SimplyBlue Plus Silver 19 by Excellus
Scroll down to the Summary of Benefits PDF
Plan Information
- Plan Name
- SimplyBlue Plus Silver 19
- Insurance Company
- Excellus
In Network Benefits
- Office Co-pay
- $25 after deductible
- Specialist Co-pay
- $50 after deductible
- Hospital Co-pay
- $500 after deductible
- Emergency Room
- $300 after deductible
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $5/$45/$90 after deductible
- In-Network Deductible (single/family)
- $2,250/$4,500
- In-Network Co-Insurance
- 0%
- Max Out of Pocket (single/family)
- $6,550/$13,100
Out Of Network Benefits
- Co-Insurance
- 40%
- Deductible
- $2,250/$4,500
- Out of Pocket Max (single/family)
- $6,550/$13,100
Other Benefits
- Vision/Dental
- Pediatric Vision and Dental; Adult Vision Only
- Renewal Date
- Annual
- HSA Eligible
- Yes
Check if you qualify for this Health Insurance plan:
Or give us a call, our expert agents will be happy to assist you. It's toll-free!