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 Offices

Altoona, Bloomsburg, Harrisburg, Lancaster, State College and Wilkes-Barre

Take a look at information about our organization:

Background

Network of Healthcare Providers

Products

Quality Performance

Awards

Health Management

Wellness Programs

Structure

Background

Begun in 1985, the Health Plan is known for providing high quality, affordable healthcare benefits. Geisinger Health Plan has approximately 540,000 members. 

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

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. 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 healthcare 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. Today, the Health Plan provides a variety of coverage options to fit the needs and budget of all Pennsylvanians including:

  • Businesses of all sizes
  • Individuals and families
  • Medicare beneficiaries and Medical Assistance recipients
  • Children enrolled in the Children's Health Insurance Program (CHIP)

The Health Plan also continues to develop new products to help meet employers' needs. "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 PPO products are available through Geisinger Quality Options, Inc., an affiliate of GHP. GHP also offers SmartSteps, a wellness-based plan which directly incents employees to improve their health in key measures such as weight, blood pressure, blood sugar and not using tobacco. These options provide more flexibility in plan design and premium than the standard HMO.

Geisinger Health Plan has received national attention for its ability to foster innovation, while uniquely and effectively managing medical costs and improving outcomes. The passage of the Affordable Care Act in 2010, as well as escalating healthcare costs, the need for different payment models, changes in Medicare reimbursement and an increased focus on quality brought many healthcare market changes. As a result, many organizations approached the Plans to share this knowledge, and the Health Plan began offering coverage outside Pennsylvania in 2012.

As a result, GHP serves the healthcare needs of members in Pennsylvania, Delaware, Maine, and New Jersey. 

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Network of Healthcare Providers

More than 31,000 healthcare providers participate in our network including:

  • 3,500 Primary Care Physicians
  • 27,000 Specialist Physicians
  • 110 Participating Hospitals
    as of 1/04/2016

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Products

Products available for businesses, individuals and families:

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Service Area

Adams, *Bedford, Berks, Blair, Bradford, Cambria, Cameron, Carbon, Centre, Clearfield, Clinton, Columbia, Cumberland, Dauphin, *Elk, Fulton, 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

NCQA is an independent, not-for-profit organization dedicated to measuring the quality of America's healthcare. Quality Compass® is a registered trademark of the National Committee for Quality Assurance (NCQA).

National Committee for Quality Assurance (NCQA) 2015 Commendations

(Commercial HMO):

  • Rated #3 in the country for children ages 12 to 24 months accessing their primary care physician (PCP)
  • Rated #3 in the country for dispensing of corticosteroid for management of chronic obstructive pulmonary disease (COPD)
  • Rated #4 in the country for children receiving Hepatitis B immunizations
  • Rated #7 in the country for persistence of beta blocker treatment after a heart attack
  • Rated #8 in the country for appropriate treatment for upper respiratory infections
  • Scored in the top 10 nationally for appropriate follow up within 7 and 30 days for mental illness

Rated #1 in Pennsylvania for:

  • Adolescent immunization against human papillomavirus (HPV)
  • Weight assessment and counseling for children and adolescents
  • Spirometry testing, assessment and diagnosis of chronic obstructive pulmonary disease (COPD)
  • Follow up care for children taking medication for attention deficit hyperactivity disorder (ADHD)
  • Management of heart failure medications
  • Calls answered in a timely manner

National Committee for Quality Assurance (NCQA) 2015 Commendations

(Commercial PPO):

  • Rated #2 in the country for care after childbirth
  • Rated #2 in the country for monitoring members diabetes with a blood pressure <140/90
  • Rated #3 in the country for monitoring members diabetes with hemoglobin testing
  • Rated #5 in the country for performing eye exams on members with diabetes
  • Rated #5 in the country for monitoring kidney disease in members with diabetes
  • Rated #5 in the country for weight assessment and counseling for children and adolescents
  • Rated #6 in the country for controlling high blood pressure
  • Rated #6 in the country for monitoring lower back pain
  • Scored in the top 10 nationally for nutrition counseling for children and adolescentes
  • Scored in the top 10 nationally for recording adult member's body mass index (BMI)
  • Scored in the top 10 nationally for advising smokers to quit and providing medication and strategies for cessation
  • Scored in the top 10 nationally for calls answered in a timely manner

Rated #1 in Pennsylvania for:

  • Breast cancer screenings
  • Colorectal cancer screenings
  • Monitoring members taking blood pressure medication
  • Access to health services for members 25 months to 6 years old
  • Well visits for adolescent members
  • Calls answered in a timely manner
  • Spirometry testing, assessment and diagnosis of chronic obstructive pulmonary disease (COPD)
  • Follow up care for children taking medication for attention deficit hyperactivity disorder (ADHD)
  • Management of heart failure medications
  • Calls answered in a timely manner

Geisinger Gold HMO is rated in the top 5 percentile nationally for:

  • Appropriate follow up within 7 days for mental illness
  • Members taking two high-risk prescriptions
  • Members taking one high-risk prescription

Geisinger Gold HMO is rated #1 in Pennsylvania for:

  • Monitoring members taking persistent medications
  • Breast cancer screenings
  • Appropriate follow up within 7 days for mental illness
  • Managing women's bone health

Geisinger Gold PPO is rated in the top 5 percentile nationally for:

  • Dispensing of cortiocosteroid for management of chronic obstructive pulmonary disease (COPD)
  • Number of members taking two high-risk prescriptions
  • Number of members taking one high-risk prescription

Consumer Assessment of Healthcare Providers and Systems (CAHPS)

Both Geisinger Gold HMO & PPO met or exceeded national and state averages for:

Consumer assessment of Healthcare Providers and Systems (CAHPS) survey results reflect quality from the consumer's point of view.

  • Members felt their physicians communicated well
  • Customer service satisfaction
  • Coordination of care
  • Rating of healthcare quality
  • Overall rating of personal doctor
  • Access to necessary prescription medication
  • Flu vaccinations

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Awards

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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 healthcare services available.

Geisinger Proven Health Navigator® - ProvenHealth Navigator (PHN) is a partnership between primary care providers and GHP to improve members' health. Also known as a "medical home", PHN provides a case manager who works closely with the member's healthcare 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
  • Well on Your Weigh (weight management)

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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.

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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 healthcare network that provides healthcare services throughout 45 counties.

The System is dedicated to community-focused, not-for-profit, physician-led healthcare 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 our members. Sites throughout our service area provide additional convenience to our members and better meet the needs of employers.

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Information updated: 1/19/16