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PSE Health & Welfare BenefitsEffective January 1, 2015 – December 31, 2015

PSE Health & Welfare Benefits

About Your Benefits Page 4

Open Enrollment Page 7

Mid-Year Changes Page 13

Wellness Page 15

Medical Benefits 0

Dental Benefits Page 28

Life, AD&D and LTD Page 30

Flexible Spending Accounts Page 32

How to Enroll Page 36

Legal Notices Page 39

Glossary Page 44

Contacts Page 45

Effective January 1, 2015 – December 31, 2015

2015 BENEFITS GUIDE 3

The PSE 2015 Benefits Guide is your interactive, online overview of your benefit plan coverage. You’ll also find important enrollment information, including how to enroll. (Enrollment instructions are included on page 36.) Your benefits are an important part of your overall compensation. Please take the time to review your options and the cost of coverage, which may change from year to year. You can do this using a new Health Plan Cost Calculator available in the online enrollment system.

Using this guide

Online plan summaries in standardized format

In addition to the plan information in this benefits guide and on PSEWeb, you can also review a Summary of Benefits and Coverage (SBC) for each PSE medical plan.

The federal health care law requires standardized health plan information so that you can better understand and compare plan features.

Access your plan summaries with the links listed below. If you require a paper copy, please contact the Employee Information Center as noted to the left.

2015 Group Health Options Plan SBC

2015 Regence Engage Plan SBC

2015 Regence HSA Plan SBC

2015 Regence PPO Plan SBC

Puget Sound Energy offers a comprehensive, competitive benefits package to help you and your family stay healthy and protect you against financial loss in the event of accident or illness.

2015 Benefits Guide paper copy

The 2015 Benefits Guide is a long document. Please print only the pages you need to save resources and reduce cost. If you require a complete paper copy of the guide, call the HR Employee Information Center (EIC) at 425-462-3389, option 6, or send an email to [email protected].

http://pse.com/PSEemployees/Documents/GHC_SBC_2015.pdf

http://pse.com/PSEemployees/Documents/Regence_Engage_SBC_2015.pdf

http://pse.com/PSEemployees/Documents/Regence_HSA_SBC_2015.pdf

http://pse.com/PSEemployees/Documents/Regence_PPO_SBC_2015.pdf

mailto:employee-information-center--pse-mail%40pse.com?subject=


Your benefits include:

• Medical coverage

• Dental coverage

• Life insurance

• Accidental Death & Dismemberment (AD&D) insurance

• Long Term Disability (LTD) insurance

• Flexible spending accounts (FSAs) for health care and dependent care

About your benefitsFlex Credits | Who is eligible to participate | Benefit plan updates

PSE Flex Credits and benefit costs

PSE provides employees with Flex Credits to offset most of the monthly cost of health care. The amount of Flex Credits you receive is based on the medical coverage option you choose:

• Employee Only

• Employee + Family (one or more dependents, including spouse)

• Opt Out Medical

If the cost of the medical plan you choose is less than the Flex Credits provided, the additional credits are available to reduce your cost for other benefits such as dental, AD&D, supplemental life and flexible spending accounts. Unspent Flex Credits are paid to you as taxable income in your paycheck.

If the cost of your benefit elections exceeds the Flex Credits, your share is paid with a pre-tax payroll deduction.

Wellness credits

Employees who earn 1,000 points in the myWellness at PSE program will receive $360 annually ($30/month) to offset the cost of their benefits. Additionally, covered spouses are also eligible to earn wellness credits for a total savings of $720 annually ($60/month). This applies to non-represented and UA–represented employees, at this time. All employees are eligible and encouraged

to participate in the program where they can earn points for gift cards, giveaways and entries into drawings.

Go to myWellness at PSE or see page 15 for details.

Note: The deadline to earn points for 2015 wellness credits has passed. Participant point totals returned to zero on October 6, 2014.

Eligible employees have until September 30, 2015 to earn points for 2016 wellness credits.

If you are considering any of the options below, Open Enrollment is your opportunity to make changes to your 2015 plan coverage. Please read the detailed information about these benefit elections so that you have the best coverage for you and your family.

If you plan to: Go to:

Change medical plans or covered dependents

Page 7

Opt out of medical/dental coverage

Page 7

Add or drop coverage for a domestic partner

Page 10

Add or increase Supplemental Life insurance

Page 30

Enroll in a flexible spending account

Page 32

Joint Health & Welfare Committees

PSE recognizes that a diverse and changing workforce requires many benefit options. The Joint Health & Welfare Committees meet on a regular basis to review health care trends, benefit plan design and claims experience. Decisions about benefits are based on careful analysis of the collected data. PSE offers a variety of plans with different features so that you can select the benefits that best fit your situation.

http://mywellnessatpse.limeade.com


Who is eligible to participate

• Active regular employees working a minimum of 20 hours per week as:

- IBEW-represented employees

- Non-represented employees

- UA-represented employees

• Qualified dependents of eligible employees:

- Legal spouse — opposite or same sex

- Natural, adopted, foster and/or stepchildren under age 26

- Natural, adopted, foster and/or stepchildren age 26 or older who are permanently and totally disabled

- Domestic partners of eligible employees, and their natural, adopted, foster and/or stepchildren under age 26

Dependents

It’s your responsibility to comply with PSE eligibility rules and IRS tax regulations when enrolling dependents in medical and dental plans.

Make sure you log on and confirm your dependents.

Note: Spouses who both work at PSE may not double-cover each other or their dependents. An individual can only be covered once under the PSE plans.

PSE temporary employees, seasonal employees and casual employees are not eligible for benefits while in these categories. Job change to a regular employee category working a minimum of 20 hours per week would qualify for eligibility.

Are you a new employee or newly eligible for benefits?

If you recently enrolled in benefits for 2014 as a new employee (or as newly eligible for benefits), some of your choices will not roll over to 2015. Make sure you enroll for 2015 benefits. It’s your only opportunity, even if the annual Open Enrollment has passed for other employees. Flex Credits and costs are also different for 2015. (The online process prompts you to enroll for 2015 benefits that do not automatically roll over.)



Federal health care reform and your benefits

PSE employees, like most individuals and families with company-sponsored benefit plans, will see little impact from the Affordable Care Act on their plan cost or benefit plans. Many of the law’s key requirements, such as full coverage for preventive care, have been in place at PSE for a number of years.

PSE benefit plans currently meet, and in most cases, exceed the coverage requirements of the federal law. We will continue to comply with all the requirements of the Affordable Care Act.

The best way for PSE to keep everyone’s healthcare cost down is to support employees in making healthy lifestyle choices. To accomplish this, we will continue to highlight and enhance our wellness program, myWellness at PSE, as part of a comprehensive benefits package.

money for medical expenses you may incur in the future or during retirement.

At this time, only PSE non-represented employees are eligible to participate in the Regence Health Savings Account Plan.

For more information on the HSA plan, go to the HR Benefits page at pse.com/hsaplan.

Reduced rates for life insurance — enrollment opportunities for supplemental life insurance

On January 1, 2015, MetLife will become the new carrier for PSE plans covering life, accidental death & dismemberment (AD&D) and long-term disability (LTD) insurance. As a result, employees who have not signed up for supplemental life insurance have a one-time opportunity to enroll in the coverage for 2015 without a medical review.

If you do not have supplemental life insurance, you may purchase coverage of one times your annual base pay during Open Enrollment.

Employees who already have supplemental life insurance coverage can take advantage of the new lower rates and increase their coverage by one times their annual base pay for 2015 — also without a medical review. This option is available every year at Open Enrollment.

See page 30 for applicable rates.

2015 Benefit Plan Updates: PSE introduces Health Savings Account plan option

If you’re looking for an additional way to save for retirement and set aside before-tax dollars for current and future medical expenses, a health savings account or HSA may be right for you. The newly offered Regence HSA Plan is a qualified high deductible health plan (HDHP), which is paired with a Health Savings Account. If interested, you must choose this option during the upcoming Open Enrollment period.

Contributions to the HSA are made through payroll deductions deposited to an HSA-approved financial institution — in this case, HealthEquity. The funds in this account can be used to pay qualified out-of-pocket expenses. The financial institution also provides savings and investment options, similar to an individual retirement account (IRA) or 401(k) plan.

A health savings account (HSA) is sometimes confused with a flexible spending account (FSA). Both allow you to pay for out-of-pocket medical, dental and vision expenses with tax-free dollars. However, money set aside in an HSA rolls over from year to year, unlike an FSA in which money must be used during the calendar year or forfeited. The money in your HSA belongs to you, even if you switch health plans, retire or leave employment. An HSA allows you to save


http://www.pse.com/hsaplan


3 easy steps: Opt Out Medical/Opt Out Dental

When you elect Opt Out Medical and/or Opt Out Dental coverage, you can do it online in three easy steps.

1. Elect the Opt Out option on the medical and/or dental page.

2. Complete the Opt Out certification page by filling out the required fields.

3. Read the Confirmation Statement carefully after making your elections. You must elect Opt Out and provide all of the information requested.

Important: Remember that if you elected to opt out for 2014, that election does not roll over to 2015. You must elect to opt out each calendar year and provide updated certification online that you have other employer group coverage.

Open Enrollment begins October 17 and ends October 31, 2014

Open Enrollment is your annual opportunity to:

• Review your benefit plan choices and costs.

• Change your enrollment decisions for the next year, including your medical, dental, AD&D, life insurance and flexible spending accounts.

• Change who is covered under your plan. (They must be eligible for enrollment.)

• Change premium payment election for LTD — taxable or nontaxable.

• Elect:

1. Opt Out Medical.

2. Opt Out Dental.

3. Flexible spending accounts.

If you are enrolled for 2014 benefits, your coverage for the three items listed above ends December 31 and does not roll over to 2015.

Check your beneficiaries for life and other benefit plans

You can review and update your beneficiaries at any time during the year. However, Open Enrollment is a good time to check your designations to make sure they reflect your current situation and wishes. Review and make beneficiary updates for your pension plan at Milliman Benefits Service Center and for your 401(k) plan at T. Rowe Price. Life and Accidental Death & Dismemberment insurance beneficiaries can be updated on the benefits enrollment site.

Open enrollmentOpt Out medical/dental | Open Enrollment checklist | Employees on a leave of absence | Domestic partner enrollment | Understanding imputed income | Frequently asked questions


To access the online benefits enrollment site, go to page 36.

The benefit elections you make will remain in effect from January 1 to December 31, 2015.

No changes are permitted and no exceptions are made unless you have a mid-year status change, and you enroll within the enrollment period. (For details, see Mid-Year Benefit Elections on page 13.)

5 easy steps to complete your benefits enrollment

Follow this step-by-step checklist to ensure a smooth benefit enrollment process. It’s your responsibility to complete your benefits enrollment by October 31 and confirm your benefit elections for 2015.

1. Review your 2015 Benefits Guide.

Your benefits guide provides the information you need to understand the coverage options and costs for you and your family.

2. Calculate your coverage and costs.

Understand how your decisions affect your paycheck and household budget. The new Health Plan Cost Calculator on the enrollment site makes it easy to evaluate plan benefits before you complete the enrollment process. Here you can calculate your total out-of-pocket cost based on your family’s expected health care needs.

NEW Make side-by-side comparisons of your annual out-of-pocket cost for each plan option with our new Health Plan Cost Calculator.

3. Understand how Flex Credits affect your costs.

Flex Credits and benefit costs change annually. Review your credits carefully because your current elections may no longer be the most cost-effective choice for you and your family.

4. Complete your benefits enrollment by October 31.

You must complete the enrollment process during the Open Enrollment period for your benefit elections to take effect in 2015.

5. Carefully read the Benefits Confirmation Statement.

The confirmation statement you receive in the mail must reflect the benefits you elected during online enrollment. This is your last chance to correct any errors or take specific actions, such as opting out of medical/dental coverage, enrolling in a flexible spending account, or completing a domestic partnership declaration form.



Employees on leave must re-enroll

The health and welfare benefits plan covers employees during most leaves of absence. If you’re on a leave of absence, you are required to complete the Open Enrollment process.

If, while you are on leave, you increase your level of Supplemental Life insurance or change your LTD taxation election, your choices will not take effect until you return to work and meet the carrier requirement to be an active employee. Increasing by more than one level of Supplemental Life coverage requires an Evidence of Insurability approval from the carrier before the new benefit elections take effect.

For more information about issues affecting employees on leave, go to pseweb/employeetools/hr/la/.

For more information on Supplemental Life insurance and the one-time opportunity to increase your coverage without a medical review, see page 30.

Long Term Disability taxation options

During the Open Enrollment period you may elect to receive your LTD monthly payments as taxable or nontaxable income. See page 31 for details.


http://pseweb/EmployeeTools/HR/LA/Pages/default.aspx


Enrolling domestic partners and their dependents for the first time

If you are enrolling your domestic partner or your domestic partner’s children for the first time, you must complete a PSE Declaration of Domestic Partnership form and return it to PSE Benefits (PSE-10N) by October 31, the last day of the Open Enrollment period.

If your domestic partner or his/her children are currently enrolled, you are not required to complete a new declaration form during the Open Enrollment period. The medical/dental coverage will roll over from year to year.

If you wish to cancel your domestic partner’s coverage or his/her children’s, you must enroll online during the Open Enrollment period and elect to drop their 2015 coverage elections.

If your enrolled domestic partner ceases to be your domestic partner, he or she is no longer eligible for medical/dental coverage. You must promptly notify PSE if such an event occurs.

A domestic partner must be enrolled in the medical/dental plan in order to enroll the domestic partner’s children.

Did you know?

If a valid PSE Declaration of Domestic Partnership form is on file, the domestic partner of an employee who dies while receiving Long Term Disability payments may receive a lump-sum payment. See page 31 for details.

Understanding imputed income

PSE provides family Flex Credits to all employees who include their domestic partner (same or opposite sex) as part of their benefit plan coverage.

The PSE-covered monthly cost paid for eligible domestic partners must be counted as “imputed” or taxable income because the IRS does not recognize domestic partners as “dependents.”

Dependent children of a domestic partner are also nonqualified tax dependents. You will be responsible for paying imputed income based on the value of providing medical or dental coverage.

NOTE: Health care expenses for a domestic partner are not reimbursable under a health care flexible spending account or a health savings account.



Frequently asked questions

Do I have to re-enroll for 2015 benefits if I am making no changes?

PSE recommends that you go online to view your options and understand the implications of your decisions because PSE Flex Credits and the cost of your benefit plan change each year. Open Enrollment is your only opportunity to do so before the new benefits and costs become effective for the calendar year.

You may decide to elect different benefits based on Flex Credits and changes in benefit plan costs.

Additionally, you must re-enroll each Open Enrollment period if you want to:

1. Change plans or covered dependents.

2. Elect or re-elect Opt Out Medical or Opt Out Dental.

3. Enroll or re-enroll in a flexible spending account for health care or dependent care.

How do I find benefit plan costs and the amount of my Flex Credits?

The cost of each benefits plan and your Flex Credits are displayed when you sign in to the online benefits enrollment system. Flex Credits vary depending on whether you elect to cover yourself, yourself and your family, or opt out of medical coverage altogether. Flex Credits also vary depending on your employee group — non-represented, IBEW-represented or UA-represented. Please note that wellness credits are not displayed in the online benefits enrollment system.

If I want to choose Opt Out Medical or Opt Out Dental, what do I do?

You can do it in three easy steps as described on page 6. You must complete the enrollment process to opt out of medical and/or dental.

Important: If you do not enroll online and provide all the information requested within the Open Enrollment period, you will be enrolled in:

Regence Engage Medical — Employee Only coverage

Delta Dental Basic Option — Employee Only coverage

There are no exceptions. You will be enrolled in these benefits for the entire calendar year.



Do I need to have a medical review to add or increase my Supplemental Life insurance? During most Open Enrollment periods, you must complete a medical review or Evidence of Insurability (EOI) form. However, if you have opted out of Supplemental Life insurance in the past, you have a one-time opportunity to add this coverage without a medical review with our new plan administrator MetLife. If you have existing coverage, you can take advantage of the new lower rates and increase your coverage by one times your annual base pay without a medical review. This option is available every year at Open Enrollment.

I am currently on leave. How do I enroll for benefits?Read your 2015 Benefits Guide. Enroll online or through the Benefit Service Call Center at 1-800-531-1328. The same enrollment rules apply to employees on leave. Your elections become effective on January 1, 2015.

If you elect to increase your current level of Supplemental Life coverage, your new elections will not become effective until you have returned to work per the carrier requirements. If the election you choose requires Evidence of Insurability, approval from the carrier is necessary before the new elections take effect.

Additionally, a change in the taxation of your LTD benefit will not take effect until you return to work as scheduled.

When will I get a Benefits Confirmation Statement?A Confirmation Statement with your elections will be mailed to your home address approximately one week after the close of Open Enrollment. You can also print a copy of your Confirmation Statement directly from the confirmation page of the online enrollment system. However, because of the special enrollment rules involved in opting out of medical/dental or enrolling a domestic partner, the final confirmation is the version you receive in the mail. A grace period for corrections will be stated on the confirmation if you find any errors in your enrollment.

How does the preventive care benefit for the medical plans work?Employees have 100 percent routine preventive care coverage (not for diagnostic tests) for all medical plans. There is no maximum limit, deductible or coinsurance payment. Covered services include routine pediatric exams and adult physical exams; immunizations and flu shots; routine screening colonoscopies and mammography; and women’s preventive care, including some contraceptives and screenings.

For specific questions, call your plans’ customer service number in the Contacts section.

Will I receive a new medical plan ID?Only employees who are making a change in their medical plan coverage will receive a new medical plan ID card,

except Group Health members in Eastern Washington, who have a new group number in 2015 and will receive new ID cards.

New medical plan ID cards will be delivered to your home before January 1. Please make sure your health care provider records your new card.

Will I receive a dental plan ID card?

No. Delta Dental does not issue ID cards. When visiting the dentist, you will only need to provide your name, date of birth and dental plan number (174), along with your Social Security number or the member ID number located on all Delta Dental correspondence. If you would like to print a copy of your card, go to deltadentalwa.com.

Can I get information on 2015 plan benefits from Regence, Group Health or Delta Dental?Yes. Go to Benefits from the HR home page on PSEWeb. From the Benefits menu, you can review the medical plan comparison and the dental plan comparison charts or review your benefit booklets. If you have more detailed questions about what is or is not covered, please call the carrier or access your coverage information by logging on to your plan’s secure member website.

Do I need to re-enroll my dependents for medical and/or dental coverage for 2015?If your dependent is currently enrolled, he or she will continue to be enrolled.


http://deltadentalwa.com


31 days to make qualifying changes — mid-year benefit elections

Most benefit plan changes for next year can only be made during the fall Open Enrollment period. However, you may change your benefit plan coverage in 2015 if you or a family member experiences a “qualifying” life event, such as:

• Marriage, divorce or legal separation.

• Birth or adoption of a child.

• Newly acquired legal guardianship of a dependent child.

• Loss of benefits coverage under your spouse’s plan after a job change or death.

• Change in your spouse’s coverage during his or her open enrollment period.

You must make the benefit change within 31 days of the qualifying event — 60 days to add coverage for newborns or adopted children.

To make a mid-year change, re-enroll online or call the Benefit Service Call Center at 1-800-531-1328. A Mid-Year Status Change form must be completed for legal separation, adoption or legal guardianship.

Qualifying mid-year changes are determined in a uniform and consistent manner for all employees enrolled in a benefits plan. PSE allows qualified changes — though employers are not required to — if the change meets IRS requirements, and online election and other requirements, if applicable, are completed within the designated periods mentioned above.

Mid-year changes

What you must do: divorce or legal separation

It is your responsibility to notify PSE within 31 days if your marital status changes. That’s because your spouse is no longer eligible for coverage under PSE medical/dental plans following a divorce or court-certified separation. However, a divorce or legal separation triggers eligibility for benefits continuation (COBRA) for your spouse and/or children covered under your medical/dental plan.

Failure to notify PSE may cost you money in the following ways:

• You will not receive a refund of paycheck deductions from your divorced spouse retroactively.

• PSE may recover from you any costs incurred from providing late COBRA notice to your ex-spouse.

• Imputed (taxable) income will be added to your gross income for any months the divorced spouse was covered because PSE was not notified that he or she was no longer eligible for benefits.


Important: Only corresponding changes to your benefit elections are allowed. For example, if you gain a dependent, you may add him or her to your medical coverage, but you cannot change the medical plan you are enrolled in until the next Open Enrollment period. Make sure you follow all enrollment requirements and timelines to ensure your request for election change is completed. If benefits are paid in error due to false or misleading statements, the plan may be entitled to recover these amounts. Material misrepresentation, fraud or omission of information in order to obtain coverage for yourself or others may result in loss of coverage under the plan. The carriers can refuse to provide coverage for you and will not pay claims for ineligible dependents.

If you have a qualifying status change outside the enrollment period, enroll online at benedetails.com (enter 76389 for 2015), or call the Benefit Service Call Center at 1-800-531-1328.

How changes in your life affect your benefits and what you must do

TIP: The online system will prompt you through the changes available, based on your qualifying event.

Mid-year changes

If you: Health and dental benefits You must complete the enrollment process within:

Are getting married You may enroll your spouse and any new dependent child(ren) or elect to opt out of medical/dental coverage and enroll in your spouse’s plan coverage.

31 days of life event

Have a newborn or adopt a child You may enroll your newborn or newly adopted child. 60 days of life event

Enroll your child as soon as possible to ensure his/her coverage. Otherwise, you must wait until the next Open Enrollment period.

Are divorced or legally separated Your spouse’s coverage ends the last day of the month in which you become legally separated or divorced. Court order is required for legal separation.


Provide timely notice to PSE to ensure the rights of your spouse and children are protected; continuation rights under COBRA may be available. It’s your responsibility to notify PSE promptly.

Lose benefits coverage provided by your spouse’s plan

You may enroll yourself or your eligible dependents if they were previously covered under your spouse’s plan and that coverage ended following a change in job status or death.


Have a spouse whose open enrollment period differs from PSE’s

You may enroll or drop coverage for your spouse or eligible dependents if you elect different coverage options during your spouse’s enrollment period.


Have a domestic partner (and you have filed a valid domestic partner declaration form) whose open enrollment period differs from PSE’s

You may enroll or drop coverage for your domestic partner or eligible dependents if you elect different coverage options during your domestic partner’s enrollment period.


Terminate a domestic partner relationship

Your domestic partner’s coverage ends the last day of the month in which you separate.


http://benedetails.com


myWellness at PSE

In 2013, myWellness at PSE was launched to consolidate wellness resources under one program that rewards employees for making healthy choices with the support of an informative and engaging website. PSE teamed up with Limeade, a local wellness company that provides a broad range of offerings that cover physical, emotional and financial fitness — all designed to help you and family members reach goals for healthy living. All employees are eligible and encouraged to participate either as an individual, through group activities or working with an individual health coach.

Get started today!

Go to mywellnessatpse.limeade.com and access the tools you need to build an active, engaged and healthful future.

Rewarding you for making healthy choices

All employees and their covered spouse/domestic partner are eligible and encouraged to participate in myWellness at PSE. Once you create your account, you can start earning points for gift cards, giveaways and entries into drawings. Use the free confidential assessment to gauge your well-being and establish goals. Then, you can participate as an individual or in group activities, or work with a wellness coach to reach those goals. Here’s how to earn points and 2016 wellness credits between now and September 30, 2015.*

Level 1 – Plugged In

Earn 1,000 points and receive a water bottle and wellness credits worth $360 annually ($30/month) toward the cost of your benefits. Covered spouses/domestic partners are eligible to earn an additional $360 for a total of $720 ($60/month) in savings.

Level 2 – Fired Up

Earn 2,000 points and receive a $25 Amazon gift card and be eligible to win a free Fitbit wellness device.

Level 3 – Energized

Earn 3,000 points and receive the Energized Award and be eligible to win the grand prize valued at $700 to $1,000.

About wellness credits: These credits can be applied to the cost of your benefits such as medical, dental and flexible spending accounts. However, you may also receive taxable income, as you would with unused Flex Credits. See page 4.

*Wellness credits apply only to non-represented and UA-represented employees and their covered spouses/domestic partners at this time.

WellnessmyWellness at PSE | Resources for all PSE employees | Group Health resources | Regence resources

http://www.mywellnessatpse.limeade.com


Additional healthy living resources for all PSE employees

Preventive careRoutine screenings, at no out-of-pocket cost to you, include physicals, gynecological exams, immunizations, life-saving cancer screenings such as colonoscopies, and other important routine tests. Preventive care is available through your Group Health and Regence plans.

Flu shotsThe cost of flu shots is covered at 100 percent through your Group Health and Regence plans. Vaccinations are available at your local pharmacy or physician’s office.

Smoking cessation The nationally recognized Quit for Life™ program offers free 12-month telephone support to help you become tobacco-free at your pace. Our health plans cover prescribed smoking cessation drugs at little or no cost. The program is available through Regence at 1-866-784-8454 and Group Health at quitnow.net/ghc or 1-800-462-5327.

Dental benefits centerMySmile® is Delta Dental’s patient portal to your personal dental benefits, where you can review coverage, find a dentist, check claims status, view demos and much more: deltadentalwa.com.

Onsite fitness and companywide teamsMany PSE facilities have onsite exercise equipment, feature wellness activities such as group walks, and recruit participants for companywide sports leagues including golf, soccer and softball.

Safety information and eventsPSEWeb safety pages include stretch videos, office ergonomics, safety meeting information and much more to support a safety-first mindset. PSE Safety Days build on this information with educational speakers, company resources and hands-on learning opportunities.

Safety equipment discounts and resourcesSafety is a top priority. PSE partners with select vendors to make personal protective equipment affordable and accessible. Employees may purchase qualifying work boots from any vendor and PSE contributes up to $75 toward the cost. Red Wing provides a 17 percent discount for employees using their PSE ID.

PSE contributes up to $300 toward the cost of qualifying prescription safety glasses. SafeVision provides discounted pricing, but employees may purchase qualifying eyewear from any

vendor. Hearing resources, including clinics and test schedules, are also available for employees exposed to higher-than-average noise levels.

For more information on the full range of PSE safety resources, go to pseweb/organizations/corpsafety/.


http://www.quitnow.net/ghc

www.deltadentalwa.com

http://pseweb/Organizations/corpsafety/


Employee Assistance Program (EAP)

This program helps employees with everything from finding home repairs services to finding care providers for family members, as well as legal consultations, counseling services and financial advising. Services are confidential and most offerings are free. Behavioral health services are available to help with mental health and substance abuse issues with no charge for up to three sessions.

The EAP is a free employee resource, providing referrals and online tools for you and your household family members. Find out more at liveandworkwell.com (access code 5271), or call 1-800-358-8515 to speak with an EAP professional.

Financial Fitness

Revisiting your blueprint to retirement every three to five years is a smart thing to do. Investments rise and fall, as do income and expenses. Refocusing your goals helps to ensure your changing financial resources will sustain you into the future.

T. Rowe Price can help you update your plan with advice, online calculators and other financial tools focused on budgeting, saving for college, tax planning and more.

Employees who have a PSE Retirement Plan (or pension) can complete their financial picture with Milliman’s Personal Retirement Planner at yourpensionsite.com. This financial planner shows how your Social Security, PSE retirement and PSE 401(k) plan benefits work together, allowing you to review different scenarios based on your target retirement age, current savings and future contributions.

Washington Health Alliance

PSE is a participating employer in the Washington Health Alliance, a nonprofit organization dedicated to improving the region’s health care delivery with scorecards on health care quality, up-to-date resources for consumers and much more. Check out the Alliance’s Own Your Health, which include videos and tips on health topics, such as how to choose and partner with your primary care provider for better health. Go to oyh.wacommunitycheckup.org.


http://www.liveandworkwell.com

http://yourpensionsite.com

http://oyh.wacommunitycheckup.org


Healthy living resources from Group Health

Group Health provides free wellness support services to help its members improve health and well-being. Find out more at member.ghc.org or 1-888-901-4636.

Health ProfileIn addition to the well-being assessment on myWellness at PSE, Group Health has a unique, confidential assessment that is tied in with your care team and medical record. If you receive primary care at a Group Health Medical Center, some information will conveniently be auto-populated from your medical record. Your doctor can use this tool to better help you address health risks or concerns.

Complementary Choices The Complementary Choices program offers non-covered alternative care services at a discount. These services include acupuncture, naturopathy, chiropractic care and massage therapy.

Workshops for chronic conditionsIf you have a chronic condition like diabetes, high blood pressure, asthma or congestive heart failure, Group Health offers six-week workshops online or in-person to help you learn how to manage your condition and improve your quality of life. Call or go online for information on Living Well with Chronic Conditions or Living Well with Diabetes.

Group Health Fitness NetworkGroup Health sponsors cycling, running and other fitness events throughout the year to promote an active and engaged lifestyle. Services through the website include information on upcoming fitness events, partner sites, event updates and registration deadlines. grouphealthfitnessnetwork.com

GlobalFitA gym is a great place to get inspired, stay focused and break a sweat. Group Health partners with GlobalFit to give you low rates on neighborhood and chain fitness centers, home exercise equipment, and meal programs for improved weight management. Go to globalfit.com and enter Group Health in the search box to indicate your eligibility and to register.

Consulting Nurse helplineThe Consulting Nurse helpline, which includes a consulting physician, is available 24/7 if you have a non–life-threatening illness, injury or just want some medical advice. This resource is a great way to stay well and reduce unnecessary health care cost. Call 1-800-297-6877.

myGroupHealth Web servicesAccess healthy living services and information at ghc.org. Refill prescriptions, check your benefits coverage and look up reliable health information and classes. If you receive care at a Group Health Medical Center, you can also email your doctor, make appointments and view test results.


http://member.ghc.org

http://grouphealthfitnessnetwork.com

http://grouphealthfitnessnetwork.com

http://globalfit.com

http://ghc.org


Healthy living resources from Regence

Regence provides a range of wellness services to promote and sustain good health for its members. Find out more at regence.com or 1-866-240-9580.

Regence Advantages

Beat the high cost of health care with reduced fees from a number of nationally recognized health-related programs such as Jenny Craig and member-only discounts on hearing aids, LASIK eye surgery and other health care needs.

Special Beginnings®

This program is designed to help moms-to-be and provides phone support from a nurse case manager every trimester, access to an around-the-clock nurse line, and educational materials that support a healthy and joyful pregnancy. Call 1-888-JOY-BABY (569-2229).

Nurse Advice Line

With the Regence Nurse Advice Line, you can talk to a registered nurse — any time of the day or night — and get fast, reliable and confidential answers. The registered nurse will assess your condition and advise you on whether a trip to a doctor or clinic is necessary. Call 1-800-267-6729.

Redesigned regence.com

With a fresh new look and more robust content, regence.com is replacing myRegence.com with improved features and streamlined access.

A newly created member dashboard provides an overview of key information, including a summary of benefit maximums, how much has been used and what’s remaining.

The new site includes an enhanced treatment cost estimator that calculates your out-of-pocket costs for a particular service based on your health plan’s deductible and coinsurance amounts.

The newly enhanced regence.com website provides more visibility for the health tools and information you value most. Visit regence.com today.


http://regence.com

http://regence.com

http://regence.com

http://regence.com


Medical benefits overview

Your choices for medical coverage are:

1. Regence

• PPO Plan

• Engage Plan

• Health Savings Account (HSA) Plan

2. Group Health

• Options Plan

3. Opt Out Medical

• Opt Out certification is required when enrolling online. See page 7 for details.

Reminder: January 1 begins a new calendar-year period for the calculation of all plan deductibles, out-of-pocket maximums and plan limits.

Medical plan ID cards

Your ID cards are mailed directly from your carrier to your home, prior to January 1, 2015. If you enroll at another time (for example, as a new hire), your card will be mailed to your home within 10 business days.

If you are currently enrolled and make no changes, keep your ID card — a new card will not be mailed to you for 2015. Group Health members in Eastern Washington have a new group number in 2015 and will receive new ID cards. Be sure to provide your new ID card to your providers at your next visit.

Regence and Group Health medical plan booklets online

Enjoy the convenience of having the e-version of your plan summary as close as your desktop. Quickly search and find important information to make the best health care decisions for you and your family.

For your online copy, log on to your plan’s member site, or go to Benefits from the HR home page on PSEWeb and select your plan from the right margin.

New online tool simplifies comparing health plan costs

Our new Health Plan Cost Calculator on the benefits enrollment site makes it easy to generate side-by-side comparisons of your annual out-of-pocket cost for different plan options. Here you can view what you would pay in monthly payroll deductions, deductibles, copays and all other costs associated with your family’s expected health care needs. Make the most of this online tool to identify cost-effective plan coverage for you and your family.

Medical benefitsMedical benefits overview | Medical plan comparison | Group Health Options Plan | Regence PPO, Engage and HSA Plans


Some quick tips on what you can do to reduce health care costs

You reduce health care costs if you:

• Purchase generic drugs.

• Contact your plan’s 24-hour nurse hotline for after-hours service to get advice on appropriate treatment.

• Visit an urgent care facility instead of the emergency room for non-emergency care.

• Get routine preventive care screenings

You increase health care costs if you:

• Use brand-name drugs when generics are available.

• Visit the emergency room for after-hours services and care.

• Wait until you are sick to see a health care provider.

How to save time and money

Urgent care vs. emergency care

The overuse of emergency care for non-emergency medical conditions is a major contributor to health care cost. A visit to the emergency room can cost up to five times more than a trip to an urgent care center.

Symptoms appropriate for an emergency room include chest pain, confusion, high fever, seizures, severe burns, loss of consciousness, uncontrolled bleeding or poison ingestion. Call 9-1-1.

Injuries or illnesses that don’t appear to pose a serious health risk — colds, flu, insect bites, sprains, strains and nausea — are appropriate for urgent care or your primary care physician. When used for non–life-threatening conditions, urgent care often provides a more appropriate and less expensive level of care with costs similar to an office visit. And, it’s usually faster.

If you’re unsure which is the appropriate choice for you, contact the 24-hour nurse advice line. These professionals can help you evaluate your symptoms and determine what to do next.

• For Regence Nurse Advice Line, call 1-800-267-6729.

• For Group Health Consulting Nurse, with access to a physician, call 1-800-297-6877.

Quick Tip: Make a plan in advance so that you know where to go when you require care outside of office hours. Contact your primary care provider or go online to locate an emergency room or urgent care center near you.

Group Health members can access this information, and much more, with the Group Health mobile app for smartphones.

Reducing costs with “formulary” drugs

Every medical plan has a drug formulary: a list of generic and brand-name drugs developed by a panel of doctors and pharmacists to ensure that the most appropriate and cost-effective medication is used to treat your health condition.

If you are prescribed a drug that is not on your plan formulary, talk to your doctor about an alternative. Medications not included on the health plan’s formulary will cost you more.




Comparison of Medical Plans: Effective January 1, 2015 – December 31, 2015Group Health Options Plan Regence Pro Regence Engage Regence HSA

(Non-Represented employees only)In-network Out-of-network

Deductible — Calendar Year

No annual deductible $400 per person

$1,200 per family

$300 per person

$900 per family

$1,200 per person

$2,400 per family

$1,500 for Employee Only coverage. $3,000 for Employee+Family coverage (Family deductible must be met before plan pays benefits.)

Copays/Coinsurance

In-Network: $20 copay usually required per professional service. After copay, most services are covered in full unless specifically stated otherwise.

Out-of-Network: After the deductible, the plan pays 80% of Usual, Customary and Reasonable (UCR) to the out-of-pocket maximum, then 100% for the remainder of the calendar year.

After the deductible, the plan pays: In-Network (Category 1 Preferred): 80% up to out-of-pocket maximum, then 100% for the remainder of the calendar year.

Out-of-Network (Category 2 & 3 Participating and Non-Participating): 50% up to out-of-pocket maximum, then 100% for the remainder of the calendar year.

Category 1, 2 & 3 providers: After the deductible, the plan pays 80% up to out-of-pocket maximum, then 100% for the remainder of the calendar year.

After the deductible, the plan pays: In-Network (Category 1 Preferred): 80% up to out-of-pocket maximum, then 100% for the remainder of the calendar year.

Out-of-Network (Category 2 & 3 Participating and Non-Participating): 50% up to out-of-pocket maximum, then 100% for the remainder of the calendar year.

Out-of-pocket maximum including deductible amounts — calendar year

In-Network:

$2,000 per person $4,000 per family Combined for In & Out-of-Network

Out-of-Network:

2,400 per person $5,200 per family Combined for In & Out-of-Network

$1,300 per person $2,600 per family

$2,200 per person $4,400 per family

$4,500 for Employee Only coverage $9,000 for Employee+Family coverage

Accessing care & services

Choose a personal physician from any of Group Health’s 25 medical centers or a Group Health-contracted physician.

Select from physicians at Group Health medical centers statewide or contracted physicians statewide; and access specialists at Group Health medical centers by self-referring.

You can change doctors any time.

Care and services may be received from any licensed provider.

You have access to First Choice Health network and First Health network providers for less out-of-pocket costs; network discounts mean your portion of the bill is at a reduced cost.

If you use a provider who is not a First Choice or First Health provider, you may be responsible for any billed charges above the allowed amounts.

You can switch between in-network and out-of-network providers any time.

Care and services received from a Preferred provider or facility will generally be provided at a higher benefit level and reduce your out-of-pocket costs.

Category 1 & 2 (Preferred & Participating) providers: You will not be billed for balances beyond any deductible and/or coinsurance (balance billing).

Category 3 (Non-Participating) providers do not have a contract with Regence and can balance bill above the Regence allowed amount.

Care and services may be received from any licensed provider. If you use a Preferred or Participating provider you may have less out-of-pocket expense.



Care and services received from a Preferred provider or facility will generally be provided at a higher benefit level and reduce your out-of-pocket costs.



Service area Service area includes portions of Western, Central and Eastern Washington and Northern Idaho.

Service area is worldwide. First Choice Health network is available in WA, AK, ID, MT and OR. First Health network is available in all other states.

Service area is worldwide. Services received outside of Regence BlueShield service area are available through the BlueCard program.



This summary of your medical benefits is for your information only. It is not intended as a complete description of the benefits. Although we’ve made every effort to ensure this comparison is accurate, provisions of the official plan documents and contracts will govern in case of conflict. In addition, this comparison does not constitute an employment contract or a guarantee to continue employment for any period of time. This program is subject to review and (subject to the provisions of any applicable collective bargaining agreement) may be modified or terminated in whole or in part at any time for any reason.


Comparison of Medical Plans: Effective January 1, 2015 – December 31, 2015Group Health Options Plan Regence Pro Regence Engage Regence HSA (Non-Represented

employees only)In-network Out-of-network

Prescription Drugs Certain medications require pre-authorization.

Group Health: Go to ghc.org. Click on Members, then Pharmacy Services, and search their Drug Formulary to check if a medication requires pre-authorization. Or call GHC Pharmacy Help desk at 1-800-245-7979.

Regence: Go to regencerx.com Select Learn About Medications, then on Alternatives or Prior Auth/ Medication Quantities for list of specific drugs with preauthorization requirements under Regence BlueShield (WA).

Pharmacy: 30-day supply $4 copay – Value Based medication $8 copay – Formulary Generic $25 copay – Formulary Brand $50 copay – Non-Formulary Generic and Brand.

Pharmacy: 30-day supply $13 copay – Formulary Generic $30 copay – Formulary Brand $55 copay – Non-Formulary Generic and Brand.

Participating Pharmacy: 30-day supply $0 copay – Value Based medication $5 copay – Formulary Generic $25 copay – Formulary Brand $50 copay – Non-Formulary Brand

Participating Pharmacy: 30-day supply $0 copay – Value Based medication $5 copay – Formulary Generic $25 copay – Formulary Brand $50 copay – Non-Formulary Brand

Participating Pharmacy: 30-day supply $0 copay – Value Based medication Ded+20% – Formulary Generic Ded+20% – Formulary Brand Ded+20% – Non-Formulary Brand

Non-participating Pharmacies: Covered at Out-of-Network benefit level or not covered.

Non-participating Pharmacies: Covered at same copays, but may be required to pay in full and submit for reimbursement. May also be responsible for excess charges by non-participating pharmacies above covered expenses.

Non-participating Pharmacies: Covered at same copays, but may be required to pay in full and submit for reimbursement. May also be responsible for excess charges by non-participating pharmacies above covered expenses.

Non-participating Pharmacies: Covered at same cost shares, but may be required to pay in full and submit for reimbursement. May also be responsible for excess charges by non-participating pharmacies above covered expenses.

Mail Order: 30-day supply $0 copay – Value Based medication All others – $5 discount per 30 days

Mail Order: Not covered If filled at GHO pharmacies or In- Network, covered through the Group Health mail order program

Mail Order: 90-day supply $0 copay – Value Based medication $10 copay – Formulary Generic $50 copay – Formulary Brand $100 copay – Non-Formulary Brand

Mail Order: 90-day supply $0 copay – Value Based medication $10 copay – Formulary Generic $50 copay – Formulary Brand $100 copay – Non-Formulary Brand

Mail Order: 90-day supply $0 copay – Value Based medication Ded+20% – Formulary Generic Ded+20% – Formulary Brand Ded+20% – Non-Formulary Brand

Preventive Care / Routine Services, i.e. well baby care, routine physical exams & screenings

100%

Covered in accordance with the well care schedule established by Group Health and the Patient Protection and Affordable Care Act of 2010. The well care schedule is available in Group Health medical centers, at ghc.org, or upon request from Customer Service.

Commercial Drivers License (CDL) exam for the Subscriber is covered once every 24 months, in-network only.

100%, Deductible waived

Covered in accordance with the well care schedule established by Group Health and the Patient Protection and Affordable Care Act of 2010. The well care schedule is available in Group Health medical centers, at ghc.org, or upon request from Customer Service.

In-Network: 100%, Deductible waived

Out-of-Network: 100%, Deductible waived Covered services are in accordance with age limits and frequency guidelines according to, and as recommended by, the United States Preventive Service Task Force (USPSTF), the Health Resources and Services Administration (HRSA), or the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). For a list of services, visit regence.com or contact Customer Service.

If a condition of employment, Department of Transportation annual physicals are covered.

100%, Deductible waived

Covered services are in accordance with age limits and frequency guidelines according to, and as recommended by, the United States Preventive Service Task Force (USPSTF), the Health Resources and Services Administration (HRSA), or the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). For a list of services, visit regence.com or contact Customer Service.


In-Network: 100%, Deductible waived Out-of-Network: 100%, Deductible waived

Covered services are in accordance with age limits and frequency guidelines according to, and as recommended by, the United States Preventive Service Task Force (USPSTF), the Health Resources and Services Administration (HRSA), or the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC). For a list of

services, visit regence.com or contact Customer Service.


This summary of your medical benefits is for your information only. It is not intended as a complete description of the benefits. Although we’ve made every effort to ensure this comparison is accurate, provisions of the official plan documents and contracts will govern in case of conflict. In addition, this comparison does not constitute an employment contract or a guarantee to continue employment for any period of time. This program is subject to review and (subject to the provisions of any applicable collective bargaining agreement) may be modified or terminated in whole or in part at any time for any reason.


http://ghc.org

http://www.regencerx.com

http://ghc.org

http://ghc.org

http://regence.com

http://regence.com

http://regence.com


Group Health Options Plan

The Group Health Options Plan gives you access to the Group Health Cooperative provider network, as well as community physicians who contract with Group Health. Most in-network services are covered at only a $20 copay. Additionally, you can choose out-of-network care through the First Choice Health network or First Health network at a discount, or see any licensed provider anywhere. If you’re considering the Group Health Options Plan, find helpful information on how it works at ghc.org/pse.

With in-network care

You can choose from hundreds of personal physicians from any of Group Health’s 25 statewide medical centers or a Group Health–contracted physician. You can also refer yourself to hundreds of specialists at Group Health Medical Centers — and change doctors at any time.

You’ll also benefit from:

• Lower costs than going out-of-network.

• Online explanation of benefits, certificate of coverage and a library of 5,000 health topics.

These convenient services are available to all plan participants who use a Group Health Medical Center:

• Use of the Group Health mobile app services.

• Secure email access to your doctor.

• Access to your online medical record and test results (and your child’s through age 12) and after-visit summaries.

• Enhanced 24-hour Consulting Nurse helpline with access to your personal medical records.

• Online appointment scheduling.

• Lab, pharmacy and X-ray services located on-site at most Group Health Medical Centers.

Preventive care is covered in full with no copay for in- or out-of-network care.

With out-of-network care

You can choose from the First Choice Health network (fchn.com) in Washington, Oregon, Idaho, Montana, and Alaska; First Health (firsthealth.com) and its affiliates in any other state; or any licensed provider. You receive care at a reduced cost at your out-of-network benefit level for your portion of the medical bill if you use a provider who is part of the First Choice Health network or First Health network. Otherwise, you can receive care from any licensed provider at your out-of-network benefit level.

You’ll also be able to:

• Visit a Group Health Medical Center, when needed, or refer yourself to hundreds of specialists at Group Health Medical Centers.

• Switch between in-network and out-of-network providers at any time.

• Access some online services such as explanation of benefits and certificate of coverage.

• Use the 24-hour Consulting Nurse helpline and online library of 5,000 health topics.

For more information, go to ghc.org and select MyGroupHealth for Members. You can link to online provider directories and find information for pharmacy services and other available health care services.

Remember: Using out-of-network providers results in greater costs to you. If you have services that would not be covered in-network, they will not be covered out-of-network.


http://ghc.org/pse

www.fchn.com

http://fchn.com

http://www.firsthealth.com

http://firsthealth.com

http://ghc.org


Prescriptions and your Group Health Options Plan

You can have your prescriptions filled at any pharmacy listed in your provider directory or at ghc.org. Prescriptions written by an out-of-network provider can be filled at any MedCare National Network Pharmacy, managed through MedImpact, at the out-of-network benefit level. They can also be filled at any Group Health pharmacy or through the Group Health mail-order service at the in-network benefit level if the prescription is on the Group Health formulary. Applicable cost shares will apply.

Value Based Pharmacy Program — helping you manage maintenance medications

Group Health has a Value Based Pharmacy Program to help plan participants significantly reduce the cost of copays for maintenance medications. The program is designed to help employees manage chronic health conditions, encourage self-care, and promote the use of preventive screening services.

30-day supply copay — in-network

$50 Nonformulary generic and

brand-name drugs copay

$25 Brand-name drugs copay

$8 Generic drugs copay

$4 Value-based drugs, in-network copay

The Group Health Mail Order Program is a great way to save money on your maintenance medications. Value-based medications have no charge for a 30-day supply. (For other in-network prescriptions, you receive a $5 discount per 30-day supply.)

For a complete list of value-based medications, go to Benefits from the HR home page on PSEWeb and select Group Health Value Based Medication List.

Four easy ways to order refills for home delivery:

1. Online — Register with MyGroupHealth. When this one-time process is completed, log in to the online pharmacy anytime with your member ID number and password.

2. Phone — Call the pharmacy line to refill a prescription and request home delivery. The telephone number is 1-800-245-7979.

3. Fax — Complete and fax a mail-order request form — available at Group Health Medical Centers and under Pharmacy Services on ghc.org.

4. Mail — Complete and mail a mail-order request form — available at Group Health Medical Centers and under Pharmacy Services on ghc.org.

For more information, go online to ghc.org or call Customer Service at 1-888-901-4636.

If you have questions about specific medications, call the Group Health Pharmacy Help Desk at 1-800-245-7979.


http://ghc.org

https://member.ghc.org/open/index.jhtml

http://ghc.org

http://ghc.org

http://ghc.org


Regence PPO, Engage and HSA plans

What’s the most cost-effective plan for you?

Regence provides two plan options for all PSE employees — Preferred Provider (PPO) and Engage. Non-represented employees may also choose the Health Savings Account (HSA) plan. Understanding the key differences between the plans could help you and your family make the most cost-effective choice.

Provider coverage: The PPO and HSA plans cover preferred providers at 80 percent, while other participating or noncontracted providers are covered at 50 percent. The Engage plan covers any licensed provider at 80 percent.

Annual deductible: The PPO plan has a $300 individual deductible as compared to $1,200 for the Engage plan and $1,500 for the HSA plan. If you include family members on the HSA plan, the family deductible of $3,000 must be met before the plan begins to pay benefits.

Annual out-of-pocket maximum: The PPO plan has an individual total out-of-pocket maximum of $1,300 per calendar year as compared to $2,200 for the Engage plan and $4,500 for the HSA plan. (Your deductible and copays count toward your out-of-pocket maximum for all plans.)

Plan cost: The PPO plan is significantly more expensive — more than 40 percent higher than the Engage plan coverage. Review your plan cost carefully, using the online enrollment system tools.

At this time, non-represented employees are eligible for the HSA plan. For more information about the HSA plan, visit pse.com/hsaplan.

Open Enrollment is a good time to sit down and review your annual health care costs and better understand which benefit plan provides the best coverage for your projected health care expenses.

Redesigned regence.com enhances online experience

Inspired by member feedback, Regence has redesigned its website for an enriched online experience. At regence.com, plan participants can now access their personal data all in one place and experience a host of new features:

• A member dashboard that provides an overview of key information including a summary of benefit maximums, how much has been used and what’s remaining.

• Claims, coverage and electronic Explanation of Benefits (EOB) that are simplified and streamlined.

• A treatment cost estimator to help members compare cost of services by different providers.

Take a test drive at regence.com today and explore the tools, tips and data you value most when making decisions about your health and your family’s.


http://pse.com/hsaplan

http://regence.com

http://regence.com


Value-based drug coverage

No copay is required for certain maintenance medications that help with asthma, diabetes, high-blood pressure, high cholesterol, nicotine dependence and other chronic conditions. You may be able to prevent specific illnesses, symptoms and improve your overall health with maintenance medications.

To find out if the formulary or generic medication you require has no copay, go to Benefits/Medical Benefits/Regence prescriptions from the HR home page on PSEWeb and select the Regence Rx Value Based Medication list.

Regence prescriptions

The Regence benefit plans’ prescription medications are defined by four tiers.

The four-tier approach encourages you and your doctor to try lower-cost medications before moving to higher-priced alternatives.

Rx: Regence PPO and Engage plans

$50 Nonformulary brand-name copay

$25 Formulary brand-name copay

$5 Generic drug copay

$0 Value-based drug, copay

Regence members have coverage for all four categories. What you pay (your copay) depends on which medication (or tier) you and your doctor choose.

You can help lower costs for yourself and for the PSE medical plan by making good choices about your prescription drugs.

• Use generics when available.

• Shop around for pharmacies charging less for the same drug.

The cost of prescription medications is not the copay or even the $50 that you pay at the pharmacy. The actual cost should be printed on your receipt — if not, ask your pharmacist.

Prior authorization required for some medicationsMedications requiring prior authorization generally are in one of these categories:

• Used for conditions excluded from the plan, such as obesity or cosmetic improvements.

• Have safety issues or a high potential for inappropriate use.

• Have a clinical alternative that is a much lower-priced medication.

For maintenance medications, order online and save

If you plan to use mail order and do not have a sufficient supply on hand to last you until your mail order arrives (allow two to three weeks), ask your doctor for two prescriptions — one for the local pharmacy and the other for mail order.

For more information, go online to regence.com or call customer service at 1-866-240-9580.


http://pseweb/EmployeeTools/HR/Benefits/Medical/Pages/RegenceRX.aspx

http://regence.com


Dental benefits overview

Choose from the following three options:

1. Basic Option

• Covers one exam and one cleaning per plan year.

• Provides comprehensive coverage (fillings and crowns).

• Does not cover additional diagnostic or preventive care (X-rays, fluoride or sealants).

2. High Option

• Provides comprehensive coverage (fillings and crowns).

• Provides for preventive and diagnostic care (cleanings and X-rays) twice per plan year.

3. Opt Out Dental

• Opt Out certification is required when enrolling online. See page 7 for details.

Did you know?

Some services covered at 90 percent in the PSE High Option plan are covered at 80 percent or less under most other employer’s dental plans. The maximum annual coverage is also generous. PSE does not restrict your choice of providers to a preferred network — you have a very wide range of providers from which to choose. However, if you visit a Delta Dental Premier® dentist, your out-of-pocket expense will be lower.

Dental benefitsDental benefits overview | Dental plan comparison

Quick Tip: Pay for noncovered services with tax-free dollars in your health care FSA or HSA.

http://www.deltadentalwa.com



Delta Dental of Washington

You may choose any licensed dentist. Selecting a Delta Dental Premier® member dentist means no claim forms to complete and may result in lower out-of-pocket costs.

The Delta Dental Premier® network (deltadentalwa.com) is the largest Delta Dental network of dental care providers.

Nonmember dentists may charge you a fee higher than the reimbursement from Delta Dental and may require you to file your own claims. The choice to use a member or nonmember provider is always up to you!

Delta Dental does not provide ID cards.

*Note: Benefit level decreases 10% each incentive period that no dental benefits are utilized; coverage will not fall below 70% level.

This summary of your dental benefits is for your information only. It is not intended as a complete description of the benefits. Although we have made every effort to ensure this summary is accurate, provisions of the official plan documents and contracts will govern in case of conflict. In addition, this summary does not constitute an employment contract or a guarantee to continue employment for any period of time. This program is subject to review and (subject to provisions of any applicable collective bargaining agreement) may be modified or terminated in whole or in part at any time for any reason.

Dental benefitsDental benefits overview | Dental plan comparison

Comparison of Dental Plans: Effective January 1, 2015 – December 31, 2015Non-Represented

and UA-Represented PlansIBEW-Represented Plans

Benefits High option Basic option High option Basic optionAnnual Deductible None None None NoneAnnual Maximum $2,500 per person $3,000 per person $2,500 per person $1,500 per personClass of Service Reimbursement

LevelsReimbursement Levels

Reimbursement Levels

Reimbursement Levels

Class I – Diagnostic and Preventive

Routine exams, cleaning up to 4 times per plan year under certain conditions of oral health, X-rays, sealants — no age limit — once every 2 years, prescription-strength antimicrobial mouth rinse or toothpaste following periodontal procedures, also mouth rinse for pregnant women. Note: Some services only covered on High Option.

100% 100%

One routine exam and cleaning per calendar year. This includes periodontal maintenance once per calendar year after active periodontal treatment (does not cover x-ray, flouride, sealants)

70%

Increases 10% each successive incentive period benefits are used to a maximum of 100%*

100%

One routine exam and cleaning per calendar year. This includes periodontal maintenance once per calendar year after active periodontal treatment

Class II – Restorative

Fillings, root canals, crowns, anesthesia, oral surgery, limited occlusal adjustments, periodontal treatments — soft tissue grafts, root planing, etc., antimicrobial agents under certain conditions of oral health and with specific limits

90% 50% 70%

Increases 10% each successive incentive period benefits are used to a maximum of 100%*

50%

Class III – Prosthodontics

Night guards once every 3 years (not covered for bruxism-teeth grinding), complete occlusal adjustment once in a lifetime, implants every 5 years, partials, dentures, bridges every 5 years

50% 50% 50% 50%







Basic Life insurance

PSE covers 100 percent of the cost of Basic Life insurance for all employees. The life insurance plan pays a benefit to your beneficiary for the coverage amount if you die while you are insured. MetLife is the insurance carrier for life and AD&D plans as of January 1, 2015.

Accidental Death & Dismemberment (AD&D) insurance (optional)

This insurance provides coverage for loss of life, loss of limb or loss of use following an accident.

• The benefit is paid to the accident survivor if the loss meets the carrier payment criteria.

• You may elect coverage of $50,000 up to $250,000, available as Employee Only or Employee + Family coverage.

• Elections cannot exceed 10 times your annual base pay.

• Eligible dependents include your spouse/domestic partner and unmarried dependent children under 26.

Supplemental Life insurance (optional)

This coverage is in addition to your Basic Life coverage amount. You may choose additional coverage amounts of one, two, three or four times your annual base pay, up to the plan limits.

One-time opportunity to add coverage during this Open Enrollment

If you are not currently enrolled for Supplemental Life insurance and you choose coverage during Open Enrollment, you are usually required to complete a medical review and Evidence of Insurability (EOI) form. However, with this year’s change to MetLife, you have a one-time opportunity to add this coverage without a medical review during this year’s Open Enrollment period, if you are not currently enrolled.

If you have existing coverage, you can take advantage of the lower rates through MetLife, the new plan administrator, and increase coverage by one times your annual base pay without a medical review.

Select the level of coverage appropriate for your needs. If any portion of the requested amount is subject to approval first, you will receive an EOI form directly from MetLife.

Keeping your supplemental life

If you leave PSE, you have the option of continuing your Supplemental Life insurance by completing a portability form and submitting payment according to the carrier requirements within 31 days from the day your coverage terminates.

Enrolling as a new hire

If you enroll in Supplemental Life insurance within the first 31 days of eligibility, you do not need to provide an EOI. You may enroll for up to four times your annual base salary.

Important: The IRS tax code requires PSE to charge you imputed income for life insurance in excess of $50,000.

Life, AD&D and LTD InsuranceLife, AD&D insurance | Long-term disability

Supplemental Life insurance rates (per $1,000 of coverage)

Example: For a 50-year old employee earning $50,000 per year: $.25 x $50,000/1,000 = $12.50 per month. $12.50 x 12 = $150 (your annual cost)

Age band Rate< 30 0.06

30 – 34 0.0835 – 39 0.10

40 – 44 0.1045 – 49 0.1650 – 54 0.2555 – 59 0.4460 – 64 0.6665 – 69 1.27

> 70 2.06


Life, AD&D and LTD InsuranceLife, AD&D insurance | Long-term disability

Long Term Disability

PSE covers 100 percent of the cost of your Long Term Disability premium. MetLife is the insurance carrier for the Long Term Disability plan as of January 1, 2015.

Should you become disabled, you have the option of receiving the LTD monthly payment as taxable or nontaxable income. When you enroll online, this payroll designation will be available to you. You may only change this option, which becomes effective January 1, at annual Open Enrollment.

Your premium election for LTD may be made with pre-tax or post-tax dollars: You decide.

• Pre-tax premium election: You are not taxed on the value of the LTD premium paid by PSE. If you have an approved disability in the future, your monthly benefit payments are reduced by applicable federal income taxes.

• Post-tax premium election: You are taxed now on the value of the LTD premium paid by PSE. If you have an approved disability in the future, your monthly benefit payments are not reduced because you already paid federal income taxes. (You will see Imputed HC Cost on your paychecks.)

Your coverage

The plan pays up to 65 percent of your base monthly pay if you become disabled from a covered injury, illness or pregnancy.

Survivor benefit

If an employee dies while receiving Long Term Disability benefit payments from PSE, the surviving domestic partner may receive a one-time lump-sum payment just like a legal spouse would according to the contract. The employee must have a valid domestic partner declaration on file with PSE at the time of death and be receiving a monthly LTD benefit.

This benefit is separate from medical or dental coverage for a domestic partner. An employee who does not want domestic partner medical or dental coverage may want to complete and return a PSE Declaration of Domestic Partnership form (mail to PSE-10N) solely for the LTD benefit.

Did you know?

Most LTD plans provide 60 percent maximum coverage. PSE’s plan provides up to 65 percent coverage.

Note: When you enroll online, the premium election option will be available to you. You can change this option only at annual Open Enrollment, effective January 1. You cannot change your premium election option for this benefit if you are making other changes because of a qualifying mid-year status change.

For more information about Accidental Death & Dismemberment, Basic Life, Supplemental Life and Long Term Disability insurance, go the Human Resources dropdown on PSEWeb. Life and AD&D plan information is in the Benefits section. LTD plan information is in the Accommodations & Leaves Section.


Health care and dependent care flexible spending accounts (FSAs)

These plans are optional.

Flexible spending accounts (FSAs) are a great way to budget dependent care and/or health care expenses through a pre-tax payroll deduction. Once the money is set aside, you can use a convenient BenefitCard debit card to cover eligible health care expenses during the calendar year. These accounts allow you to better manage your health care and dependent care expenses while reducing your tax liability.

Any funds in your FSA that are not spent by December 31 are forfeited, according to the IRS “use it or lose it” rule. There is a 90-day run-out period to submit eligible claims for services received while enrolled in the plan. Claim dates must coincide with your enrollment in the plan through December 31.

Requests for reimbursement after the March 31 run-out period deadline will not be honored.

Enrolling in flexible spending accounts

• You may enroll in a health care flexible spending account and/or a dependent care flexible spending account

• You may not enroll in a health care FSA if you are participating in a Health Savings Account (HSA) plan

• Your current elections do not roll over; you must re-enroll during each Open Enrollment period

• If you enroll, the minimum annual election amount per account is $200, and the maximum amount is $2,500 for a health care FSA and $5,000 for a dependent care FSA

Questions? Go to tri-ad.com/participants/fsa.aspx, or call the TRI-AD Participant Services at 1-888-844-1372.

TIP: If you are considering budgeting an expensive procedure such as LASIK, major dental work or orthodontics, have an evaluation and receive your cost estimates before you set the money aside. Calculate your projected expenses carefully before you enroll to make the most of your spending account.

Flexible spending accountsEnrolling in an FSA | Eligible Expenses | TRI-AD BenefitCard | Dependent Care FSA

https://tri-ad.com/Participants/fsa.aspx


Flexible spending account ground rules

The IRS allows FSAs as long as certain rules are followed. Some of the rules that apply to both health care and dependent care flexible spending accounts are listed here:

• The dependent care account is not for a spouse’s or dependent’s medical costs. This account is only for child, spouse or elder day care expenses incurred because you are working.

• You must substantiate your claims. The IRS requires certain documentation to prove that your claim is legitimate. Without it, your claim will be denied.

• You will be reimbursed only for eligible expenses incurred during plan participation. (See examples listed on this page.)

• You must use all of the money, or you will lose it.

• If you terminate employment, coverage in these plans ends on the last day of the month in which you leave the company. You may continue to submit eligible health care expenses for dates of service up to the last day of the month. Termination could affect the use of the BenefitCard, and you may be required to submit a manual claim.

Health Savings Account (HSA) plan participants may not enroll in a health care flexible spending account. The list of qualified medical expenses is the same for flexible spending accounts and health savings accounts.

Common eligible expenses for health care flexible spending accounts

• Health and dental plan copays and deductibles

• Dental care• Orthodontics (including

prepaid arrangements) — certain requirements apply

• Medical supplies• Eye care: exams, prescription glasses

and sunglasses, contact lenses and solutions, LASIK procedures

• Prescription drugs and prescription vitamins

• Reconstructive surgery related to a medical condition

• Treatment for alcoholism and drug addiction

• Fertility treatments• Hearing aids

Items that may be eligible under specific conditions

• Counseling is eligible if it is related to a medical condition — for example, counseling associated with a cancer diagnosis or drug addiction treatment. General marital or family counseling is not eligible.

• Fitness programs or equipment if medically necessary

• Retin-A for a specific medical condition

• Weight-loss programs if prescribed by a doctor (Food is not reimbursable.)

• Over-the-counter (OTC) medications if prescribed by a doctor and purchased with an assigned Rx number.

Common ineligible health and dependent care expenses

• Premiums for other health plans, including COBRA

• Cosmetic procedures (teeth whitening or veneers, liposuction, Botox, etc.)

• Vitamins and supplements used for general wellness

• Incidental household services related to home care

• Preschool tuition if part of the total dependent care

• Many summer day camps, including activity-based camps where activity and day care fees are integrated. For example, if your child goes to football camp, the day-camp costs would be eligible but sports equipment would not. Costs that are not reimbursable include overnight camps, summer school programs whose primary purpose is education (not day care) and equipment costs.



TRI-AD BenefitCard

Easy access to your health care flexible spending account

TRI-AD — the PSE vendor for FSA administration — will send new enrollees a debit card called a BenefitCard for the health care account. It provides easy access to account balances. You may use the card, or submit claims online for reimbursement.

Features and benefits of the TRI-AD BenefitCard include:

• Instant access to your account at approved merchants. You can use the BenefitCard at any provider of health care services who accepts Visa.

• Greater convenience in paying health care bills with a card rather than a check.

• Easy online or mobile app process for submitting documentation when required.

Quick tip: Whenever possible, make your eligible purchases at the pharmacy counter. That’s because an eligible merchant may be the pharmacy counter in a drugstore and not the general checkout counter. This reduces the chances that you will be asked to provide supporting documentation that charges on the debit card meet IRS eligibility requirements.

Once you enroll in an FSA, you will receive a welcome kit from TRI-AD. Separately, you will receive the BenefitCard debit card with the TRI-AD and Visa logos.

Keep Your BenefitCard!

Your BenefitCard is effective for a four-year period. If you re-enroll in the health care FSA for 2015, continue to use your card in the new plan year. If your card expires, you will receive a new card within 30 days of the expiration date printed on the card. If you are enrolling in the health care FSA for the first time, you will receive your card before January 1, 2015.

It’s your responsibility — use your BenefitCard properly and verify claims

Follow this checklist for proper BenefitCard use and completing claims verification, when asked. It’s an IRS requirement.

Use your card only for health-related expenses incurred in the plan year.

• Pay ineligible expenses, such as toothpaste or other drugstore products, separately and not with your BenefitCard.

• Maintain good records in case you need to verify your purchase as an eligible expense.

• If asked, promptly submit proof of eligible purchases to maintain card use.

• If your card is turned off due to nonsubmission of receipts, send in unreimbursed receipts or send a check to repay the plan. IRS requires that ineligible expenses be resolved before future manual claims can be reimbursed.

• Resolve all requests for documentation regarding unsubstantiated claims by December 1. If you do not, the reimbursed amounts will be counted as taxable income on your W-2 form.

If you have questions, go to TRI-AD’s website at tri-ad.com/participants/fsa.aspx or call the TRI-AD Participant Services at 1-888-844-1372.




Which is right for you?

Dependent care FSA or federal income tax credit

The IRS allows a tax credit for dependent care. You cannot claim the same expenses for both the dependent care FSA and the federal income tax credit, so you need to decide which is better for you.

In general, higher wage earners and those with one eligible dependent benefit more from the dependent care FSA, and lower-wage earners and those with more than one child may benefit more from the tax credit.

Because your situation is unique, we suggest you consult with your tax adviser before making your choice.

You and your spouse or ex-spouse together cannot receive more than the $5,000 annual IRS limit for dependent care.

TIP: Spouses who work at different employers can each contribute up to $2,500 to the healthcare FSA.

Enrolling in the dependent care FSA

Eligibility rule: To be eligible for benefits under the dependent care FSA, an individual must be your dependent for tax purposes (as specifically defined under Code Section 21).

Other requirements: Eligible dependent care expenses are payable only for a dependent child who is under age 13; or a child age 13 or older, a spouse, parent or other individual who is physically or mentally incapable of self-care and lives with you in your home for more than half the year.

Note: Whether an individual satisfies the code requirements necessary to be your tax dependent for purposes of the FSA depends on your specific facts and circumstances. If you have any questions regarding whether an individual qualifies as your tax dependent under the code, please contact your tax adviser. Neither PSE nor its vendors can provide or is providing tax advice.

Note: Do not elect a dependent care flexible spending account for a spouse’s or dependent’s medical expenses. This account is only for employees with a spouse, parent or child in day care so that the employee is able to work.



Online benefits enrollment instructions

These easy-to-follow instructions are designed to help you navigate and make updates when using the online benefit enrollment system. Once you access the system through the benefits portal, you’ll be able to find up-to-date information about your benefits, locate personal data and make your 2015 enrollment elections.

Before you begin, here are a few important tips:

• This system provides access to your personal information. Do not share your login or password with anyone.

• Keep your personal information up-to-date: When you have changes to your personal information, please use PSE’s Employee Self-Service to make updates.

• Review Flex Credits and benefit plan options: This ensures your plan elections are still the right choice for you. Use the Recalculate button on each benefits page to experiment and see how different plan selections impact your monthly cost. Please note that wellness credits are not displayed on the online benefits enrollment system

• If you elect to Opt Out of Medical and/or Dental: Electing to opt out is a three-step process. You must complete all steps each year or you will be enrolled in Default benefits (Employee Only coverage in Regence Engage Medical and Delta Dental Basic Option):

1. Elect the Opt Out option on the medical and/or dental page.

2. Complete the Opt Out certification page by filling out the required fields.

3. Read the Confirmation Statement carefully after making your elections. You must enroll in Opt Out and provide all of the information requested.

• If you enroll in an FSA: You must enter an election amount each year to enroll in a health care or dependent care flexible spending account (or enter 0).

• Open Enrollment is your only opportunity to change the taxation of your LTD premium and benefit. Refer to page 31 for details.

• Review your Confirmation Statement: This is your final opportunity to review the accuracy of your enrollment decisions and make any necessary corrections. Corrections must be made within the grace period stated on the Confirmation Statement mailed to your home.

• Regulations governing the plan do not allow changes after Open Enrollment unless you experience a qualifying mid-year status change. Refer to page 13 of this benefits guide for details.

• New hires: If you are hired between October 1, 2014 and November 30, 2014, you must enroll for both 2014 and 2015 benefits.

Call the Benefit Service Call Center at 1-800-531-1328 if you have questions.

To access the PSE Benefits Portal:

1. Visit benedetails.com

2. Enter portal 76389.

How to enroll



1. To log in to your personal account, you must enter both your employee ID (EID) and password. First, enter your 8-digit EID. Next, enter your password, using MMYY of your birth date + ZIP code. Once your EID and password are entered, click Sign In.

2. The home page contains valuable information about your benefit plans. You will also find information about what to do if you experience a qualifying event in your life, and Quick Links to some of your benefit providers.

3. To enroll in benefits, click Select Benefits.

4. The Next box contains options to assist you in creating an enrollment. View Current Elections allows you to see all your current benefit information. You can also begin a new enrollment or resume where you left off.

5. Now you are ready to begin your enrollment. Select Start New Enrollment from the Next box, then select Continue.

6. During Open Enrollment, you will only be able to make your Open Enrollment selections. During all other times, you will receive the Life Events menu from which you can choose a specific type of change. Some life events, like birth or adoption of a child, will allow you to make changes to certain benefits, such as medical and dental coverage.

7. You will be guided through a series of screens that ask you to update or enter information that affects your benefits. As you progress from screen to screen, your information is automatically saved. Should you need to leave the system and return at a later time, the information you have already entered will be saved. Select Resume Enrollment the next time you enter the site to continue the process.

8. Please complete each screen as thoroughly and accurately as possible. Enter or update your dependent information, as needed.

A separate election screen appears for each benefit.

Once you make a benefit election, select Recalculate to see the effects of your election change.

Continued on next page...

How to enroll


New Health Plan Cost Calculator

Make side-by-side comparisons of your annual out-of-pocket cost for each plan option with our new Health Plan Cost Calculator.

Here you can view and compare what you would pay in monthly payroll deductions, deductibles, copays and all other costs associated with your family’s expected health care needs.

9. Once you finish making your benefit elections, the summary and pre-confirmation screens allow you to review your elections. Please review the information carefully. If you would like to make changes to your elections, scroll to the appropriate benefit on the pre-confirmation screen and select the Edit button. The respective benefits election screen appears and you can change your previous election. After selecting Continue, the pre-confirmation screen reappears displaying your revised election.

10. When you have reviewed your elections and are ready to confirm your choices, select Continue. Your elections will be confirmed and a confirmation number assigned. Be sure to note this number. Print and keep a copy of your enrollment summary in your records for any future inquiries regarding your enrollment. Remember, you can see your benefit summary online at any time.

11. While the Open Enrollment period is active, you can return and make additional changes to your elections. Each time you make a change, you will receive a new pre-confirmation, confirmation page and number. The system will keep track of the changes you make.

12. The Confirmation Statement mailed to your home after Open Enrollment is the final record of your benefit elections. Always review this statement for accuracy.

For more information regarding your benefits or using the PSE Benefits Portal, contact the Benefit Service Call Center at 1-800-531-1328, Monday–Friday, 6 a.m. – 5 p.m. PST.

How to enroll


COBRA

The Consolidated Omnibus Budget Reconciliation Act of 1985 (“COBRA”) gives eligible employees and their dependents the right to temporarily continue coverage under PSE’s health plans (at their expense) when coverage is lost due to specific qualifying events (such as termination of employment, reduction in hours, divorce, death, or loss of dependent child status). To be eligible for COBRA continuation coverage, you must have health care coverage on the day before a qualifying event occurs and you must be an eligible employee or the employee’s spouse or dependent child.

If you would like more information regarding COBRA, contact your Plan Administrator.

Non-Discrimination Testing for the Cafeteria Plan

Under IRS regulations, the Plan Administrator is required to perform non-discrimination tests on an annual basis to ensure that the Cafeteria Plan does not discriminate in favor of either highly compensated or key employees. If the Cafeteria Plan is found to be discriminatory, the benefits provided to such employees under the Cafeteria Plan are generally includible in gross income. Therefore, if the Cafeteria Plan fails any of the non-discrimination tests run after annual enrollment at any time during a plan year, contributions for highly compensated or key employees under the Cafeteria Plan may be limited to prevent the Cafeteria Plan from ultimately being found to be discriminatory at the end of the plan year. If this occurs, affected employees will be notified of the required election change. For more information, click on the FSA link on the benefits enrollment website, or contact the Plan Administrator.

Women’s Health and Cancer Rights Act

Health plans that provide mastectomy benefits are required to provide certain related benefits under the Women’s Health and Cancer Rights Act of 1998 (“WHCRA”). If you have had, or are going to have a mastectomy, you may be entitled to these benefits. For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:

• All stages of reconstruction of the breast on which the mastectomy was performed;

• Surgery and reconstruction of the other breast to produce a symmetrical appearance;

• Prostheses;

and• Treatment of physical

complications of the mastectomy, including lymphedema.

These benefits will be provided subject to the same annual deductible and coinsurance provisions applicable to other medical and surgical benefits provided under PSE’s health plans.

If you would like more information on WHCRA benefits, contact your Plan Administrator.

Legal noticesCOBRA | Non-Discrimination Testing for the Cafeteria Plan | Women’s Health and Cancer Rights Act |

Medicare Drug Plan Notice of Creditable Coverage | PSE Prescription Drug Benefit | HIPAA Notice of Privacy Practices


Medicare notice of creditable coverage for employees and dependents

The government offers prescription drug coverage to those eligible for Medicare. The purpose of this notice is to help you decide whether you want to enroll in a Medicare drug plan. This notice has information about your current prescription drug coverage with Puget Sound Energy and the government-sponsored Medicare prescription drug coverage. Please read this notice carefully and keep it handy.

Medicare prescription drug coverage is available to everyone with Medicare. You can get this coverage if you join a Medicare Prescription Drug Plan or join a Medicare Advantage Plan (like an HMO or PPO) that offers prescription drug coverage. All Medicare drug plans offer at least a standard level of coverage set by Medicare. Some Medicare drug plans may also offer more coverage for a higher monthly premium.

PSE coverage is creditable coverage

Puget Sound Energy conducted an actuarial review of our PSE Medical Plan coverage for comparison to the standard Medicare prescription drug coverage. We are pleased to let you know the prescription drug coverage you have now — under either the Group Health or the Regence BlueShield plan sponsored by PSE — is creditable coverage; meaning on average for all plan participants, it is expected to pay out at least as much as the standard Medicare prescription drug coverage. Because you currently have prescription drug coverage that is expected to pay out at least as much as the standard Medicare drug plan coverage, you can choose to join a Medicare drug plan later without paying a higher premium (as long as you do not have a lapse in coverage, as explained below).

When you can enroll in a Medicare drug plan

You can join a Medicare drug plan when you first become eligible for Medicare and each year thereafter from October 15 through December 7. If you lose creditable prescription drug coverage through no fault of your own, you may be eligible for a 2-month special enrollment period to join a Medicare drug plan. Contact Medicare for details.

What happens if you enroll in a Medicare drug plan

If you decide to join a Medicare drug plan, your current PSE coverage will not be affected. You may be covered by both programs: a Medicare drug plan and your PSE-sponsored prescription drug coverage. PSE coverage is coordinated with Medicare and PSE coverage is primary; the Medicare drug plan pays only for medications it covers if not paid by your PSE plan. Your cost for PSE’s medical plan will not decrease if you enroll in a Medicare drug plan. Contact Medicare for details.

Do you need both? Be sure to compare your current coverage, including costs and which drugs are covered, with the Medicare prescription drug plans in your area. While you can be covered under PSE’s prescription drug program as well as a Medicare drug plan, remember there’s a cost for both and you don’t want to pay for something unnecessarily. Explore all of your options. There is a summary of your prescription benefit, along with contact information, at the end of this notice.

You may drop your PSE medical and prescription drug coverage if you are covered under another group policy. You will be able to re-enroll in PSE coverage during the next annual open enrollment or during a mid-year change consistent with the qualifying events that are allowed by IRS guidelines, PSE plan documents and vendor contracts. PSE cannot guarantee that the other company-sponsored prescription drug coverage will be creditable.

When you would pay a higher premium for a Medicare drug plan

If you go 63 days or longer without creditable prescription drug coverage immediately before you enroll in a Medicare drug plan, your monthly Medicare drug plan premium will go up at least 1 percent of the Medicare base beneficiary premium per month for every month you did not have that coverage. For example, if you go 19 months without coverage, your premium may consistently be at least 19 percent higher than the Medicare base beneficiary premium. You may have to pay this higher premium as long as you have Medicare coverage. In addition, you may have to wait until the next October to enroll.




Requesting an individual notice

Although you should keep this notice, you may request another at any time. Also, you will receive this non-personalized notice each year before open enrollment or if the PSE-sponsored prescription drug coverage changes.

Remember: If you decide to enroll in a Medicare drug plan, you may be required to prove whether you had creditable coverage when you join Medicare to determine whether you are required to pay a higher premium. Once you leave your PSE-sponsored plan, you may contact your medical carrier to request a personalized notice showing the dates you had creditable coverage.

More information about your current PSE prescription drug benefit

Each carrier has its own formulary, which is a list of preferred medications. The formulary generally changes each year. You can obtain the formulary, a directory of retail pharmacies, and mail order details by contacting the carrier at the phone number or website shown on the chart.

More information about your options under medicare prescription drug coverage

More information about Medicare prescription drug plans is available in the Medicare & You handbook. If you are eligible for Medicare, you will receive a copy of the handbook in the mail every year from Medicare. You may also be contacted directly by Medicare prescription drug plans. You can get more details by:

• Visiting medicare.gov.

• Calling your State Health Insurance Assistance Program (see the inside back cover of your copy of Medicare & You handbook for the phone number).

• Calling Medicare at 1-800-633-4227 (TTY: 877-486-2048).

For people with limited income, help is available to pay for a Medicare prescription drug plan. Find out more from the Social Security Administration online at socialsecurity.gov or by calling 1-800-772-1213 (TTY: 800-325-0778).



PSE Prescription Drug Copays

Carrier Pharmacy Type # Days SupplyTier 1 Preventive

Tier 2 Generic Forumla

Tier 3 Brand Formulary

Tier 4 Nonformulary

Group #

Group Health 888-901-4636 ghc.org

Retail

In-Network30 days $4 $8 $25 $50

UA/Non-Rep: 061000

IBEW: 6170700Mail Order

(in-network only, $5 discount per 30-day supply)

90 days $0 $9 $60 $135

Regence BlueShield 866-240-9580 regence.com

Retail 30 days $0 $5 $25 $50

All groups: 10000780Mail order 90 days $0 $10 $50 $100

Has Retail & Mail 30 or 90 days $0Deductible +20%

Deductible +20%

Deductible +20%

http://medicare.gov

http://socialsecurity.gov

http://ghc.org

http://regence.com


HIPAA Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

If you have any questions about this notice, please contact the Privacy Officer, Health & Welfare Benefits at Puget Sound Energy, Inc., P.O. Box 97034, PSE-10N, Bellevue, WA 98009-9734.

This notice describes the medical information practices of the Puget Sound Energy, Inc. Health & Welfare Benefits Program (the “Program”) and of certain third parties that assist with the administration of the Program.

This notice will tell you about the ways in which the Program may use and disclose medical information about you. It also describes the Program’s obligations and your rights regarding the use and disclosure of medical information. The Program understands that medical information about you and your health is personal. The Program is committed to protecting medical information about you. The Program creates a record of the health care claims reimbursed under the Program for Program administration purposes. This notice applies to all of the health care records the Program maintains. Your personal doctors or other health care providers may have different policies or notices regarding the use and disclosure of your health care information.

The Program is required by law to:

• Make sure that medical information that identifies you is kept private

• Provide you with certain rights with respect to medical information about you

• Give you a copy of this notice and follow the duties and privacy practices described in this notice

• Not use or share your information other than as described here unless you tell us we can in writing

• Promptly notify you if a breach occurs that may have compromised the privacy and security of your information

Effective date: This notice is effective October 2014.



How the Program may use and disclose your medical information — treatment, payment and health care operations

The Program uses and discloses your protected health information for treatment, payment and health care operations. Some examples of when the Program may use or disclose your health care information for these purposes include:

• Sharing test results with other health care providers for confirmation of a diagnosis

• Providing your diagnosis or other information about your health to your insurance provider or the Program’s billing service to obtain payment for the health care services the Program provides

• Reviewing information as part of the Program’s quality improvement program

• The Program is not allowed to use genetic information to decide whether to give you coverage and the price of that coverage. (This does not apply to long term care plans.)

Other uses and disclosures

The Program may also use or disclose your protected health information, in compliance with guidelines outlined by law, for the following purposes:

• Providing you with information related to your health

• Contacting you regarding appointments, information about treatment alternatives or other health-related services

• Incidental uses or disclosures (e.g., listing your name on a sign-in sheet, etc.)

• Compliance with all laws (including reports of suspected abuse, neglect or violence)

• Providing certain specific information to law enforcement or correctional institutions

• Providing information to a coroner, medical examiner, funeral director, or organ procurement organization

• Public health activities when requested by a public health authority or the FDA

• Responding to health oversight agencies• Responding to court or administrative

tribunal orders, subpoenas, discovery requests or other lawful process

• Research activities• When necessary to avert a serious

threat to health or safety• Military affairs, veterans’ affairs, national

security, intelligence, Department of State, or presidential protective service activities

• Providing information regarding your location, general condition or death to public or private disaster relief agencies

• Informing a family member, another relative or a close personal friend when information is: - Relevant to the individual’s

involvement with your care - Necessary to notify the individual of

your location, general condition or death


The Program may disclose your protected health information to certain employees of the plan sponsor for the purpose of administering the Program. However, those employees will only use or disclose that information as necessary to perform plan administration functions or as otherwise required by HIPAA, unless you have authorized further disclosures. Your protected health information cannot be used for employment purposes without your specific authorization.

The Program may also contract with business associates to perform various functions on behalf of the Program or to provide certain types of services. In order to perform these functions or services, business associates may receive, create, maintain, transmit, use and/or disclose protected health information, but only after they agree in writing with the Program to implement appropriate safeguards regarding your protected health information.

Your rights regarding medical information about you

Subject to limitations outlined by law, you have certain rights related to the use and disclosure of your protected health information, including the right to:

• Request restrictions on certain uses and disclosures, although the Program may not be obligated to agree to requested restrictions;

• Request confidential communications of protected health information;

• Inspect and copy your protected health information with some limited exceptions;

• Correct your health information;

• Request an accounting of disclosures of your health information;

• Choose someone to act for you; and

• Obtain a paper copy of this notice.



Changes to this notice

The Program reserves the right to change this notice. The Program reserves the right to make the changed notice effective for medical information the Program already has about you, as well as any information it receives in the future. The Program will post a copy of the current notice on the Program’s website: PSEWeb/HumanResources/ Benefits-Benefits forms & documents, select HIPAA Notice of Privacy.

Complaints

If you believe your privacy rights have been violated, you may contact the Privacy Officer at the address listed on the previous page. You may also file a complaint with the Office for Civil Rights of the United States Department of Health and Human Services by sending a letter to: 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints/. All complaints must be submitted in writing. You will not be penalized, or in any way retaliated against, for filing a complaint with us or with the Office for Civil Rights.

Other uses of medical information

Other uses and disclosures of medical information not covered by this notice or the laws that apply to the Program will be made only with your written permission. For example, in general and subject to specific conditions, we will not use or disclose your psychiatric notes; we will not use or disclose your protected health information for marketing; and we will not sell your protected health information, unless you give us written authorization. If you provide the Program permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke that permission, the Program will no longer use or disclose medical information about you for the reasons covered by your written authorization. You must understand that the Program is required to retain its records of the care that was provided to you.

http://pseweb/EmployeeTools/HR/Benefits/General/Pages/forms.aspx

http://pseweb/EmployeeTools/HR/Benefits/General/Pages/forms.aspx

http://pseweb/EmployeeTools/HR/Documents/HIPAA_PrivacyNotice.pdf

http://www.hhs.gov/ocr/privacy/hipaa/complaints/


COBRA: see “Legal Notices” for an explanation of COBRA.

Coinsurance: a percentage of the total costs you pay after the medical plan has paid for covered services — for example, you pay 20 percent and the plan pays 80 percent.

Coordination of benefits: situations in which carriers determine which medical and/or dental plan pays claims first when employees and/or their covered dependents are enrolled in more than one plan.

Copay: a fixed dollar amount you pay for your portion of the costs associated with certain covered services, and the medical plan pays the balance: for example, prescription copay.

Deductible: the amount you pay toward medical services before the plan pays anything toward covered services.

Evidence of Insurability (EOI): a requirement by the carrier for an applicant to be approved for coverage by completing a health history form.

Explanation of Benefits (EOB): a statement provided by the medical and/or dental carrier that states services provided, provider information, date of service, charges, coinsurance, deductibles, noncovered services and the employee’s portion, if any, of charges after carrier pays the provider for services.

Flex Credits: PSE provides Flex Credits to employees to offset the monthly cost of health care — spending more than the Flex Credits results in a pre-tax payroll deduction, and spending less than the Flex Credits results in additional taxable income to the employee.

Flexible spending accounts (FSAs): accounts that allow you to set up pre-tax payroll deductions to reimburse yourself for eligible expenses (as defined by the IRS) that are not covered under the medical and/or

dental plans expenses are to pay for eligible dependent care expenses. These accounts are called Health Care and/or Dependent Care Flexible Spending Accounts (dependent care refers to child care or elder day care only).

Formulary: a board of physicians and pharmacists determines the formulary, which is a list of generic and brand-name drugs that are preferred by your health plan because they reduce plan costs while providing safe and proven alternatives.

Health care reform: refers to the federal Patient Protection and Affordable Care Act (PPACA), which became law in March 2010 and is being rolled out over a multiyear period.

Health Savings Account (HSA): an IRS-governed account for individuals with a high deductible health plan (HDHP), which is used to pay for qualified medical expenses. Contributions are tax-free and can be invested over time to pay for future medical expenses.

High Deductible Health Plan (HDHP): a health care plan with lower monthly cost and a higher deductible that is combined with a Health Savings Account to help participants set aside tax-free dollars for current and future medical expenses.

Imputed income: additional income added to your gross taxable wages for receiving benefits from your employer that are subject to taxation according to IRS rules: examples include life insurance of more than $50,000, enrolling domestic partners or their children in medical and/or dental plans, or electing a post-tax LTD premium payment.

Mid-year election change: certain election changes may be allowed to your plan coverage outside of annual benefits Open Enrollment if you have a qualifying change in status as defined by the IRS and complete your request for change within defined grace periods.

Opt Out: PSE allows employees to opt out of enrollment in the medical and/or dental plan if (according to IRS criteria) they provide proof of other employer group coverage for each calendar year and complete required enrollment actions; this election does not roll over and must be made during each Open Enrollment period.

Participating providers: medical and dental carriers contract with providers at discounted rates; these providers accept the medical plan carrier’s payment combined with any deductible, coinsurance and/or copay from the employee as payment in full for services provided; they will process claims directly with the carrier for the employee.

Preferred providers: a network of providers in the Regence Preferred Provider Organization (PPO) that accepts discounted rates; for a member of a preferred network, the discounts are typically greater than from a participating provider, meaning more savings for the employee who uses a preferred provider within a PPO network.

Primary Care Provider (PCP): Group Health Options requires the selection and use of a PCP who manages your care; in some cases, you may be required to obtain a referral from the PCP before accessing specialty or routine services.

Summary of Benefits and Coverage (SBC): standard health plan summaries required by federal Affordable Care Act.

UCR: the usual, customary and reasonable cost of service within a defined geographic area, as defined by each carrier.

Well-being assessment: a confidential tool available through myWellness at PSE via Limeade to help employees understand their health status and risks.

Glossary


Note: This 2015 Benefits Guide is for your information only and is not intended as a complete description of benefits. For detailed benefit coverage information, refer to the summary plan description booklets provided by the carrier for each plan: Group Health Options, Regence, MetLife, TRI-AD and Delta Dental of Washington.

Although we make every effort to ensure accuracy, provisions of the official plan documents and contracts will govern in case of conflict. Benefit programs are subject to review and the provisions of any applicable collective bargaining agreement. They may be modified or terminated in whole or in part at any time for any reason.

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If you have questions about: Contact this provider at: Get information online at:

Regence plans• Your benefits coverage• Finding an in-network health care

provider, clinic or hospital • Pharmacy benefits

Regenceregence.com1-866-240-9580Group number: 10000780Nurse Advice Line: 1-800-267-6729 (available 24 hours)

RegenceRegister at regence.com to:

• View claim information.• Use cost comparison tools.

(Each family member age 13 years or older may have his/her own account.)

Health Savings Account Health Equity 1-866-960-8055

healthequity.com

Group Health Options plan• Your benefits coverage• Finding a Group Health provider• Finding a First Choice Health or First

Health provider• Pharmacy benefits• Out-of-area benefits• Using Group Health online services

Group Health Optionsghc.org1-888-901-4636First Choice Health network at fchn.comFirst Health network at firsthealth.comGroup numbers:UA and Non-Rep — 061000IBEW — 617070024-Hour Consulting Nurse helpline: 1-800-297-6877

Group Health OptionsRegister online at ghc.org and use your account to:

• Refill prescriptions.• Send your physician secure email.*• Get test results or request appointments.*• Access medical records and email on behalf

of your child through age 12.* * When using a Group Health Medical Center.

Delta Dental plan• Your benefits coverage• Finding a Delta Dental member dentist• Using Delta Dental online services

Delta Dental of Washingtondeltadentalwa.com 1-800-554-1907Group number: 174

Delta Dental of WashingtonRegister for MySmile® at deltadentalwa.com to:

• View claims information or print an ID card.• See how much coverage you have remaining

for the year.

Flexible spending accounts• Eligible expenses• Reimbursements• Documentation requests

TRI-AD1-888-844-1372Fax claims: 1-866-233-4741Email: [email protected]

TRI-ADRegister at tri-ad.com/participants/fsa.aspx to:

• Submit FSA claims for reimbursement.• Submit documentation for BenefitCard

transactions.• Access your full FSA account details.

Leaves of Absence MetLife 1-877-8OFFWORK (877-863-3967)

mybenefits.metlife.com

myWellness at PSE • Wellness challenges and points• Goals and coaching

LimeadeEmail: [email protected]

LimeadeRegister at mywellnessatpse.limeade.com to:

• Access tools for healthy living.

• Earn points toward rewards.

For other benefit questions, enrollment help or to make mid-year benefit changes

Benefit Service Call Center1-800-531-1328

benedetails.com, then enter: 65233 for 2014, 76389 for 2015

Contacts

http://regence.com

http://regence.com

http://healthequity.com

http://ghc.org

http://fchn.com

http://firsthealth.com

http://ghc.org



mailto:flexmail%40tri-ad.com?subject=


http://mybenefits.metlife.com

mailto:support%40limeade.com?subject=

http://mywellnessatpse.limeade.com
