| Benefit Summary | Summary of Benefits & Coverage | Prescription Plan* |
|---|---|---|
| Classic Blue 50/150 (3T9) | Classic Blue 50/150 (3T9) | $ 10/25/40 Retail $ 20/50/80 Mail |
| Platinum Plan | Platinum Plan |
$ 5/35/70 Retail |
| Medicare Supplement MS3 | $10/25/40 Retail $20/50/80 Mail |
* Prescription Plan is linked to Drug Formulary.
* To view Participating Providers and your subscriber information please sign on to your Excellus account