Member FAQs

It can take 7-10 days to receive a new card.

You can request a new card and print a temporary ID card through the member portal.

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 emergency care if care can't wait. Call 911 or go to the nearest emergency room for treatment of life-threatening issues such as:

• Difficulty breathing
• Chest pain
• Poisoning
• Sudden/severe pain
• Uncontrolled bleeding
• Fainting

If you have an emergency while traveling, emergency room services are covered worldwide. It must be an emergency room, not a convenient care/urgent care clinic.

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, make every effort to use a participating provider and assist in the transfer as much as your condition allows.

If you need urgent or emergency care outside the Geisinger Health Plan network, you'll be transferred to a network facility as soon as your condition stabilizes and the emergency situation is under control.

Your PCP gives a referral for you to see a specialist. A prior authorization gives permission for a service or medication.

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 they can continue to direct your care appropriately.

• Behavioral health services
  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 other substance dependency provider for outpatient and/or inpatient substance use disorder services without first seeing your provider.
  
  Please note that any non-routine outpatient services or any inpatient services require a prior authorization. Members should contact the Behavioral Health Care Connector team at 888-839-7972 to discuss a providers' network status or if services require a prior authorization.
  
  
• Women's health services
  Women do not need a referral in order to schedule an appointment with a participating obstetrician or gynecologist.

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

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

Visit the member portal to check your benefit documents for more details or call the number on the back of your ID card to confirm what inpatient and outpatient procedures require precertification to be covered.

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.

View the list of covered preventive health services.

If your doctor provides medical services during your preventive care visit that aren’t 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. Visit the member portal to view your plan materials for specific details about your plan coverage.

View all covered Medications.

If you'd like to ask GHP to consider covering a drug that isn't available on your formulary, you can request a formulary exception. Pennsylvania state law requires that all formulary exceptions are initiated by a physician.

To begin the process, sign in to the member portal and send us a secure message to request a formulary exception. A representative will review your request and contact your physician for you.

As a member of GHP, you can save on a variety of health-related products and services, amusement park tickets, golf lessons and more. You won't need a referral, only your GHP membership ID card. Sign in to the member portal to access the local and national discounts program.

Routine office visits to your PCP require a copay as specified on your ID card. If not listed on your ID card, sign in to the member portal and check your Schedule of Benefits.

Emergency services require the emergency room copay listed on your ID card or policy's Schedule of Benefits. They're limited to the annual Maximum out-of-pocket (MOOP) amount, also on the Schedule of Benefits.

The total amount you might pay out of pocket for covered healthcare services within a certain period, typically a year. Once you reach this limit, your insurance covers the rest.

You can make your premium payment online, by phone or by mail.

If you're no longer covered under your employer's plan, you can convert to individual coverage. Find an insurance plan that fits your needs.

For security reasons, you must be an active member to access the secure 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.