What’s covered by GHP Family's Medicaid plan?
GHP Family provides complete healthcare coverage for you and your entire family.
GHP Family benefits and services
Your health matters. Not just to you, but to us. We know that health insurance can be confusing, so Geisinger Health 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 well.
You may have questions about your health along the way. Our nurse navigators are available to answer your questions and listen to your concerns. We’re here when you need us. No question is too big or too small.
Pair these resources with comprehensive medical benefits, access to prescription drugs, and coverage for dental and eye exams and you’ve got a winning partnership.
Depending on your level of eligibility for Medicaid, your benefits may include immunizations, checkups, prescription drugs, eye care, dental care and more. In addition to your healthcare coverage, GHP Family benefits include:
- No limit on prescriptions – GHP Family doesn't limit the number of prescriptions you can receive each month. Having difficulty managing multiple prescriptions? You can receive help from a GHP Family pharmacist. Our pharmacists work with you and your doctor to make it easier for you to stay on the medications you need.
- ProvenHealth Navigator – Professional nursing staff located in your primary care office (or available by phone) can help you get the care you need. Specially trained nurses can help you manage chronic disease, complex medications or your move from hospital to home. Our nurses help coordinate your appointments and deliver needed support services.
- Wellness programs – Our health and wellness programs are designed to help you live well, get medical advice and save on health products.
- Women’s and kids' health – A healthy family starts with a healthy mom and baby. Our women’s and kids' health services will help to make sure you receive the care you need during pregnancy and after birth. If you’re pregnant, or if you’re a new mom, we also offer Healthy Rewards debit cards to help you purchase baby care products, feminine hygiene products and other health supplies for you and your family.
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.
You can search the formulary to see if your prescriptions are covered.
You can also print a copy of the GHP Family Formulary (effective 3/1/2022) or you can ask for a printed copy over the phone.
Your pharmacy benefits include:
Specialty drugs are medications used to treat complex diseases. Specialty medications can only be filled by certain pharmacies in the GHP Family network. These medications usually require specialized handling and monitoring. Specialty medications have the words “Specialty Drug” next to them in the formulary.
The GHP Family Specialty Drug List document is a list of all specialty drug information.
- The first column is the drug name. This shows the name of the medications that are included in the program.
- The second column tells you whether prior authorization is needed. If it is, your doctor will need to get prior authorization from GHP Family before you can get your medication.
- The third column lists which pharmacies carry each medication. The key on the final page gives the details for the pharmacy codes lists. Talk to your doctor about these pharmacies and which pharmacy you prefer to use.
Taking a specialty medicine? Need to find a specialty pharmacy? Call GHP Family Pharmacy Services at 855-552-6028 or 570-214-3554 between 8 a.m. and 5 p.m. Monday, Tuesday, Thursday and Friday, or between 8 a.m. to 8 p.m. on Wednesdays.
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.
If you need prior authorization of your drug, you have two options:
- You can ask GHP Family Pharmacy customer service for a list of similar drugs that are on the GHP Family formulary. Show the list to your doctor to see if one of these drugs will work for you.
- Your doctor can ask GHP Family for approval of your current drug through a prior authorization.
See our prior authorization criteria.
Pharmaceutical and therapy committee notes:
Important information you may need
If we remove drugs from our formulary or add prior authorization, quantity limits and/or step therapy restrictions on a drug, or if we move a drug to a higher cost-sharing tier, we must notify affected members of the change (30 days for employer coverage and GHP Family; 60 days for other plans) before the change becomes effective or at the time the member requests a refill of the drug.
If the Food and Drug Administration (FDA) deems a drug on our formulary to be unsafe or the drug’s manufacturer removes the drug from the market, we will immediately remove the drug from our formulary and notify members who take the drug.
GHP Family customer service
If you have questions about your pharmacy or medical benefits, call the GHP Family customer service team at 855-227-1302.
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.
Programs for GHP Family moms and kids
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.
Healthy Beginnings Plus
Healthy Beginnings Plus provides a wide range of special services to pregnant women across Pennsylvania. We can help you pay for and get to your prenatal appointments. The program also can provide food at low or no cost to you. Education on the following topics is available:
- Childbirth preparation
GHP Family offers Health Rewards debit cards to help pregnant women and new moms stay on schedule with all appointments. Click here to learn more.
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
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 866-847-1216.
Back-to-school vaccination guide
Public schools require certain vaccinations to ensure children are protected from preventable diseases. View this guide to make sure your child's vaccination records are up to date before the new school year begins.
Health and wellness program
Our health and wellness programs can help you develop long-term healthy habits for life. We focus on physical, mental and emotional health and wellness needs.
As a member of GHP Family, you’ll have access to a wide range of online and in-person services to help you stay on top of your health. At Geisinger Health Plan, we would rather see you when you’re well, so we don’t have to see you get sick.
And we want to care for you, too.
Choose from helpful, free online resources like:
Services – In person or on the phone