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