Questions and answers

We know health insurance can be complicated. Here are the answers to the most common questions we hear.

How can I get information about Geisinger Marketplace plans?
You can contact a representative at 800-223-1282, Monday - Friday,
8 a.m. - 6 p.m. or email us at ghpinquiries@thehealthplan.com. You can also visit in person at our Geisinger Health Plan Store.

How do I enroll in a Geisinger Marketplace plan?
Open Enrollment for 2017 coverage is now closed. Individuals who recently experienced life changes may qualify for a Special Enrollment Period. Open Enrollment for 2018 coverage will begin this fall.

Do I need to seek services only with Geisinger-owned providers and facilities? 
No. Geisinger Health Plan’s network offers access to 30,000 providers, including 110 hospitals and more than 50 urgent and convenient care locations, along with access to emergency care anywhere in the world. Find a doctor.

Qualified Health Plan transparency: Claims payment and other information

What is coinsurance?
Once your deductible is met, GHP pays a percentage and you pay a percentage of the remaining costs. The percentage you pay is coinsurance.

If you have a plan with 20 percent coinsurance. GHP will pay 80 percent of covered services after your deductible has been met and you pay the remaining 20 percent. Once you reach your maximum out-of-pocket you will no longer have to pay coinsurance.

What does maximum out of pocket (MOOP) mean? 
The maximum out-of-pocket (MOOP) amount includes all member expenses, such as deductibles, coinsurance and copays, for all covered services within a plan period. Once your maximum out-of-pocket costs are met, your insurance plan will pay 100 percent of costs for covered services.   
 
What are metallic levels? 
Under the Affordable Care Act (ACA, also known as healthcare reform), the metallic level categories are based on how you and your plan splits your healthcare costs. There are four metallic levels (bronze, silver, gold and platinum).

  • Bronze: Your health plan pays 60 percent on average. You pay about 40 percent.
  • Silver: Your health plan pays 70 percent on average. You pay about 30 percent.
  • Gold: Your health plan pays 80 percent on average. You pay about 20 percent.
  • Platinum: Your health plan pays 90 percent on average. You pay about 10 percent.

As you go from bronze to platinum, the monthly premiums tend to go up. So, a bronze plan would generally have a lower premium than a platinum plan.

If your question isn’t answered here, let us know.

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