Fast Facts
Welcome to Geisinger Health Plan's fast facts. In this section you will find the most up-to-date information about the Health Plan.
Geisinger Health Plan: A Choice for the Better
Geisinger Health Plan, a not-for-profit health maintenance organization (HMO), serves the health-care needs of members in 42 counties throughout central and northeastern Pennsylvania. Begun in 1985, the Health Plan has steadily evolved into one of the nation’s largest rural HMOs by providing high quality, affordable health-care benefits.
Headquarters
Danville, Pennsylvania
Regional Sales Offices
Danville, Harrisburg, Moosic, State College, Wilkes-Barre
Membership:
208,437*
Participating Hospitals: 84 *
Primary Care Sites: 1,234 *
Primary Care Physicians: 3,766 *
Specialists: 11,713 *
* as of 1/31/08
Service Area
Adams, *Bedford, Berks, Blair, Bradford, Cambria, Cameron, Carbon, Centre, Clearfield, Clinton, Columbia, *Cumberland, Dauphin, *Elk, Huntingdon, Jefferson, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Luzerne, Lycoming, Mifflin, Monroe, Montour, Northumberland, Northampton, *Perry, Pike, Potter, Schuylkill, Somerset, Snyder, Sullivan, Susquehanna, Tioga, Union, Wayne, Wyoming, York
*Denotes partial counties
Click here to see map (.pdf format)
History
A rural, prepaid Health Plan was offered as a pilot program in 1972 to Geisinger Medical Center employees and residents of the five-counties that surrounded the hospital. The five counties included Montour, Columbia, Northumberland, Snyder and Union. In 1985, the Health Plan received its Certificate of Authority to operate an HMO under the authority of the Pennsylvania Health Maintenance Act of 1973. The Health Plan had a significant premium advantage during the period of escalating health-care costs in the 1980s and ‘90s. Membership grew rapidly, and in 1990, the Health Plan reached its 100,000-member milestone.
Geisinger Health Plan offers coverage for businesses of all sizes, individuals and families, and Medicare beneficiaries. PPO and high deductible plans are sold through Geisinger Quality Options, Inc. Self-funded and indemnity plans are sold through Geisinger Indemnity Insurance Company.
Products
- HMO coverage for groups
- PPO coverage for groups
and individuals
- a small business plan
- high deductible health plans with or without a health savings account
- Medicare Advantage products with prescription drug options, Geisinger Gold
- stand-alone Medicare prescription drug plan
- a third-party administrator (TPA) service, Geisinger Health Options, for self-funded employers
- a fully insured point-of-service (POS) product
- Geisinger Indemnity Insurance Company (GIIC) for employers who want to provide coverage options for employees who reside outside of the Health Plan’s service area.
Quality Performance
National Committee for Quality Assurance (NCQA)
NCQA is an independent, not-for-profit organization dedicated to measuring the quality of America's health care. Quality Compass® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Pennsylvania Health Care Cost Containment Council (PHC4)
PHC4 is an independent state agency created under Pennsylvania statute (Act 89) to collect, analyze and report data to the public about the cost and quality of health care in Pennsylvania.
- Ranked #1 in monitoring kidney disease for members with diabetes, screening for breast cancer and annual monitoring for patients on persistent medications (2008)
- Scored higher than state and national averages in members receiving A1c blood tests and eye exams in the past year and screening members with diabetes for cholesterol (2008)
- Scored higher than state and national averages in childhood immunizations, timely initiation of prenatal care, screening for colorectal and cervical cancer, controlling high blood pressure and using beta-blockers after a heart attack (2008)
- Exceeded the national average in getting needed care and seeing a specialist (2008)
- Scored higher than state and national averages in controlling Hemoglobin A1c levels, eye exams and screening for cholesterol for members with diabetes (2007)
- Scored higher than state and national averages in childhood immunizations, timely initiation of prenatal care, screening for breast and colorectal cancer and using beta-blockers after a heart attack (2007)
- Scored higher than the state average in members receiving approvals without delay, getting help from customer service and contacting customer service (2007)
- Scored higher than state and national averages in controlling Hemoglobin A1c levels, receiving A1c blood tests in the past year, monitoring kidney disease, screening for cholesterol and controlling bad cholesterol for members with diabetes (2006)
- Scored higher than state and national averages in receiving cholesterol screenings, controlling bad cholesterol and using beta-blockers after an acute cardiac event (2006)
- Scored higher than state and national averages in childhood immunizations, timely initiation of prenatal care, controlling high blood pressure and screening for breast and colorectal cancer (2006)
Awards
Health Management
For members with a complex medical history, our case management nurses can help them and their families navigate through the wide variety of health care services available.
We also offer programs that provide members with specialized instruction on how to deal with specific disorders, better manage their symptoms and improve their quality of life.
These programs include:
- Adult and Pediatric Asthma Care Program
- Chronic Kidney Disease
- Chronic Obstructive Pulmonary Disease (COPD) Program
- Chronic Heart Failure (CHF) Program
- Diabetes Care Program
- HeartWise Program
(coronary artery disease)
- Hypertension Program
- Osteoporosis Program
- Tobacco Cessation Program
We do more to keep our members healthy.
- Tobacco cessation. This 12-week program is extremely successful in helping members to quit smoking. For all participants, whether or not they complete the course, our quit rate is two times the success rate of other programs.
- Health reminders by phone. For members who scheduled a recommended appointment, we'll contact them directly at home to remind them about childhood and adolescent immunizations, breast and cervical cancer screenings, and diabetic eye exams.
- Prenatal education. A variety of prenatal classes are available through contracted hospitals.
- Out-of-network services. If a member is outside our service area and requires medical attention, we'll still see to it he or she gets the needed care. In fact, if necessary, we'll even arrange to have the member transported back home to be cared for by his or her own physician.
Structure
Geisinger Health Plan is an integral part of what is collectively referred to as Geisinger Health System. The System is a large, comprehensive health-care network that provides health-care services throughout 40 counties.
The System is dedicated to
- community-focused, not-for-profit, physician-led health care
- medical research and education
- service to rural areas
Initially, Geisinger Health Plan was a group practice HMO, meaning its provider network was composed of Geisinger Health System providers only. The Health Plan has since expanded into a network model to better serve the residents of central and northeastern Pennsylvania. Sites throughout our 42-county service area provide additional convenience to our members and better meet the needs of employers.
Information updated 04/15/08
