GEISINGER HEALTH PLAN Coverage you can count on For individuals and families seeking coverage on Pennsylvania's insurance exchange We’ll help you every step of the way. Call us 800-918-5154 to speak to our dedicated team of trained advisors. Open Enrollment Period: Nov. 1, 2020, through Jan. 15, 2021 Hours: Monday–Friday, 8 a.m. to 7 p.m.; Saturday, 10 a.m. to 2 p.m. Jan. 16, 2021, through Oct. 31, 2021 Hours: Monday–Friday, 8 a.m. to 5 p.m. Due to COVID-19 restrictions, Geisinger Community Place will be closed until further notice. A new election period begins Feb. 15. Are you ready? Pennsylvania has transitioned from HealthCare.gov to its own state-based health insurance marketplace, Pennie™, where you can enroll in or make changes to your Marketplace coverage. The 2021 Open Enrollment Period (OEP) has ended, but the COVID-19 pandemic has affected millions - and that's why Pennie has initiated a statewide Special Election Period (SEP), available to all. The COVID-19 SEP runs from Feb. 15, 2021, through Aug. 15, 2021 Your coverage effective date will be the first day of the following month, even if you apply on the last day of the prior month. The Qualifying Life Event (QLE) that you will select for this enrollment period will be the date you enroll on Pennie’s website yourself or with our team’s help. And, with the recently passed American Rescue Plan Act of 2021 (ARPA), you and your family could qualify for unprecedented financial aid. That means that more Pennsylvanians than ever can save on quality, affordable healthcare. Are you in our service area? Geisinger Health Plan's service area includes the following counties: • Adams • Cumberland • Luzerne • Somerset • Berks • Dauphin • Lycoming • Snyder • Blair • Elk • Mifflin • Sullivan • Bradford • Fulton • Monroe • Susquehanna Visit pennie.com or call • Cambria • Huntingdon • Montour • Tioga 844-844-8040 to find • Cameron • Jefferson • Northumberland • Union information and assistance • Carbon • Juniata • Northampton • Wayne on your health insurance. • Centre • Lackawanna • Perry • Wyoming • Clearfield • Lancaster • Pike • York • Clinton • Lebanon • Potter • Columbia • Lehigh • Schuylkill County restrictions for Premier network plans and Geisinger Extra plans can be found on pages 6 and 7 respectively. 3 Why Geisinger Health Plan? We give you more. Healthcare reform has changed the way you purchase health insurance. What hasn’t changed is our dedication to helping you find the perfect plan to fit your needs and budget. In 2021, we are offering Gold, Silver and Bronze plans. ID cards, premiums, billing, benefit/plan information, Choose from HMO and PPO plans with a variety of application status, removing/adding dependents and monthly premiums and out-of-pocket cost options. In much more. addition, you can choose between two dynamic networks, plus Geisinger Extra, a unique plan designed to save Network of providers you money. We also offer a catastrophic Value plan that Select from our large provider network that includes provides the most basic coverage to people under 30. Plus, Geisinger hospitals and physicians, as well as thousands of you'll get plenty of perks to keep you healthy and well. other providers throughout the service area. Our network includes: Local and nationwide discounts • More than 20,000 primary care and specialty physicians You'll have access to our local and nationwide discounts • More than 120 hospitals program that gives you discounts on health- and • More than 220 urgent and convenient care facilities wellness-related products, such as: • Telemedicine services for one-stop virtual care • Fitness center memberships • Eyeglasses Find a provider online • Contact lenses Go to GeisingerHealthPlan.com/ProviderSearch and enter • Chiropractic care your location and plan type. Your plan type will include • Massage therapy and more your network. Select a category to search from our entire library of applicable providers, or narrow your search by Health management programs searching for providers by name, specialty or location. We offer a number of award-winning health management programs to help our members with chronic conditions. Pediatric dental Members can enroll at no cost and can work with one coverage through of our health managers to better manage their health Avesis conditions. Programs include: Dental coverage for children under the age of 19 is • Asthma • COPD included in our Geisinger Marketplace plans. All pediatric • Diabetes • Quitting tobacco dental benefits are provided by Avesis. • Heart failure • Weight management Pediatric dental plans from Avesis include coverage for Wellness coaching and support the following services: You'll have access to certified wellness coaches who • Routine oral exams and • Extractions support your efforts to quit tobacco, manage weight, cleanings • Repairs and maintenance increase physical activity, decrease stress and improve • X-rays • Anesthesia their lifestyle. There are also numerous online tools that • Fillings • Root canal you can access and complete at your own pace, including • Fluoride treatments • Orthodontia wellness workshops, fitness trackers and a meal planner. After you enroll, you'll receive a Schedule of Benefits. Make sure to review for a more detailed list of covered Customer care services. Call our customer care team at We pride ourselves on our customer care. Our 866-379-4489 with questions about your pediatric Marketplace customer care team delivers a better service dental benefits. experience through one-call resolution. Each customer care team member can assist with questions regarding 4 Things to know before you shop Our plans have distinct names and numbers. Here's how to understand them. Geisinger Marketplace All-Access PPO 20 / 40 / 3000 All of our plan names The first number is the The second number is the The third number is the start with Geisinger primary care provider (PCP) specialty care provider deductible amount. Marketplace. The next copay. (SCP) copay. This means each This is the amount you will part tells you the network A copay is a fixed amount time you visit a specialty care pay for healthcare services name, which will be either you will pay for a covered provider (SCP), you would before your insurance coverage an All-Access or Premier healthcare service, usually pay $40. begins. In the example above, network. The plan type, when you receive the service. you would have to pay $3,000 explained below, is listed In the example above, you for healthcare services before as well. Some All-Access would pay $20 each time you GHP coverage begins. network plans also have a visit your PCP. Geisinger Extra component (see below). What are the different plan types? HMO (health maintenance organization) With an HMO plan, you select a primary care physician (PCP) who will help manage you health and wellness. HMOs generally cost less because you use in-network providers. POS (point of service) With POS, you select a PCP to help coordinate your care. You can see other healthcare providers — in or out of our network. You will pay more for services received from providers outside our network. PPO (preferred provider organization) With a PPO, you do not need to select a PCP. You can see other healthcare providers — in or out of our network. You will pay more for services received from providers outside our network. Geisinger Extra With our Geisinger Extra plans, if you visit a primary care site designated as a “Geisinger Extra” site, you will pay lower office visit copays. Some Geisinger Extra sites are also ProvenHealth Navigator® locations, where extra care is provided because the office is staffed with a Geisinger Health Plan nurse. To find a Geisinger Extra site, visit GeisingerHealthPlan.com/ProviderSearch. Geisinger Extra plans are only available in select counties and can be found on page 7. QHDHP A qualified high-deductible health plan (QHDHP) has lower premiums and higher deductibles than a traditional insurance plan. You must have a QHDHP to have a health savings account. 55 Get to know our network options All-Access network Premier network What is it? What is it? The All-Access network includes all participating The Premier network is a narrow, selective network providers across the entire service area. network made up of the providers with proven track records of providing great care. What are the benefits? With All-Access, members enjoy access to our What are the benefits? entire provider network all with a single level of Health plans using the Premier network cost-share. generally have a lower cost. Key consideration? Key consideration? With broader access and one cost-share level, This network is available in 13 counties1. Only premiums may be higher than with other network services obtained through Premier network options. Some All-Access plans come with the providers will be covered. This network's Geisinger Extra component, giving you additional provider options are limited to a small, care for less. exclusive list. Our All-Access PPO plans give you access to even Visit GeisingerHealthPlan.com/ProviderSearch more providers. to see if your provider is in the Premier network before making your selection. 1The Premier network is only available in the following counties: Carbon, Centre, Columbia, Lackawanna, Luzerne, Mifflin, Monroe, Montour, Northumberland, Schuylkill, Snyder, Union and Wayne. 66 Geisinger Extra: Care you need at a lower cost You can get the care you need in a truly innovative way through Geisinger Extra, which is available through select plans within the All-Access network. When you select a primary care site designated as an Extra site, you will pay lower office visit copays. Some Geisinger Extra sites are also ProvenHealth Navigator® (PHN) locations. At these offices you’ll receive “extra” care because PHN sites include a Geisinger Health Plan nurse who works closely with physicians and office staff to provide additional services. Service area & eligibility Geisinger Extra is available to individuals and families as long as their physical location is in our Geisinger Extra service area.