Geisinger Health Plans

Geisinger Marketplace Extra HMO 10/50/4500

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Links

Plan Overview

Medical Deductible	Individual: 4500 Family: 9000 Per Person: 4500
Prescription Drug Deductible	Individual: 500 Family: 1000 Per Person: 500
Medical Out-of-Pocket Maximum	Individual: 7400 Family: 14800 Per Person: 7400
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Office Visit

Primary Doctor	Standard: $10 Copay
Specialist	Standard: $50 Copay

Prescription Drug Information

Preferred Brand Drugs	Standard: $45 Copay after deductible
Non Preferred Brand Drugs	Standard: $80 Copay after deductible
Generic Drugs	Standard: $20 Copay
Specialty Drugs	Standard: 50% Coinsurance after deductible

Inpatient Coverage

Hospital Services	Standard: 30% Coinsurance after deductible
Inpatient Services	Standard: 30% Coinsurance after deductible

Emergency and Urgent Care

Emergency Room

Standard: $300 Copay after deductible

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