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Geisinger becomes the first member of Risant Health

Geisinger employee plan offerings remain the same in 2024. Each plan features two network groups and member out-of-pocket costs, such as copays, deductibles and coinsurance, are determined by the network group to which their healthcare provider belongs. Members can see any provider from either group at any time. Referrals are not required for specialist visits. Out-of-network coverage varies by plan. 

  • Geisinger Enhanced: Offers premium coverage for those who use Group 1 doctors and hospitals, with out-of-network coverage for emergencies and urgent care visits only.
  • Geisinger Value: This QHDHP plan comes with higher up front out-of-pocket costs compared to the Enhanced plan. It offers a substantial Health Savings Account (HSA) annual contribution from Geisinger, plus out-of-network coverage at a higher cost.
  • Geisinger Essential: This plan covers the same essentials but comes with higher out-of-pocket costs such as copays, deductibles and coinsurance, compared to the other two plans. Offers out-of-network coverage at a higher cost.

What group are you in?

Use the Find a Doctor or Location search function to verify your information and your group designation for the 2023 Geisinger employee plans. Search results are available to patients seeking care and represent most of the important information we have on file for you and your office(s). Use these results to confirm your network grouping or to refer your patients to providers in the lowest cost tier of their plan.

To find Group 1 providers quickly, click on All Plans in the top right corner. Then enter “Geisinger Employee Plan”.

If you want to see all the plans a provider accepts, ignore the All Plans option and search by provider instead. The Plans Accepted feature on a provider’s profile will show you a list of GHP plans that provider accepts and what network group or tier they are in.

Curious about what plans you accept? Find your own profile and use this feature to verify the GHP plans you accept.

Elective spine surgery benefit

For elective spinal surgeries, Geisinger Enhanced, Value and Essential plan members will continue to have access to the Center of Excellence Spine program through the Comprehensive Spine Center at Geisinger, in 2024.  Members experiencing new or ongoing neck or back pain, who are considering or have been recommended for surgery, will need to use the Center of Excellence Spine program for any resulting spinal surgery to be covered at the lowest possible cost-sharing. Members will have higher cost-sharing if they receive spinal surgery services at non-Geisinger facilities.

Network group cost-sharing exception process

Under certain circumstances, medically necessary services rendered by a Group 2 provider may be paid at the Group 1 benefit level when a network group cost-sharing exception request is approved by GHP medical management.

You can request a network group cost-sharing exception for members under the following circumstances:

  • When a Group 1 provider sees the member at a Group 2 office/facility
  • When a Group 2 provider sees the member at a Group 1 office/facility
  • When a particular service or specialty is not available from a Group 1 provider
  • When a member is unable to schedule an appointment or reasonably access a Group 1 provider for needed services when those services are otherwise available from a Group 2 provider

There may be additional circumstances under which you may request a network group cost-sharing exception for a member. It’s important to thoroughly document the reasons why a member should receive the exception during the request process.

Urgent admissions will automatically incur the Group 1 cost-sharing regardless of rendering provider group designation. The network group cost-sharing exception process does not affect existing prior authorization requirements. Be sure you obtain prior authorization for all services identified on GHP’s prior authorization list.

How to request a network group cost-sharing exception

Network group cost-sharing exceptions must be obtained by the provider — not the member. Fax the request and supporting information to medical management at 570-271-5534.

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