What’s covered by GHP Family's Medical Assistance plan?
Your health matters. Not just to you, but to us. We know that health insurance can be confusing, so Geisinger Health Plan (GHP Family Plan) has you covered. We’ve worked hard to give you and your family robust benefits that cover the services you need, plus access to our wellness programs to keep you healthy.
You may have questions about your health along the way. Our customer care team is available to answer your questions. We’re here when you need us. No question is too big or too small. Our customer care team can be reached at 855-228-1302 Monday, Tuesday, Thursday, and Friday 7 a.m.- 7p.m.; Wednesday 7 a.m. – 8 p.m.; Saturday 8 a.m. – 2 p.m.
Your plan includes broad health care coverage, including:
- Doctors and hospitals nearby
GHP Family has a network of contracted providers, facilities, and suppliers to provide covered physical health services to members. Search for providers at Find Care - Geisinger Health Plan.
- Maternity Care
Prenatal care is the health care a woman receives through her pregnancy and delivery from a maternity care provider, such as an obstetrician (OB or OB/GYN) or a nurse-midwife. Early and regular prenatal care is very important for you and your baby’s health. Even if you have been pregnant before, it is important to go to a maternity care provider regularly through each pregnancy.
It is important that you stay with the same maternity care provider throughout your pregnancy and postpartum care (1 year after your baby is born). They will follow your health and the health of your growing baby closely. It is also a good idea to stay with the same HealthChoices plan during your entire pregnancy.
- Routine check-ups and immunizations
You should have a physical exam by your Primary Care Physician (PCP) at least once a year. This will help your PCP find any problems that you may not know about. Your PCP may order tests based on your health history, age, and sex. Your PCP will also check if you are up to date on immunizations and preventive services to help keep you healthy.
- Prescription drugs
GHP Family covers pharmacy benefits that include prescription medicines and over-the-counter medicines and vitamins with a doctor’s prescription. When a provider prescribes a medication for you, you can take it to any pharmacy that is in the GHP Family’s network. Search for covered drugs at Benefits Preview (navitus.com)
- Vision and dental care
Regular eye exams are important. With GHP Family, you do not need to pick one eye doctor for all your eye appointments; you can go to any eye doctor in the GHP Family network.
It is important to have regular visits with your dentist. Members are eligible to receive all medically necessary dental services. No referral is needed for a dentist visit. Our team of dental hygienists can provide dental education via phone, help you find a dentist, and answer any questions you have about oral health.
- Emergency care
An emergency medical condition is an injury or illness that is so severe that a reasonable person with no medical training would believe that there is an immediate risk to a person’s life or long-term health. You do not have to get approval from GHP Family to get emergency services and you may use any hospital or other setting for emergency care.
- Behavioral Health Services
Behavioral health services include both, mental health services and substance use disorder services. These services are provided through behavioral health managed care organizations (BH-MCOs) that are overseen by the Department of Human Services’ Office of Mental Health and Substance Abuse Services (OMHSAS). Search for Behavioral Health MCOs in your county at https://www.geisinger.org/health-plan/plans/ghp-family-medicaid/bhs-contacts
- Tobacco Cessation
GHP Family is here to help you in becoming healthier by becoming smoke-free whether it be through medicines, counseling services, behavioral health treatment, case management programs, or other tobacco cessation resources.
Find a pharmacy
More than 3,000 in-network pharmacies
Find out what drugs are covered by GHP Family
GHP Family has what’s called a formulary, or a list of drugs covered under your plan. GHP Family covers medicines listed on the Statewide Preferred Drug List (PDL) and the GHP Family supplemental formulary.
If you have any questions or to get a copy of the Statewide PDL and GHP Family’s supplemental formulary, call Customer Care at 1-855-552-6028, PA Relay 711 or visit GHP Family’s website at www.ghpfamily.com. A copy of the Statewide PDL can be found at https://papdl.com/preferred-drug-list.
Your pharmacy benefits include:
Do you need specialty medications? GHP Family uses Navitus Specialty Pharmacy Network. That means you can use any network specialty pharmacy. Find the list of medications here.
You can use an out-of-network pharmacy:
- If the medications you need aren’t at a network pharmacy. This is called “limited distribution.” It’s when the drug maker only lets some pharmacies dispense their medication.
- If a network pharmacy can’t give you medications in time to prevent harm.
Taking a specialty medicine? Need to find a specialty pharmacy? Call 855-552-6028 or 570-214-3554.
Hours:
Monday, Tuesday, Thursday, Friday: 8 a.m. – 7 p.m.; Wednesday: 8 a.m. – 8 p.m.; Saturday: 8 a.m. – 2 p.m.
Either way, you may need permission to get a drug that is not listed on the formulary. Perhaps you need a prior authorization from us before filling your prescription. If so, talk with your doctor to decide if you should switch to an appropriate formulary drug or request a formulary exception. While you find your best option, we will cover your current drugs during the first 60 days of your membership.
GHP Family requires your physician to get prior approval for certain drugs. This means that your prescriber will need to get approval from GHP Family before you fill prescriptions for these drugs. Without this approval, GHP Family will not pay for the drug.
If you need prior authorization of your medication, you have two options:
- Ask for a list of similar medications on the GHP Family Formulary. Show the list to your doctor. They can tell you if one will work for you.
Call GHP Family Pharmacy Customer Service at 855-552-6028 or 570-214-3554 (PA Relay 711).
Hours:
Monday, Tuesday, Thursday, Friday: 8 a.m. – 7 p.m.; Wednesday: 8 a.m. – 8 p.m.; Saturday: 8 a.m. – 2 p.m.
- Your doctor can ask GHP Family to approve your current drug through a prior authorization. See our Geisinger policy.
Click to see the Statewide Preferred Drug List (PDL) – Prior authorization criteria
Pharmaceutical and therapy committee notes:
GHP Family Customer Care
If you have questions about what is covered by GHP, call the GHP Family customer care team at 855-227-1302.
We’re available:
Monday, Tuesday, Thursday and Friday: 7 a.m. – 7 p.m.
Wednesday: 7 a.m. – 8 p.m.
Saturday: 8 a.m. – 2 p.m.
GHP Family Special Needs Unit
The Special Needs Unit staff work with families on their goals and needs. They also work with community resources, such as county agencies, community organizations, home health agencies and medical equipment providers. You may contact them by calling 855-214-8100, Monday through Friday from 8:00 a.m. to 5:00 p.m.
Programs for GHP Family Members
Our health and wellness programs can help you develop long-term healthy habits for life. We focus on your physical, mental and emotional health, as well as wellness needs to keep you feeling your best.
Member Rewards Program
Receive incentives for attending and completing certain doctor visits.
Text4Baby Program
Text messages sent at no cost to you that offer information about caring for newborns, tips to help pregnant women and new moms care for their own health. For more information, including a list of participating cell phone service carriers, visit text4baby.org.
Nurse-Family Partnership
If you’re having your first baby, this free program is available to you. A GHP Family nurse will visit you throughout your pregnancy and up until your child is 2 years old. Call 866-864-5226 or visit NurseFamilyPartnership.org for more information.
Healthy Kids Are Happy Kids
This program offers services to families with younger children, including information about important care and screenings.
Right From the Start
Join this no-cost program when you find out you’re pregnant. Our nurses will guide you through a healthy pregnancy and will help you manage your appointments, including scheduling and transportation, or any other health needs you may have while you are pregnant.
Early and periodic screening diagnosis and treatment (EPSDT) exams, also called well visits, are important for every child. Your child's doctor will let you know when your child needs an EPSDT exam. Our quality improvement nurses can also help with your little one’s EPSDT care. To speak with a nurse, call GHP Family SNU at 855-214-8100.
Telemedicine
We cover care by video or phone so you can get care when you need it.
Tel-A-Nurse
Talk with a nurse 24 hours a day, 7 days a week, about urgent health matters.
You may contact Tel-A-Nurse at 877-543-5061.
Neighborly
Find free or reduced-cost services in your community at www.NeighborlyPA.com.
GED Scholarship Program
Available to assist with the costs of getting your GED including: training materials, practice testing, the GED test and retests. You may contact our Customer Care Team for more information.
GHP Family Member Handbook
Learn more about your coverage
