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We’ve updated our Terms & Conditions and Privacy Policy. By using this site, you agree to these terms.

Thank you for your successful submission. 

Next step: 

Mail the signed authorized form (POA) and all requested supporting documentation to (or fax at 570-271-5871):

Geisinger Health Plan
Authorized Personal Representative Form
100 N. Academy Ave.
Danville, PA 17822-3229

We will process your request within 5-7 business days of receiving the signed form.
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