Geisinger Health Plan does not cover costs related to COVID-19 surveillance testing for purposes such as work, school or travel.

• Diagnostic tests: Members currently do not pay for a diagnostic COVID-19 test. Members also do not pay a visit fee to a primary care provider (PCP), urgent care center or emergency room if they are tested for COVID-19. These cost waivers will remain in effect until May 11, 2023, when the federal PHE ends, and cost-sharing goes into effect.
• Cost-sharing will be applicable starting May 12, 2023, for most Geisinger Health Plan members including self-insured/third party administrator groups.
• Vaccine and testing cost-share waivers will remain in place through Sept. 30, 2024, for GHP Family (Medicaid) and GHP Kids (CHIP) members.

Effective May 12, 2023, Geisinger Health Plan will no longer cover at-home COVID-19 tests.

• Geisinger Health Plan will continue to cover at-home tests with no cost share for GHP Family and GHP Kids through Sept. 30, 2024.

Geisinger is administering COVID vaccines in accordance with state and federal recommendations. After the PHE ends, starting May 12, 2023, employees can go to their doctor, local pharmacy, or other health care provider that administers vaccines.

• There will be no cost-sharing for Geisinger Health Plan members to receive the vaccine. If a member goes out of network their standard coverage and cost sharing rules will apply.

COVID-19 antibody testing will be covered if a member:

• Had symptoms consistent with COVID-19 infection but tested negative
• Recovered from a documented COVID-19 infection and is now considering plasma donation
• Is a child with suspected multisystem inflammatory syndrome in children (MIS-C)

Through May 11, 2023, we’re allowing early refills for 30- or 90-day prescriptions at retail pharmacies. Members should ask about and use home delivery, when available, for their prescriptions. We are also allowing early refills on 90-day prescriptions from our mail order pharmacy, which delivers directly to the member’s home at no extra cost. Early refills are available for controlled substances but will not apply for prescriptions that contain opioids outside of certain conditions.

Yes. Through May 11, 2023, Geisinger Health Plan is relaxing its requirement that employees be actively working to be eligible for coverage and will allow you to continue coverage for laid-off employees. Note that this is subject to all monthly premiums being paid and coverage offered on a uniform, non-discriminatory basis. You may not choose only certain people for whom you continue coverage and pay premium.

After the PHE ends, Geisinger will resume pre-pandemic coverage policies and processes.

If at least one person remains employed by the company and covered by the plan (e.g., the owner or a management employee), the company can continue to cover laid-off employees through May 11, 2023, if premium is paid. Note that you must offer this coverage on a uniform, non-discriminatory basis. In other words, you may not choose only certain people for whom you continue coverage and pay premium.

After the PHE ends, Geisinger will resume pre-pandemic coverage policies and processes.

If your group is subject to COBRA and one person remains actively employed, employees may elect to continue coverage under COBRA under the normal notice and election procedure. If Geisinger Health Plan is your stop-loss carrier, we will not limit the number of COBRA participants under the stop-loss policy through May 11, 2023. If Geisinger Health Plan is not your stop-loss carrier, check with your stop-loss carrier about any rules it may have regarding minimum enrollment of active employees for stop-loss coverage. If the plan has no active employees, the plan is terminated, and COBRA is not an option. In that case, employees would have a special enrollment period to enroll in individual or other coverage (e.g., through a spouse).

This exception will expire on May 11, 2023.

Through May 11, 2023, if the loss of enrollment is a result of the COVID-19 pandemic, rates and premiums will not be adjusted due to enrollment change.

After the PHE ends, Geisinger will resume pre-pandemic coverage policies and processes.

Yes. An employee returning from layoff or leave is eligible to enroll if they were not covered by Geisinger Health Plan before their departure and they meet eligibility criteria. When the new application is submitted, write “recalled from layoff” across the top. The effective date will be the day they return to work.

Yes. An employer group could waive part or all of the new hire probationary period and allow employees to enroll in coverage earlier.

Coverage will end on the last day of the last month for which we received premium payment unless otherwise noted on the Geisinger Health Plan Change Form. The employer’s request should indicate the last day of coverage.

An employee returning from layoff or leave is eligible to enroll if they were covered by Geisinger Health Plan before their departure and they meet eligibility criteria.

When the new application is submitted, write “recalled from layoff” across the top. The effective date will be the day they return to work.

Effective July 10, 2023, 60 days after the end of the PHE, COBRA rules will revert to what they were pre-pandemic. Employers will no longer exclude March 1, 2020, to May 11, 2023, when making the determinations about:

• The 60-day election period for COBRA continuation coverage
• The date for making COBRA premium payments
• The deadline for employers to provide individuals with notice of their COBRA continuation rights
• The 30-day Special Election Period to request enrollment in a group health plan
• The timelines for filing claims under the plans’ claim processing procedures
• The deadlines for requesting internal and external appeals for adverse benefit determinations

Once the PHE ends, cost-share for both testing and treatment will apply per the plan’s standard cost sharing and coverage rules.

Geisinger Health Plan can offer ACA-compliant individual plans for those who have been laid off and lost employer-sponsored coverage, and those people may be able to benefit from premium subsidies (advanced premium tax credits). Those interested in an individual plan should call 800-918-5154 to speak with a Geisinger Health Plan individual sales center associate. We can help them determine whether they qualify for premium subsidies to help reduce their monthly premium and, when applicable, can also refer those with qualifying income to be evaluated for Medicaid eligibility.

If you have furloughed employees/members who are 65 years of age or older, have them call Geisinger Gold at  877-821-5056 as soon as possible to review their options with one of our Medicare Advantage plans. We offer all-in-one $0 deductible health plans that include prescription drugs, as well as optional supplemental benefits such as dental, vision, hearing and even gym memberships all with monthly premiums as low as $0.

Pennie^®, the state insurance marketplace, will determine the earliest allowable effective date, which may be the first day of the following month. For plans sold off the marketplace, accelerated effective dates may be available. If someone is interested in an individual plan, they can call 800-918-5154 to speak with our Marketplace team. Note that premium subsidies may be available for plans purchased on Pennie. Premium subsidies are not available for off-exchange plans.