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.

The popularity of managed care grew steadily, and new products were introduced to the marketplace. In addition to the traditional HMO coverage for groups and individuals, the Health Plan began offering third-party administrator (TPA) services through Geisinger Indemnity Insurance Company in 1994. In April 1994, the Health Plan introduced its Medicare risk product, Geisinger Health Plan Gold, which currently covers more than 40,000 members. In 1995, the Health Plan began offering a small business product for employers with 3-9 employees. The following year, a fully insured point-of-service (POS) product was launched. In October 2009, Geisinger Health Plan began offering the Children's Health Insurance Program (CHIP).

GHP continues to develop new products to help meet employers' needs for plan options. "Solutions" is a variation of the standard HMO with a lower premium due to increased cost sharing for some services. Geisinger Health Plan Direct offers HMO coverage without the need for a referral. "Geisinger Choice" PPO products are available through Geisinger Quality Options, Inc., an affiliate of GHP. These options provide more flexibility in plan design and premium than the standard HMO.

Network of Health Care Providers

More than 28,000 health care providers participate in our network including:

3,696 Primary Care Physicians
24,397 Specialist Physicians
1,531 Primary Care Sites
89 Participating Hospitals

as of 3/24/10

Products

Products available for businesses, individuals and families:

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 2009

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 (2009)
Rated number one in the country for monitoring digoxin used for heart conditions (2009)
Rated number one in the country for monitoring diuretics used for heart conditions (2009)
Scored in the top ten nationally for annual monitoring for members using medications for heart conditions, high blood pressure and seizures (2009)
Scored in the top ten nationally for adolescents receiving an annual well visit from ages 12-21 (2009)
Scored in the top ten nationally for children receiving immunizations including polio (IPV) (2009)
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 prenatal care within the first trimester (2009)
Scored in the top ten nationally for appropriate use of Spirometry testing in the assessment and diagnosis of COPD (2009)
Scored in the top ten nationally for appropriate treatment for children with Upper Respiratory Infection (URI) (2009)
Rated number one in Pennsylvania for breast cancer screenings (2009)
Ranked #1 in screening for breast cancer and annual monitoring for patients on persistent medications (2009)
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 (2009)
Scored higher than state and national averages in childhood immunizations, timely initiation of prenatal care, screening for colorectal and cervical cancer, and for providing beta-blocker treatment to members for six months following a heart attack (2009)
Exceeded the national average in getting needed care and seeing a specialist (2009)

National Committee for Quality Assurance (NCQA) Accreditation

Received a three-year "Excellent" Accreditation during NCQA’s 2009 review for our Commercial HMO/POS, maintaining the highest level of accreditation since GHP's first review in 1993 (2009)
Received a three-year "Excellent" Accreditation for Geisinger Gold during NCQA's 2009 review. In addition, Geisinger Gold also received a Medicare Advantage deemed status from NCQA (2009)
Received a three-year "Excellent" Accreditation, during NCQA's 2009 review for Geisinger Choice’s Coordinated Care PP0 (2009)

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. Professional support is provided through phone, individual or group counseling over the course of five sessions. The program goal is to help you break your addiction to tobacco products such as cigarettes, pipes and smokeless tobacco.

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.

Health Risk Assessment (HRA). Geisinger Health Plan members have access to a health risk assessment (HRA) which provides a current health snapshot and evaluates a member’s risk for certain health conditions. In addition, after the HRA is taken, a member will receive regular customized health information e-mails.

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.

America's Best Health Insurance Plans 2009-10 is a trademark of U.S. News & World Report

Information updated: 4/9/10

Geisinger Health Plan

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