Town of Ithaca Plan Information

CLASS  Benefit Summary Summary of Benefits & Coverage Prescription Plan*
Actives and Cobra  Signature Platinum 15/25 Copay Signature Platinum 15/25 Copay $  5/35/70    Retail
$10/70/140  Mail
Actives and Cobra $10 PPO $10 PPO $  5/20/35    Retail
$10/40/70  Mail
Retirees Classic Blue Supplement     $ 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