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  • Legal Documents
  • Summary Plan Descriptions
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Step 3—Apply for Your Retirement Benefits: Health Care

As a PSEG retiree, you have the option to elect certain forms of health care coverage including:

• Medical Coverage
• Medical Premiums
• Postretirement Supplemental Health Benefits Plan
• Prescription Drugs
• Dental Coverage

However, you also can elect to continue the medical, dental, and prescription coverage you had as an active employee through COBRA. Under the law, you can continue this coverage for a specified period of time (normally 18 months, or 29 months if you become disabled at any time during the first 60 days of COBRA). However, you would be responsible for the full cost of coverage, plus a 2% administrative fee. Please note that after you have received the maximum amount of COBRA coverage you are entitled to or attained age 65, whichever occurs first, all coverage under COBRA ends and you will have no health or dental insurance coverage through PSEG. You may not enroll in health benefits for retired employees at that time. To enroll for COBRA, call 1-800-571-0400 and follow the voice recognition prompts to speak with a Benefits Express representative.

Medical Coverage

You have several options for medical coverage in retirement. Please see your personalized Retirement Kit for details on your available options.

Traditional Deductible Option

• You can receive care from any doctor or hospital
• If you use a physician who participates in the Preferred Provider Organization (PPO), you pay less for the services and you have no claim forms to complete
• All eligible expenses are subject to an individual or family annual deductible
• After the deductible, you pay only 20% of most eligible expenses, until your costs reach the out-of-pocket maximum. Once the maximum is reached, the plan pays 100% for the rest of the calendar year
• Reasonable and Customary fees apply to anesthesia and surgery

Point-of-Service (POS) Option

• Both in- and out-of-network features are available.

In-Network

• You choose a Primary Care Physician (PCP) to manage your health care. Family members can each have a separate PCP
• When care is received by a network provider and arranged by your PCP, you reduce your out-of-pocket cost—you pay a copayment for most services
• There are no claim forms or deductibles

Out-of-Network

• You receive care from any health care provider in or outside the network without a referral from your PCP
• You must first meet the plan deductible and then pay expenses until you reach an out-of-pocket maximum
• You must fill out a claim form for reimbursement
• All reimbursements are based on Reasonable and Customary fees

Health Maintenance Organization (HMO) Option

• Features a group of health care providers that meets certain quality standards and agrees to provide services at reduced rates to participants
• No benefits are provided (except in emergency situations) for care received outside the HMO
• You must live in a geographical area that offers an HMO
• You choose a Primary Care Physician (PCP) to manage your health care. Family members can each have a separate PCP
• When care is received by a network provider and arranged by your PCP, you reduce your out-of-pocket cost—you pay a copayment for most services
• There are no claim forms or deductibles

See the Medical Comparison tool for a comparison of medical options.

Medical Premiums

You are responsible for paying 100% for medical benefits through PSEG.

Postretirement Supplemental Health Benefits Plan

If you participated in the Postretirement Supplemental Health Benefits Plan while an active employee, the money you set aside from your pay on an after-tax basis can be used for unreimbursed health care expenses in retirement or for the medical costs incurred by a surviving spouse, including premium payments in the event of your death. Money placed in the trust, including interest, is available to use after retirement.

PSEG contributes $75 a year to the account of each employee with 25 or more years of service until they retire. Active employees did not have to make contributions to the Retiree Health Expense Reimbursement Account in order to receive the Company contribution. If you are 55 and have worked for PSEG for 5 years, the Company contributes $300 to your account.

At the time you retire, and every annual enrollment thereafter, you make an election to determine how to use money from the account for the coming year. The money in the trust can be used to offset medical/dental premiums in retirement and/or a specific amount can be designated to set up a Retiree Health Expense Reimbursement Account so you can reimburse yourself for health care expenses not covered by other insurance plans, including Medicare.

Prescription Drug Coverage

You'll have prescription drug coverage. When you purchase a covered prescription from one of the 50,000 retail pharmacies that participate in the Medco network, you must present your ID card. You'll pay 20% of the cost of each generic drug and brand-name drug, when no generic is available, but if the pharmacy dispenses the brand-name drug for any reason, you will pay the difference between the brand-name drug and the generic, plus the brand-name copayment and PSEG will pay the rest. You also can order up to a 90-day supply of a long-term medication through the Medco Mail-Order Program to save money. Mail your original prescription and a Mail Order Form to the address on the form. You pay 10% of the cost of the medication and PSEG will pay the rest! Either through mail-order or at a retail pharmacy, you do not have to meet a deductible, and there are no claim forms to submit.

Dental Coverage

When you retire, you may be eligible to continue your active dental coverage for a specific period of time through COBRA. For more information or to enroll for COBRA, call 1-800-571-0400 and follow the voice recognition prompts to speak with a Benefits Express representative.