Now that the introductions are out of the way, I’m excited to have Nick and Brad here from Geisinger to walk us through Geisinger’s GFA product. I hope you find this presentation valuable. The GFA product is something we’re actively promoting, especially with their new Cigna network integration. It’s a strong offering, and I think you’ll find it beneficial.

With that, I’ll turn it over to Nick to properly introduce himself.

Thank you, Elise, and good morning, everyone. As mentioned, my name is Nick Gamo, and I’m the Commercial Small Group Manager at Geisinger. Today’s presentation will focus on the Geisinger Funding Alternative (GFA) and how you can position it as an additional product to offer your groups throughout our Pennsylvania service area. However, with the recent news that Geisinger will now be using the Cigna PPO network for our PPO plans effective June 1st, I’ll begin by reviewing our service area and how this enhancement expands access.

Our current service area includes all the counties shaded in blue on our coverage map. Businesses must be located in one of those counties to offer a Geisinger Health Plan. The counties shaded in green are technically outside our service area, but they include providers and hospitals that are part of our extended network. For example, Philadelphia hospitals are part of our network footprint even though Philadelphia County may not be within the primary service area.

Geisinger offers three network options across our ACA plans, level-funded GFA plans, fully insured plans, and ASO plans. For today’s purposes, we’ll focus on the GFA. Our broadest network is the All-Access Network, which has historically been our most widely used option. This includes access not only to Geisinger providers and facilities but also major names such as Lehigh Valley, Hershey Medical Center, St. Luke’s, Johns Hopkins, and the Philadelphia hospitals like CHOP, Wills Eye, and Penn Medicine.

On the opposite end, we offer the Premier Network, which is a more limited, cost-effective option that primarily includes Geisinger providers and hospitals along with select partners like St. Luke’s, Hershey, and Johns Hopkins. In the middle, we have a hybrid tiered network structure. Tier 1 includes Premier Network providers and offers lower deductibles and copays. Tier 2 utilizes the broader All-Access Network but with slightly higher member cost-sharing. As a result, pricing for the tiered network falls between the All-Access and Premier options.

We also have a flyer available showing the All-Access hospital network. In our full service area—both the blue and green shaded counties—you’ll find that nearly every major facility is included and accepts Geisinger. The only significant exception that comes to mind is UPMC Bedford in Bedford County, which does not participate in our network and would therefore be considered out-of-network under current conditions.

Starting June 1st, we will begin using the Cigna PPO network as our wrap network, replacing the First Health network. This change applies to out-of-area members and employees who currently rely on First Health for out-of-network benefits. With this update, all employees—whether located in central Pennsylvania near a Geisinger hospital or on the geographic fringe—will have access to the Cigna PPO network.

Cigna is one of the most widely recognized and robust national networks. It includes over 1.5 million providers and 6,500 hospitals. More importantly, Cigna offers a superior claims experience compared to First Health, providing a smoother and more reliable member experience.

Here's how this integration works: In Pennsylvania, the counties in our service area will continue to use the Geisinger network. The gray-shaded areas on our updated maps represent hospitals and counties outside Geisinger’s footprint—like UPMC in Pittsburgh—which do not currently participate with Geisinger. These services will now fall under the Cigna network. The Cigna logo will appear on our member ID cards, allowing access to in-network benefits at Cigna-participating facilities. For members on Premier and Choices networks, Cigna-participating providers located outside the Geisinger area will automatically fall into Tier 1, offering favorable cost-sharing.

In simple terms: if a member is within the Geisinger service area, they’ll use Geisinger providers. If they’re outside the area, they’ll use Cigna. Members won’t need to take any extra steps; their ID card will contain everything they need to access care. For PPO plan members, services accessed through the Cigna network will be treated as in-network. This effectively gives us a national network footprint.

On the HMO side, dependents who live outside of the Geisinger area will have access to Cigna through the HMO plan. However, employees who live out of the area must be placed on a PPO plan to meet our standard out-of-area eligibility rules. HMO members living within the service area will continue to use the Geisinger network exclusively.

There was a question in the chat about whether there’s an enrollment requirement to gain access to Cigna. That’s a great question. While our out-of-area requirements remain in place—we still require at least five enrolled employees and no more than 40% of them residing out of the area—there is no additional requirement to access the Cigna network. Any group enrolled with Geisinger will automatically gain access to Cigna.

This means even a small group of five, such as a business where the owner needs a scan every six months at Sloan Kettering in New York but is otherwise located in Geisinger’s core area, can now confidently choose Geisinger and still access that care through Cigna. There are no additional requirements beyond our standard eligibility rules.

If you want to verify a provider's participation in the Cigna network, it’s easy. Just visit cigna.com and use the “Find a Doctor” tool. Be sure to select the PPO network at the bottom of the search settings to get the correct results.

That wraps up the Cigna portion. If there are no further questions, we’ll now move into the core of the presentation—the Geisinger Funding Alternative, or GFA.

The GFA is our level-funded option, available to groups with at least five enrolled employees. It closely follows the structure of our fully insured large group plans. This is especially important for ACA clients, as it allows them to move away from the rigid metal-tier structures where, for example, a Gold plan might now have a $2,000 deductible and specific copay limitations. With GFA, plan designs range from a $0 deductible up to $5,000, with a variety of PPO and HMO options. Regardless of the deductible level, the copays for primary care, specialists, and emergency room visits remain consistent, offering a more flexible and competitive benefits package.

There are four pharmacy plan options available under GFA. When we receive a quote request, we typically map benefits as closely as possible to the group’s current coverage. In most cases—especially when competing against carriers like Capital, Highmark, or Aetna—our benefits end up being more generous, even when compared to their own level-funded offerings.

Another important advantage of our GFA plans is the availability of an implementation credit for groups with at least 10 enrolled employees that are transitioning to Geisinger. We understand that change can come with challenges, so this credit helps ease that process.

When you're getting new ID cards from a new provider, it often feels like Murphy's Law applies—if something can go wrong, it might. Cards may get lost in the mail, or other small issues might pop up. That said, if we find ourselves in a situation where we need to make a group whole—by covering most or even all of the surplus they’d be losing by switching from another level-funded carrier—or if we just need to close the gap a few points to win the business, we do that through an implementation credit.

We started offering implementation credits about a year and a half ago. Sometimes the group needs it, sometimes they don’t—it’s really up to you as the broker to tell us what’s needed to win the business. The implementation credit is not a bait-and-switch where we offer a lower price and then try to make up for it at renewal. It’s a one-time payment made 60 days after the group’s effective date. If the group performs well on GFA, their renewal will reflect that. If they don’t, that will be reflected too. That’s one of the major advantages of moving a fully insured small group over to a level-funded product.

For those unfamiliar, GFA stands for Geisinger Funding Alternative—our level-funded product available to groups with between five and 199 enrolled employees. For smaller groups under five, if they’ve been with Geisinger on a fully insured ACA plan for at least a year and have two or more enrolled employees, they can be offered a GFA renewal at that time. We've seen groups perform very well under this model. Unlike in the ACA market, where small groups often face annual increases due to broader risk pool performance, these GFA groups are sometimes seeing rate decreases.

Groups on GFA can choose from standard benefit plan designs, ranging from $0 to $5,000 deductibles. These designs include fixed costs and an aggregate claims estimate based on underwriting. For small groups, there's a $30,000 specific stop-loss deductible. So, if one employee has high claims, once they hit $30,000, additional claims for that individual won’t impact the group’s aggregate claims pool.

We use a 110% risk corridor, meaning we estimate expected claims and add 10% as a buffer. If the group stays within or under this threshold, they are eligible for a surplus return. This is done via an experience credit, and the group must renew in order to receive it.

Let’s say we estimate a group’s aggregate deductible to be $100,000, and by the end of the year, they only use $50,000 in claims. That creates a $50,000 surplus. Most groups choose the 50% return option, as it comes with a lower premium upfront. In this case, the group would receive $25,000 back. Additionally, one of the fixed costs in our plan is a terminal liability reserve. This covers claims incurred during the plan year but submitted after the group has terminated coverage—up to four months after the end of their contract. So if the group decides not to renew with Geisinger, they still have no further liability for prior claims.

Many of you have likely worked with other level-funded products like Aetna's AFA or Capital's ASO and stop-loss models. But for those newer to level funding, you should know that over half of our small group clients are now on GFA. It's a compelling option, especially for ACA groups. If it doesn't work out, they can treat it as a one-year savings opportunity and return to traditional ACA plans. With GFA, you return to a five-tier rating structure where every employee in a specific tier pays the same rate.

GFA clients also receive monthly utilization reports that show what they’ve paid into the plan and what has been paid out in claims. While these reports don’t show member-level detail, they do provide a helpful overview of the group's performance. Ultimately, GFA puts the group in control of its own destiny. If they utilize our wellness programs, participate in on-site visits to manage chronic conditions, and work with Geisinger doctors, they’re likely to see improved outcomes and lower renewal rates. Because Geisinger is an integrated health system, our doctors and insurance teams work closely together to manage care effectively—often resulting in healthier members and lower costs.

So, for a group that’s used to annual 5%, 10%, or even 12% increases because of ACA age bands or carrier rate filings, GFA offers an alternative. If their employees are generally healthy and don’t frequently use their insurance, GFA can be a plan that actually saves them money—and offers the potential for a surplus return at the end of the year.

Now, to answer Dustin’s question about the 100% surplus return option versus the 50% option: yes, we do offer both, and the 100% option does come with a higher premium. Unfortunately, it's been a while since we've had a request for the 100%, so I can't give you an exact difference in cost. It is more expensive, but I’d be guessing if I quoted a specific figure.

To follow up on that, another great question came up—can we request both the 50% and 100% surplus return options when quoting? The answer is yes. While I don’t often request the 100% either, there’s no harm in asking for both. In fact, it might help give you and the client a better idea of the cost difference. So, feel free to request both options until we’re told otherwise by underwriting.

We also shared an example of one of our standard benefit designs—a $1,000 deductible with office visit copays of $20 and $45, and a $150 emergency room copay. This plan is often the lowest-cost option compared to similar benefits from other carriers. It follows the same format as our fully insured mid-market or large group plans.

For smaller groups—up to 99 enrolled—the specific deductible is still $30,000 with a 12/12 contract. If they leave, the terminal liability reserve covers run-out claims for four additional months. The surplus return, again, applies to anything under the aggregate attachment point, and 50% of that surplus is typically returned within 60 days, as long as the group renews with GFA or even shifts to an ACA plan within Geisinger. If they leave Geisinger altogether, they forfeit the surplus. The contract must be active for a full 12 months for the surplus to be payable.

That brings us to what you need to quote this product—which offers tiered rates, potential money back, implementation credits, and the ability to see premium decreases for well-performing groups. For the small group segment, with at least five enrolled employees in an eligible county, all we need is a census and a copy of their renewal.

As for the census format—no specific template is required. It just needs to include the employee’s name, date of birth, zip code, and preferably gender. If you’re not sure how to submit it or what’s needed, reach out to your assigned representative at URL, such as Courtney or Jackie. They can send you the correct paperwork and checklist, which is also available in the handouts.

We’ve recently started using RX and medical claims data in our underwriting process. This data is de-identified and used to assign a score to each group, which helps us assess risk more accurately. If a group scores well—meaning no major expected claims or high-risk individuals—underwriting can incorporate that into pricing to give the most competitive rate possible.

While we can’t guarantee that every quote will come back looking better than a group’s current plan, it’s always worth taking a look. Some ACA groups, particularly those with around 40 or more members, may not be in level-funded products for a reason. But submitting a quote never hurts. When you submit a census through BenefitsCensus and select Geisinger, remember that in some counties—especially in areas like Harrisburg, Lancaster, York, Huntingdon, and Cumberland—our ACA rates just aren’t competitive. For now, Geisinger’s ACA pricing may not be the strongest option in those counties, which is why GFA becomes your best shot at offering Geisinger competitively.

Since GFA isn’t currently listed on the EF system within BenefitsCensus, you’ll want to submit quotes directly through your contact at URL. All you need is the group’s renewal and a completed census. From there, our team can generate a GFA quote alongside the ACA option, giving you something meaningful to present. This applies whether the group is currently on ACA, a grandmothered plan like Highmark in the northeast, or a level-funded plan with another carrier. Across the board, we are seeing success and winning groups with GFA.

Now, you may have noticed that not all 44 counties in Geisinger’s service area are eligible for this style of quoting yet. Counties like Centre and Susquehanna are not currently included, but we are working to expand this methodology in the near future. If you’re quoting in a county that isn’t listed, there may be more requirements to fulfill. Elise’s team can walk you through what’s needed, and there’s also a checklist available to guide the process.

On the commission side, for ACA business, brokers are paid $50 in year one, $32 in year two, and $30 in year three. For GFA, we default to $30 PMPM. That said, you’re not locked in at 30. If you need more—whether it’s 36, 42, or even as high as 75—just ask. We’ve won cases where the commission exceeded 30, and we want to make sure you’re taken care of. On the flip side, you can also go below 30 if that works better for a specific case or market.

We’ve had some questions about whether Geisinger can cover employees in other states. The answer is yes, with some parameters. The group’s headquarters—or the physical location the business is written under—must be in Geisinger’s 44-county Pennsylvania service area. Beyond that, the group can have employees in other states, like Maryland or California, as long as those out-of-state employees make up less than 40% of the total population on the plan. So if a group is based in York County and has a handful of remote employees out of state, we can still write that group as long as the numbers work.

Another question came in about whether brokers can write coverage for employees from different companies under one group plan. The answer is no, unless those companies share common ownership. It has to be a true employer-employee relationship with W2 employees. So if someone owns multiple businesses—say a KFC, Taco Bell, and Burger King across different counties—they can offer one plan that covers all employees, but only if all businesses are commonly owned and all employees are offered the same benefits. Everything must still align with FTE counts and group size rules, but this structure is allowed and often used.

There was also a question about new businesses and eligibility for GFA. To qualify, a business must have been in operation for at least two years. They do not need to currently offer health insurance. Even if they have no group claims history, individual members within the group may have received services under other coverage. As long as the business itself has a two-year operating history, we can write the group.

Some additional fine print to note: groups must go through a credit check and meet a minimum score to be eligible. This is critical because while the monthly premium stays fixed, a portion of that payment goes toward future claims. If the group fails to pay premiums on time, it disrupts the claim-funding process. That’s why we don’t offer much of a grace period. Premiums must be paid via ACH—either through a business account or a dedicated secondary account. We do not accept checks or credit cards. This structure ensures claims can be paid without delay.

In some counties, or for groups without any health coverage history (virgin groups), we may need medical questionnaires. The GFA checklist outlines these requirements clearly, so you’ll know exactly when those questionnaires are necessary and when they’re not.

Another incentive to note is our current broker bonus. We are offering $100 per subscriber on all new business in the 1–50 market segment, regardless of which product is selected. This may change in the fall, but it’s currently active and available.

I also want to make a quick note about our HMO plans. Across all platforms—GFA, ACA, small group, large group—our HMO plans do not require referrals. That’s true whether it's for primary care, specialists, or included services like refractions and impacted wisdom teeth. These are standard benefits, not extras.

Starting June 1st, Geisinger members will also have access to a national network through Cigna’s PPO. This means GFA members can now use providers across the country where the Cigna PPO is accepted, all while carrying the same Geisinger ID card. This is a major benefit for groups with employees outside of Pennsylvania. Geisinger may not be processing those out-of-state claims directly, but the network access is seamless for the member.

To wrap things up, most group health decisions come down to three key factors: cost, network access, and benefit design. Geisinger has always led in terms of benefits, but ACA disrupted the small group space by removing medical underwriting and limiting flexibility. GFA brings that flexibility back. Groups get tiered composite rates, fixed monthly premiums, better-than-ACA benefits, wellness tools, and the potential for surplus returns.

One final and important distinction: we do not bucket or blend our renewals. If a group performs well—say they receive a $20,000 surplus when $5,000 was expected—that result is reflected in their renewal. We do not smooth that out across pooled groups. Your clients’ renewals are based on their performance, not the average of others.

Thank you again to everyone who joined the session or is watching this later. We’re excited about GFA and what it offers your groups, and we’re always here to help. If you have questions or need help quoting, just reach out to Courtney, Jackie, or your contact at URL. We’ll make sure you get what you need.