadlines apply for the transition of HealthEquity | WageWorks to Optum. For details on claim filing deadlines, click here.

The March 31 deadline only applies when you use your Optum Financial payment card.

If you use Optum Financial Reimburse Myself or Pay Provider, no deadline to file your Health Account claim. The verification process is part of the claims filing process, so there’s no separate verification deadline.

Using the Optum Financial payment card if you have a Health Care Flexible Spending Account (FSA)

Different rules apply when you have only the Health Account – versus when you have a Health Care Flexible Spending Account (FSA). If you have both the Health Account and a Health Care FSA, the Health Care FSA rules govern.

Can you use the Optum Financial payment card for prior-year expenses?

YES if you have the Health Account only

NO if you elected the Health Care Flexible Spending Account (FSA) – even if you also have the Health Account

Don’t use your card for prior year expenses

Don’t use your health payment card in 2023 to pay for 2022 expenses. Instead, you’ll need to file a claim to reimburse yourself or pay your provider.

There are three ways to get reimbursed:

Tip: Don’t wait!

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

Optum will send multiple reminders if you need to verify expenses. You’ll have 180 days to verify your expenses. After 180 days, if you haven’t verified expenses and they total more than $150, Optum will suspend your card.

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

Your Optum Financial account

You can access your Optum Financial account directly after logging into myPlans Connect and clicking the Access Your Health Account link under the Your Health Insurance box. You may also log onto OptumFinancial.com or download the Optum Financial mobile app to check balances, upload receipts, and file claims.

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

Using your Optum Financial payment card

You can use the Optum Financial payment 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. Optum Financial 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, Optum Financial will then debit your Health Account. Once you receive your Explanation of Benefits (EOB) from Anthem, Delta Dental or VSP, you can use your Optum Financial payment card to pay your health care provider the amount you owe, 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 Optum Financial:

• Claims filing deadline
• When you can use the Optum Financial payment card
• Deadline for verifying expenses if you use the Optum Financial payment card

*Optum will send multiple reminders if you need to verify expenses. You’ll have 180 days to verify your expenses. After 180 days, if you haven’t verified expenses and they total more than $150, Optum will suspend your card.

There are three ways to get reimbursed:

Tip: Don’t wait!

Send your explanation of benefits (EOB) to Optum Financial when you get it—even if you paid with your Optum Financial payment 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 1 and then option 1 for Optum Financial.

Set up your Optum Financial account

To set up your account, log on to your myPlans Connect account and click on the Access Your Health Account link under the Your Health Insurance box. You’ll be able to go straight to your Optum Financial account without creating a username and password.

Alternatively, you can log into OptumFinancial.com or use the Optum Financial mobile app.

Optum Financial won’t know who you are—so you’ll need to register your account the first time you visit Optum Financial outside of myPlans Connect. When accessing your account for the first time, you’ll need to create a HealthSafe ID® username and password. HealthSafe ID adds an extra layer of security to your account by using two-factor authentication.

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 Optum Financial payment 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 Optum Financial payment 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 Optum Financial payment 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 use disorder expenses

After you receive mental health or substance use disorder care from a Carelon Behavioral Health (formerly Beacon Health Options) provider, you’ll need to wait a few weeks for Carelon to process your claim, determine what you owe, and mail you an Explanation of Benefits (EOB) form. Once you receive your EOB, you can use your Optum Financial payment 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 Optum Financial payment card to pay at the time of service, but you may have to submit documentation to Optum Financial 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 Optum Financial to verify all health care 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 Optum Financial:

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, Optum will send multiple reminders if you need to verify expenses. You’ll have 180 days to verify your expenses. After 180 days, if you haven’t verified expenses and they total more than $150, Optum will suspend your card. Additionally, 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 Optum Financial payment 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 express-scripts.com to view your statement.

At an out-of-network pharmacy, you can use your Optum Financial payment 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 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

Filling a prescription for an opioid

If your doctor or dentist prescribes you an opioid, here’s what you should know.

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 $570 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 Optum Financial. For additional information, see Spending Accounts.

To check your FSA or Health Account balance, log on to Optum Financial through myPlans Connect. Alternatively, you can log into OptumFinancial.com or use the Optum Financial mobile app.

Optum Financial won’t know who you are—so you’ll need to register your account the first time you visit Optum Financial outside of myPlans Connect. When accessing your account for the first time, you’ll need to create a HealthSafe ID® username and password. HealthSafe ID adds an extra layer of security to your account by using two-factor authentication.

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

Did you know that you can choose and register a Personal Care Physician (PCP) with Anthem? It can make a big difference in your health. A PCP can help you stay healthy and manage certain ongoing health problems, which can help lower your health care costs and save time in getting specialized care. Click here to learn how you can find an Anthem PCP.

With Anthem’s telehealth program, LiveHealth Online, Anthem members can use a computer or mobile device to virtually meet with a board-certified doctor, psychiatrist, or a licensed therapist from anywhere—including home and work. Learn more below or by clicking here.

Doctor Visits

Easily accessible and convenient 24/7, LiveHealth Online saves you time and the hassle of driving to a doctor’s office for consultation when you’re sick, have a rash or even to receive a prescription. 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 $5.90, if you are an Anthem HAP member. If you aren’t enrolled in the Anthem HAP, the cost is $59. You can use your Health Account to pay this cost.

Mental Health Visits

Visit a licensed therapist.

• LiveHealth Online: Have a video visit with a therapist to get help with anxiety, depression, grief, panic attacks and more. Schedule your psychology appointment online (see below) or call 1-888-548-3432 from 8 a.m. to 8 p.m., seven days a week. You’ll see the cost before the visit starts and you pay just a 10% co-insurance, no deductible. To schedule a video visit for a child ages 10 and up, just log in to your account and choose LiveHealth Online Psychology for Teens.
• Talkspace: Through Carelon’s Talkspace program, Anthem members ages 13 and older can get matched with a therapist for support via text, chat, phone and/or video call.

Consult a board-certified psychiatrist.

• LiveHealth Online: If you’re over 18 years old, you can get medication support to help you manage a mental health condition. Schedule your appointment online (see below) or call 1-888-548-3432 from 8 a.m. to 8 p.m., seven days a week. You’ll see the cost before the visit starts and you pay just a 10% co-insurance, no deductible. Your Anthem plan includes benefits for video visits using LiveHealth Online, so you’ll just pay your share of the costs.
• Talkspace: Through Carelon’s Talkspace program, Anthem members ages 18 and older can schedule a video appointment with a psychiatrist.

Remember, if you’re in crisis or having suicidal thoughts, go to the nearest emergency room or call 911.

Sleep Specialist Visits

Visit with a board-certified sleep specialist. Visit with a board-certified sleep specialist for an initial evaluation, referral for testing if appropriate, a personalized treatment plan, and follow-up visits as needed for a wide range of sleep disorders.

Get Started

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

Questions?
For additional information about Anthem’s telehealth 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 Care Line at 1-888-449-7787.

Talkspace
Register by going to talkspace.com/carelonbehavioralhealth and entering the primary subscriber’s eight-digit PG&E personnel number (PRNR) when the Talkspace website prompts for the member/subscriber ID. Once you create an account, you can connect with a provider using the Talkspace app or your computer.

Questions?
Call Carelon at 1-888-445-4436.

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 Anthem's case management program — a cancer resource that specializes in oncology, and is designed to help members understand what to expect and plan how to move forward with a cancer diagnosis.

A nurse specially trained to support oncology patients will be available by phone to:

• Answer your questions
• Explain next steps
• Connect you with resources to support you
• Enroll you in outreach support from the American Cancer Society if you choose

Are you currently undergoing treatment for cancer? If you have questions about benefits or resources, please contact Anthem for referral to a case manager: 1-888-613-1130. Representatives are available Monday through Friday from 9 a.m. to 8 p.m. and Saturday 9 a.m. to 4:30 p.m. Pacific time.

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

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

Carelon Behavioral Health (formerly Beacon Health Options) administers all mental health and substance use disorder care for Anthem. To preauthorize care, contact:

• A Carelon care manager at 1-888-445-4436
• 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

Benefit of Using In-Network Providers
You generally will be charged fees that are higher than the NEGOTIATED RATE charged by a NETWORK PROVIDER and will be responsible for the portion of those fees that are over the reasonable and customary limits. You may also be responsible for any ineligible expenses or even the entire bill. You should discuss this with your PROVIDER, as these amounts can be substantial. Read more here.

File a Claim
To file a claim for reimbursement, go to Carelon’s MemberConnect website, download a claim form and submit using the online form. You may also create an account on MemberConnect to access benefits information, claims and other resources. Enter your social security number where a nine-digit member ID number is requested.

Finding a Counselor

When seeking assistance from a counselor, it’s important to find someone who is trained to treat your problem, makes you feel comfortable, and is someone you can trust. Click here for helpful hints on finding someone who is a good fit for you.

Substance Use Disorder Treatment

There are a range of formal treatment options for substance use disorder treatment such as detoxification, acute inpatient treatment, intensive outpatient treatment and residential treatment which require meeting medical necessity in order to be covered by your health insurance plan. There are also 12-step programs, such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), which anyone can attend.

With the guidance of a skilled EAP counselor, you can determine which type of treatment would be most effective and appropriate for you. Call the EAP at 1-888-445-4436 to get the process started.

Telehealth options

If you’d like to see a provider via telehealth, you have a few options:

1. With Anthem’s telehealth program, LiveHealth Online, Anthem members can use a computer or mobile device to virtually meet with a board-certified psychiatrist or licensed therapist from anywhere. See the Telehealth – Virtual Doctor And Mental Health Visits section above for more details.
2. Through Carelon’s Talkspace program, Anthem members ages 13 and older can get matched with a telehealth provider for support via text, chat, phone and/or video call.
3. Call Carelon at 1-888-445-4436 for assistance selecting an in-network provider or search the online provider directory and refine your search results to include only telehealth. Then contact the provider and request a telehealth (telephonic or video) appointment.

Autism and Applied Behavior Analysis (ABA)

Applied Behavior Analysis services are also provided through Carelon (at no charge, with no deductible). To obtain prior authorization or pre-certification, 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). Click here to learn more.