Silver Select NS by Excellus
Scroll down to the Summary of Benefits PDF
Plan Information
- Plan Name
- Silver Select NS
- Insurance Company
- Excellus
In Network Benefits
- Office Co-pay
- 20% after deductible
- Specialist Co-pay
- 20% after deductible
- Hospital Co-pay
- 20% after deductible
- Emergency Room
- 20% after deductible
- Referrals Needed
- No
- Rx: Generic/Brand/High Brand
- $10/$45/$90
- In-Network Deductible (single/family)
- $2,400/$4,800
- In-Network Co-Insurance
- 20%
- Max Out of Pocket (single/family)
- $6,900/$13,800
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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