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.
Altoona, Bloomsburg, Harrisburg, Lancaster, State College and Wilkes-Barre
Take a look at information about our organization:
Geisinger Health Plan has approximately 480,000 members and is consistently recognized for quality.
The organization offers coverage for:
- Businesses of all sizes
- Individuals and families
- Medicare beneficiaries and Medical Assistance recipients
- Children enrolled in the Children's Health Insurance Program (CHIP)
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 Pennsylvania, Delaware, New Jersey, Maine and West Virginia. 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 Gold, which currently covers more than 80,000 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). Geisinger Gold began offering a Medicare Supplement plan to all Pennsylvania Medicare-eligible residents to help pay for health care costs not covered by Original Medicare in 2011. In March 2013, the Plans entered Pennsylvania's HealthChoices managed care program for Medical Assistance recipients. Geisinger Health Plan introduced Healthy Connect, a Healthy PA Private Coverage option in January 2015.
The Health Plans also 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. 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 health-care costs, the need for different payment models, changes in Medicare reimbursement and an increased focus on quality brought many health-care market changes. As a result, many organizations approached the Plans to share this knowledge, and the Plans began offering coverage outside Pennsylvania in 2012.
GHP now serves the health-care needs of members in Pennsylvania, Delaware, Maine, New Jersey and West Virginia and have steadily evolved into one of the nation's largest rural insurers by providing high-quality, affordable health-care benefits.
Network of Health Care Providers
More than 26,000 health care providers participate in our network including:
- 3,200 Primary Care Physicians
- 22,700 Specialist Physicians
- 104 Participating Hospitals
as of 1/01/2015
Products available for businesses, individuals and families:
- HMO coverage for groups
- PPO coverage for groups
- Third-party administer (TPA) service, Geisinger Health Options, for self-funded employers
- Fully insured point-of-service (POS) product for groups
- Small business plans
- High-deductible health plans with or without a health savings account
- Marketplace coverage for businesses and individuals
- Children's Health Insurance Program
- Medical Assistance
- Healthy PA coverage
- Medicare Advantage products with prescription drug options
- Medicare supplement plans (available to all Pennsylvania residents)
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
National Committee for Quality Assurance (NCQA) Commendations for 2014:
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 #3 in the country for providing DTaP (diphtheria, tetanus and pertussis) immunizations to children turning two
- Rated #4 in the country for providing beta-blocker treatment to members for six months following a heart attack
- Scored in the top five nationally for appropriate follow up within 7 and 30 days for mental illness
- Scored in the top 10 nationally for children receiving immunizations including:
- #2 for H influenza type B
- #2 for child combo 2 (Diphtheria, tetanus and pertussis; polio; measles, mumps and rubella; Haemophilus influenzae B; Hepatitis B; and chicken pox)
- #3 for Hepatitis B
- #4 for child combo 3 (Diphtheria, tetanus and pertussis; polio; measles, mumps and rubella; Haemophilus influenzae B; Hepatitis B; chicken pox; and pneumococcal conjugate vaccine)
- #4 for child combo 5 (Diphtheria, tetanus and pertussis; polio; measles, mumps and rubella; Haemophilus influenzae B; Hepatitis B; chicken pox; pneumococcal conjugate vaccine; and rotavirus)
- #5 for polio
- #5 for chicken pox
- #6 for child combo 10 (diphtheria, tetanus and pertussis; polio; measles, mumps and rubella; Haemophilus influenzae B; Hepatitis B; chicken pox; Pneumococcal conjugate vaccine; Hepatitis A; rotavirus; and influenza)
- #7 for child combo 7 (diphtheria, tetanus and pertussis; polio; measles, mumps and rubella; Haemophilus influenzae B; Hepatitis B; chicken pox; Pneumococcal conjugate vaccine; Hepatitis A; and rotavirus)
- #7 for child combo 8 (#7) diphtheria, tetanus and pertussis, polio ; measles, mumps and rubella;, Haemophilus influenzae B, Hepatitis B, chicken pox, Pneumococcal conjugate vaccine, Hepatitis A, Influenza
- #10 for child combo 4 (diphtheria, tetanus and pertussis; polio; measles, mumps and rubella; Haemophilus influenzae B; Hepatitis B; chicken pox; Pneumococcal conjugate vaccine; and Hepatitis A)
- #10 for child combo 6 (diphtheria, tetanus and pertussis; polio; measles, mumps and rubella; Haemophilus influenzae B; Hepatitis B; chicken pox; Pneumococcal conjugate vaccine; and influenza)
- Scored in the top 10 nationally for adolescents receive the HPV immunization
Rated #1 in Pennsylvania for:
- Appropriate treatment for upper respiratory infections
- Weight assessment and counseling for children and adolescents
- Spirometry testing, assessment and diagnosis of chronic obstructive pulmonary disease (COPD)
- Dispensing a systemic corticosteroid for chronic obstructive pulmonary disease (COPD)
- Use of appropriate medications for members ages 12 to 18 with asthma
- Monitoring members with diabetes with a blood pressure <140/90 and <140/80
- Anti-rheumatic drug therapy for members with rheumatoid arthritis
- Appropriate use of imaging studies for low back pain
- Customer service
- Rating of personal doctor
- Rating of specialist seen
- Geisinger Health Plan and Geisinger Gold rank #1 for private and Medicare Health Plan in Pennsylvania according to the NCQA Health Insurance Plan Rankings 2014-15.
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 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 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
- Well on Your Weigh (weight management)
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.
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 43 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 43-county service area provide additional convenience to our members and better meet the needs of employers.
Information updated: 1/02/14