Get to Know Geisinger Gold's Classic Advantage Rx Plan

Annual Certification for 2022

Classic Advantage Rx plan benefits at-a-glance

• Premium: varies (see county breakdown below)
• Annual deductible: $0
• Maximum out-of-pocket (MOOP): $3,450
• Office visit (PCP/specialist): $0/$20
• Inpatient hospital care – acute: $150/day (days 1–5) not to exceed $750 annually, $0/day (days 6–90)
• Dental (prevented and comprehensive): Exam: $0, 2/year, X-rays: $0, 1/year
• Vision: Exam: $20, 1/year, eyewear: $200 benefit limit per year
• Hearing: Exam: $20, 1/year, hearing aids: $500 copay/ear, $1,250 limit per ear every 3 years
• Fitness: $90/every 3 months
• Vaccines: $0
• Teladoc e-visits (PCP): $

Your clients’ premiums will vary depending on their county.

Here’s how prescriptions will break down:

• 30-day retail copay:

• ~~Tier 1 – $3
• ~~Tier 2 – $20
• ~~Tier 3 – $47
• ~~Tier 4 – $100
• ~~Tier 5 – 33%
• ~~Tier 6 – $0 vaccines

• 100-day retail copay:

• ~~Tier 1 – $7.50
• ~~Tier 2 – $50
• ~~Tier 3 – $117.50
• ~~Tier 4 – $250
• ~~Tier 5 – Not available

• 100-day mail order copay:

• ~~Tier 1 – $0
• ~~Tier 2 – $0
• ~~Tier 3 – $70.50
• ~~Tier 4 – $150
• ~~Tier 5 – Not available

Need insulin?

• Novo Nordisk:

• ~~Novolin® N
• ~~Novolin R
• ~~NovoLog®
• ~~Novolin 70/30
• ~~NovoLog Mix

• Lantus®
• Levemir®
• Toujeo®
• Tresiba®
• Xultophy®

Other insulin products are not available through this program, but if your brand is on the list and you have your medications delivered to your door, copays have never been lower:

• 1-month supply: $35
• 2-month supply: $70
• 3-month supply: $87.50

Rather pick up your medications in person? Your copays are lower for that option, too:

• 1-month supply: $35
• 2-month supply: $52.50
• 3-month supply: $52.50

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