| Benefit Summary | Summary of Benefits & Coverage | Prescription Plan* |
|---|---|---|
| PPO 15/35 (3T9) | PPO 15/35 (3T9) | $10/25/40 Retail $20/50/80 Mail |
| 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