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Important questions

Have a question about your plan or the Geisinger Gold annual wellness gift card? Need a new ID card? The answers to your questions may be covered here.

Geisinger Gold annual wellness gift card frequently asked questions: 

If you’re a Geisinger Gold member with a Jan. 1, 2024, effective date, you should have received your member ID card. Next, we encourage you to schedule and complete an annual wellness visit — you’ll receive a $40 gift card. Questions? Find answers below.

Do I need to activate the ID card to get the gift card?

You don’t need to activate your ID card to begin using your benefits. To receive the gift card, you need to schedule and complete your annual wellness visit. Once you’ve done both these things, we’ll send you a $40 gift card.

How do I schedule my wellness visit, and whom should I see?

You’ll see your primary care provider (PCP). Just contact them to make an appointment. They’ll let us know when your visit is completed.

What if I had my annual wellness visit already? Do I still receive a gift card?

Annual Medicare wellness visits are a yearly benefit, and you’re eligible for one per benefit year. You’ll receive your gift card once you complete your 2024 visit.

 

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Questions about your plan

How long does it take to get an ID card?

It can take seven to ten days to receive a new card.

I lost my member ID card. Can I request a new one?

You can request a new card and print a temporary ID card if you have a member portal account. Log in here.

What’s the difference between urgent and emergent care? 

Use urgent and convenient care facilities if your doctor is not in the office and you have:
  • Accidents/falls
  • Sprains/strains
  • Fever/flu
  • Minor broken bones
  • Vomiting/diarrhea
  • Skin rashes
  • Eye irritation

Use emergent care if care can’t wait. Call 911 or go to the nearest emergency room for treatment of life-threatening issues:
  • Difficulty breathing
  • Chest pain
  • Poisoning
  • Sudden/severe pain
  • Uncontrolled bleeding
  • Fainting

When is emergency coverage provided?

Should you have an emergency while traveling, emergency room services are covered worldwide, but it must be an emergency room and not a convenience/urgent care clinic.

Is emergency transportation covered? What about when I'm outside the Geisinger Health Plan network?

In an emergency, or when approved by a Geisinger Health Plan medical director, transportation by land or air ambulance is covered. If you need emergency transportation services, you must make every reasonable effort to request services provided by a participating transportation provider to a participating provider and assist in such transfer to the extent physically able or medically possible.

If you seek urgent or emergent care outside the Geisinger Health Plan network, you’ll be returned to a network facility as soon as possible after your emergency situation is over and your condition stabilizes.

When may I see a provider, other than my PCP, without first getting a referral?

Depending on your plan, you may not need a referral from your PCP to see another participating provider. However, always inform your PCP if you decide to see another provider so that they can continue to direct your care appropriately.

Most members do not need a referral to gain access to a participating mental health provider or facility for outpatient services. 

You may seek care from a participating alcohol or chemical dependency provider for outpatient and/or inpatient substance abuse services without first seeing your provider.

Women do not need a referral in order to schedule an appointment with a participating obstetrician and gynecologist.

If my plan requires referrals, can I see more than one specialist using the same referral to a like specialty?

Yes, referrals are written by specialty not a particular doctor. Depending on your plan you will need an active referral to see a doctor in the specialty. Check you benefit documents for further details or call the number on the back of your member ID card.

How long is a referral effective?

18 months, generally.

What’s a precertification and why do you need it for services to be covered?

A precertification is a decision made by your health plan provider that a particular service or medication is medically necessary.

All non-emergency hospital admissions and certain outpatient procedures require precertification to be covered.

What is the difference between a referral and a prior authorization?

A referral is given by your PCP to see a specialist while a prior authorization gives permission for a service or medication.

Does GHP cover flu shots and vaccinations?

Yes, we offer immunization programs and other preventive services to adults, adolescents and children.*
 

*Many of these preventive services are covered with no member cost sharing when obtained from a participating/preferred doctor, unless otherwise noted.

If your doctor provides medical services during your preventive care visit that are not included in the preventive care list, these items will be considered under your standard medical plan coverage. This means you may be responsible for cost sharing. 

See your plan materials for specific details about your plan coverage.

What copayments am I responsible for?

Routine office visits to your PCP require a copay as specified on your ID card. If not listed on your ID card, check your Schedule of Benefits. 

Emergency services are subject to the emergency room copay listed on your ID card or policy’s Schedule of Benefits. They are limited to the annual aggregate maximum copayment amount, also on the Schedule of Benefits.

What medicines are covered by my plan?

Search to see all covered medicines.

How do I request a formulary exception?

If you would like to request that the Health Plan consider covering a drug that is not currently available on our formulary, you can request a formulary exception. Pennsylvania state law requires all formulary exceptions to be initiated by a physician. To begin the process, log in and send us a secure message to request a formulary exception and a representative will then review your request and contact your physician.

How do I get discounts offered through GHP?

As a member of Geisinger Health Plan you have access to a variety of discounts for health related products and services, amusement park tickets, golf lessons and more. To use our "Local Discounts" program, all you need is your Geisinger Health Plan membership ID card. You do not need a referral. Log in to get started. 

I received a monthly premium payment bill in the mail. Where do I mail my payment?

The easiest way to make payments is to log in and use our online premium payment tool.
 
You can also pay your premium over the phone by calling customer service at the phone number found on the back of your ID Card.
 
If you prefer to mail your payment, please remit your payment to the following address:

Geisinger Health Plan
P.O. Box 829703
Philadelphia, PA 19182

This address will receive payments for all plan types.

What happens if I lose my employer-provided health insurance coverage?

If you’re no longer covered under your employer’s plan, you can convert to individual coverage. We have insurance plans to fit your needs.

I no longer have coverage with the plan, but wanted to log in to see my claims history. Why can’t I log in?

For security reasons, you must be an active member to access the secured member portal. Our customer service team can provide claims history information or answer any other questions you might have. Call them at the number listed on the back of your member ID card. If you no longer have your ID card, contact us for help.

Related information

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