Applications and forms

Find the documents you need to enroll and manage your company’s healthcare coverage with Geisinger Health Plan.

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For new businesses - Geisinger Health Plan application

Forms

HMO subscriber application

Add employees to the employer sponsored plan with the HMO subscriber application.

PPO with No Referral subscriber application

Add employees to the employer sponsored plan with the PPO with No Referral subscriber application.

PPO with Referral subscriber application

Add employees to the employer sponsored plan with the PPO with Referral subscriber application

Enrollment application change form

Use the enrollment application change form to add or remove employees and their dependents and to update name, phone, address, PCP or plan information for employees.

How to submit forms

You’ll need to create a secure digital ID to electronically sign these documents. Learn how.

Once, you’ve signed the document, email it to clientgroupservices@thehealthplan.com.

 Log in for forms specific to your account.

Related information

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