| Benefit Summary | Summary of Benefits & Coverage | Prescription Plan* |
|---|---|---|
| Classic Blue 100/200 (3T10) | Classic Blue 100/200 (3T10) | $15/30/45 Retail $30/60/90 Mail |
*Prescription Plan is linked to Drug Formulary
* To view Participating Providers and your subscriber information please sign on to your Excellus account