Silver Standard Plus 3 by Excellus
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Plan Information
- Plan Name
- Silver Standard Plus 3
- Insurance Company
- Excellus
In Network Benefits
- Office Co-pay
- $35
- Specialist Co-pay
- $55 after deductible
- Hospital Co-pay
- $1,500 after deductible
- Emergency Room
- $250 after deductible
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $10/$40/$80
- In-Network Deductible (single/family)
- $1,875/$3,750
- In-Network Co-Insurance
- 0%
- Max Out of Pocket (single/family)
- $8,150/$16,300
Out Of Network Benefits
- Co-Insurance
- N/A
- Deductible
- N/A
- Out of Pocket Max (single/family)
- N/A
Other Benefits
- Vision/Dental
- Pediatric Vision Only
- Renewal Date
- 12-31-2020
- HSA Eligible
- No
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