Geisinger Health Plan®

PPO and high deductible plans are sold through Geisinger Quality Options, Inc. Self-funded plans are sold through Geisinger Indemnity Insurance Company.

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.

Our roots evolved from a rural, prepaid health plan 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.

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Network of Health Care Providers

More than 27,000 health care providers participate in our network including:

3,507 Primary Care Physicians
23,721 Specialist Physicians
1,438 Primary Care Sites
88 Participating Hospitals

Products

Products available for businesses, individuals and families:

HMO coverage for groups
PPO coverage for groups
PPO coverage for individuals
Small business plan
High deductible health plans with or without a health savings account
Medicare Advantage products with prescription drug options and Geisinger Gold stand-alone Medicare prescription drug plan
Third-party administrator (TPA) service, Geisinger Health Options, for self-funded employers
Fully insured point-of-service (POS) product

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

Link to Service Area Map (PDF Format)

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Quality Performance

National Committee for Quality Assurance (NCQA) Commendations for 2008

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).

Rated number one in the country for providing beta-blocker treatment to members for six months following a heart attack (2008)
Rated number one in the country for monitoring anticonvulsive drugs used for seizures (2008)
Rated number one in the country for monitoring diuretics used for heart conditions (2008)
Scored in the top ten nationally for annual monitoring for members using medications for heart conditions, high blood pressure and seizures (2008)
Scored in the top ten nationally for children receiving at least six well child visits during their first 15 months (2008)
Scored in the top ten nationally for children receiving immunizations including diphtheria, tetanus and pertussis (DTaP); Hepatitis B; measles, mumps and rubella (MMR); varicella; pnuemococcal conjugate (2008)
Scored in the top ten nationally for appropriate follow up for children taking medication for attention deficit and hyperactivity disorder (ADHD) (2008)
Scored in the top ten nationally for appropriate follow up with in 7 days for mental illness (2008)
Rated number one in Pennsylvania for breast cancer screenings (2008)
Top rated health plan in Pennsylvania customer service (2008)

National Committee for Quality Assurance (NCQA) Accreditation

Received a three-year "Excellent" Accreditation and "Quality Plus" distinction during NCQA's 2006 review, maintaining the highest level of accreditation since GHP's first review in 1993 (2006)
Received a three-year "Excellent" Accreditation for Geisinger Gold during NCQA's 2006 review (2006)
Received a three-year "Full" Accreditation, the highest level for a PPO, during NCQA's 2006 review for Geisinger Choice (2006)

National Committee for Quality Assurance (NCQA) Accreditation for Disease Management

Received "Full" Accreditation for eight disease management programs from NCQA (2006)

Pennsylvania Health Care Cost Containment Council (PHC4) 2008

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)

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.

Geisinger Health Plan Health Navigator^SM — Health Navigator is a partnership between primary care providers and GHP to improve members’ health. Also known as a “medical home,” GHP provides a case manager who works closely with the member’s health-care providers, the member and their family by coordinating care with hospital, specialists, pharmacists and skilled nursing facilities. Members have access to a Health Navigator case manager 24 hours a day, 7 days a week. This program has significantly reduced the number of hospital admissions and readmissions by providing members an additional resource at the first signs of a complication. Click here to see a video for Health Navigator.

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
Congestive Heart Failure (CHF) Program
Diabetes Care Program
HeartWise Program (coronary artery disease)
Hypertension Program
Osteoporosis Program
Tobacco Cessation Program

Wellness Programs

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.

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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, and service to rural areas. Please visit their Web site at www.geisinger.org.

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.

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America's Best Health Plans 2008-09 is a trademark of U.S. News and World Report

Information updated: 8/10/09

Geisinger Health Plan

Key Facts

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