Bassett Preferred Silver NS by Excellus
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Plan Information
- Plan Name
- Bassett Preferred Silver NS
- Insurance Company
- Excellus
In Network Benefits
- Office Co-pay
- $30 after deductible
- Specialist Co-pay
- $50 after deductible
- Hospital Co-pay
- $1,250 after deductible
- Emergency Room
- $250 after deductible
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $10/$45/$90
- In-Network Deductible (single/family)
- $1,800/$3,600
- Max Out of Pocket (single/family)
- $5,400/$10,800
Out Of Network Benefits
- Co-Insurance
- N/A
- Out of Pocket Max (single/family)
- N/A
Other Benefits
- Vision/Dental
- Pediatric Vision
- Renewal Date
- 01/01/2018
- HSA Eligible
- No
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