Common member forms and documents
Members
Coordination of Benefits form
If you have a health insurance plan other than Geisinger Health Plan or if you received a letter from the plan's coordination of benefits department.
Authorized representative statement
Use this form to designate a person to assist with handling your health insurance. You and the person you are authorizing must sign the form.
Disabled Dependent Certification form
Confirm that new or existing dependents are eligible for coverage under GHP.
Medical Claim Reimbursement form
File medical claims.
Pharmacy Claims Reimbursement form
Receive reimbursement for prescriptions that you've paid for out of pocket.
Request for Independent External Review of an Adverse Benefit Determination form
Request the Pennsylvania Insurance Department to review a healthcare coverage decision made by their plan. For commercial plans only.
Providers and suppliers
Medical Paper Claim form for providers
Submit a medical claim to Geisinger Health Plan.
Physician Certification for Expedited Review form
Certify that normal timeframes for the review of healthcare coverage decisions would seriously jeopardize the life or health of the covered person or would jeopardize the covered person's ability to regain maximum function.
Manage your health with GHP member portal
Use the member portal to view claims and benefits, find a provider and more.