| Benefit Summary | Summary of Benefits & Coverage | Prescription Plan* |
|---|---|---|
| Platinum Plan | Platinum Plan | $ 5/35/70 Retail $10/70/140 Mail |
| Gold Plan | Gold Plan |
$ 5/35/70 Retail After Deductible |
| Bronze Plan | Bronze Plan | $0 Copay After Deductible/ Maximum Out of Pocket is Met |
*Prescription Plan is linked to Drug Formulary
To view Participating Providers and your subscriber information please sign on to your Excellus account