Tompkins Cortland Community College Plan Information

Benefit Summary	Summary of Benefits & Coverage	Prescription Plan*
PPO $10/$35 (3T7) Classic Blue 100/200 (3T7) Platinum Plan Gold Plan Silver Plan Bronze Plan	PPO $10/$35 (3T7) Classic Blue 100/200 (3T7) Platinum Plan Gold Plan Silver Plan Bronze Plan	$ 5/20/35 Retail $ 10/40/70 Mail $ 5/20/35 Retail $ 10/40/70 Mail $ 5/35/70 Retail $ 10/70/140 Mail $ 5/35/70 Retail $ 10/70/140 Mail After Deductible $ 5/35/70 Retail $ 10/70/140 Mail After Deductible $ 0 Copay After Deductible/ Maximum Out of Pocket is Met
Medicare Supplement MS4		$ 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}

Employee & Retiree & Wellness Information