Geisinger Health Plans

Geisinger Marketplace All-Access PPO 30/60/4900

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Links

Plan Overview

Medical Deductible	Individual: $4,900 Family: $9,800 Per Person: $4,900
Prescription Drug Deductible	Individual: $500 Family: $1,000 Per Person: $500
Medical Out-of-Pocket Maximum	Individual: $9,100 Family: $18,200 Per Person: $9,100
Drug Out-of-Pocket Maximum	Individual: Included in Medical Family: Included in Medical Per Person: Included in Medical

Office Visit

Primary Doctor	Standard: $30 Copay
Specialist	Standard: $60 Copay

Prescription Drug Information

Preferred Brand Drugs	Standard: $50 Copay after deductible
Non Preferred Brand Drugs	Standard: $85 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