Key Facts
Geisinger Health Plan is committed to delivering the best value to our customers, while providing access to quality medical care.
Take a look at these facts about our health plan.
Headquarters
Danville, Pennsylvania
Regional Sales Offices
Danville, Harrisburg, Moosic, State College, Wilkes-Barre
Take a look at information about our organization:
Network of Health Care Providers
Background
Geisinger Health Plan has more than 220,000 members and is consistently recognized for quality. The organization offers coverage for:
- Businesses of all sizes
- Individuals and families
- Medicare beneficiaries
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.
Network of Health Care Providers
More than 18,000 health care providers participate in our network including:
- 3766 Primary Care Physicians
- 11,713 Specialist Physicians
- 1,234 Primary Care Sites
- 84 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)
Quality Performance
National Committee for Quality Assurance (NCQA) Commendations for 2007
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 (2007)
- Scored in the top 10 percent of all health plans in the nation for Hepatitis B; measles, mumps and rubella; varicella; pnuemococcal conjagate childhood immunizations (2007)
- Scored in the top 10 percent of all health plans in the nation for measles, mumps and rubella; Hepatitis B and varicella adolescent immunizations (2007)
- Scored in the top 10 percent of all health plans in the nation for the use of asthma medications for adolescents aged 10 to 17 (2007)
- Scored in the top 10 percent of all health plans in the nation for annual monitoring for members using medications for heart conditions, high blood pressure and seizures (2007)
- Scored in the top 10 percent of all health plans in the nation for access for at least six well child visits for children during their first 15 months (2007)
- Rated number one in Pennsylvania for breast cancer screenings (2007)
- Rated number one in Pennsylvania for kidney disease in members with diabetes (2007)
- Scored in the top 10 percent of all health plans in the nation for how well doctors communicate, and members' rating of their individual doctor and specialist (2007)
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)
National Committee for Quality Assurance (NCQA) Accreditation for Disease Management
Received a three-year "Full" Accreditation, the highest level for a PPO, during NCQA's 2006 review for Geisinger Choice (2006) 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)
Pennsylvania Health Care Cost Containment Council (PHC4) 2007
- 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)
Pennsylvania Health Care Cost Containment Council (PHC4) 2006
- 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
- Geisinger Gold and Geisinger Health Plan rank #3 for Medicare and #5 for commercial health plans in the nation in the U.S. News and World Report/NCQA America's Best Health Plans 2008 list. (U.S. News and World Report, 2008)
- Geisinger Gold was ranked one of the top Medicare health plans in Pennsylvania and #19 in the Nation in the U.S. News and World Report/NCQA America's Best Health Plans 2007 list. (U.S. News and World Report, 2007)
- Geisinger Health Plan was ranked one of the top commercial health plans in Pennsylvania and #33 in the Nation in the U.S. News and World Report/NCQA America's Best Health Plans 2007 list. (U.S. News and World Report, 2007)
- Geisinger Health Plan was awarded the Gold Award in the Pennsylvania Division Cancer Control Impact Awards by the American Cancer Society for the 2006/2007 Colorectal Cancer campaign. (American Cancer Society, 2007)
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
- 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.
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.
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.