Benefit Summary	Summary of Benefits & Coverage	Prescription Plan*
PPO $10/ $100 (3T3)	PPO $10/ $100 (3T3)	$5/10/25 Retail $10/20/50 Mail
Platinum Plan	Platinum Plan	$5/35/70   Retail $10/70/140 Mail
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