Insurance Plans

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Excellus

Go to Insurance News to learn more about Excellus member log-in


EXCELLUS MEDICAL/HOSPITAL PLANS


ABLUE PPO PLAN 2022 Summary of Benefits (PDF)
 
Participating Providers - go to your member log-in (once logged in, select Find A Doctor)   
      

BBLUE PPO 2 PLAN 2022 Summary of Benefits (PDF)
Participating Providers - go to your member log-in (once logged in, select Find A Doctor)
     

J - BLUE PPO 3 PLAN 2022 Summary of Benefits (PDF)
Participating Providers - go to your member log-in (once logged in, select Find A Doctor)
     

CCLASSIC BLUE (INDEMNITY) PLAN 2022 Summary of Benefits (PDF)                                                                                                                               Participating Providers - go to your member log-in (once logged inselect Find A Doctor)    
            

A, B, C, J - TELEMEDICINE (PDF)
Go to your member log-in (once logged inselect Find A Doctor)   


H, I - MEDICARE BLUE PPO PLAN:  Medicare Blue PPO plans through EXCELLUS ended 12/31/21.  Medicare PPO plan is now provided through UNITED HEALTHCARE (UHC) effective 1/1/22.
     


EXCELLUS PRESCRIPTION PLANS

A, B, C, J - EXCELLUS PRESCRIPTION PLAN INFORMATION:
     
EXCELLUS 3-TIER MEDICATION LIST - 
go to your member log-in  (once logged in go to prescriptions, check drug lists, under other plans offered through Employers  choose 3-tier formulary)

       3-Tier Formulary Copays for Chemung County Plan Participants (by plan):
                A, C                                           B                                               J              
      Tier 1 - $25                  Tier 1 - $10 | $15 | $20               Tier 1 - $10       
      Tier 2 - $40                  Tier 2 - $25 | $30 | $35               Tier 2 - $25               
      Tier 3 - $70                   Tier 3 - $55 | $60 | $65              Tier 3 - $55      

Members that are REQUIRED to fill maintenance medications through mail order will have their 
      Tier 1 copay waived when filled through Mail Order, except Plan J.

*Chemung County employees refer to your union contract.     

 LOCATE PARTICIPATING Rx PROVIDERS:  Pharmacy Search- go to your member log-in
(once logged on choose prescriptions)
                
MANDATORY MANDATORY MEDICATION LIST:  for members required to use mail order benefit
go to your member log-in (once logged in go to prescriptions, check drug lists, under mandatory maintenance medication lists, choose the list of medications...)

 2022 EXCELLUS PRESCRIPTION PLAN/MAIL ORDER INFORMATION (PDF)
 

H, I - MEDICARE D PRESCRIPTION PLANS INFORMATION:  Medicare Blue PPO plans through EXCELLUS ended 12/31/21.  Medicare PPO plan is now provided through UNITED HEALTHCARE (UHC) effective 1/1/22.

    

EXCELLUS DENTAL PLAN       

D
 - DENTAL PLAN INFORMATION - Dental coverage through Excellus begins 7/1/2020.  All claims incurred 7/1/2020 and after will be sent to Excellus utilizing your new Excellus dental ID card.  

Dental Plan Summary (PDF) -


UNITED HEALTHCARE MEDICARE PPO 
- MEDICARE PPO PLAN INFORMATION: EFFECTIVE 1/1/22  
 2022 UHC Plan Summary (PDF) 
 2022 UHC Plan Guide (PDF)

2022 UHC Evidence of Coverage (PDF)

2023 UHC Plan Summary (PDF)

2023 UHC Plan Guide (PDF)

United Health Care (UHC) Medicare PPO Mail Order and Prescriptions
Please be advised members enrolled in the UHC Medicare plan will no longer be able to utilize Express Scripts for their mail order. UHC's mail order is OptumRx, which you will see referenced on the bottom of your ID card. 
Please call the customer service number on the back of your ID card to learn how to get set up with OptumRx.  You can choose to fill your Rx at a participating pharmacy and pay 2 copays for a 90 day supply OR choose to utilize OptumRx mail order and pay 1 copay for a 90 day supply.  OptumRx Flyer (PDF)

United Health Care (UHC) House Call Program  - This is an optional program available to you at no cost on the Medicare Advantage PPO Plan UHC House Call  Program (PDF) 

Lifetime Benefit Solutions (LBS) - PRIOR CARRIER

D - DENTAL PLAN INFORMATION: - Dental coverage through LBS ended 6/30/2020. The deadline to submit all claims incurred prior to 7/1/2020 was 10/31/2020. Coverage is now provided through Excellus Dental.
      
- VISION PLAN INFORMATION: Vision coverage through LBS ended 12/31/21.  The deadline to submit all claims incurred through 12/31/21 is 2/28/22.  Coverage is now provided through Guardian effective 1/1/22.
(does not apply to Chemung County CSEA, CSEA Health Center, Sewer District Union Employees)

 G - VISION PLAN 2 INFORMATION:  Vision coverage through LBS ended 12/31/21.  The deadline to submit all claims incurred through 12/31/21 is 2/28/22.  Coverage is now provided through Guardian effective 1/1/22.  
(does not apply to Chemung County CSEA, CSEA Health Center, Sewer District Union Employees)

      

GUARDIAN VISION

- VISION PLAN INFORMATION:  EFFECTIVE 1/1/22 use your new Guardian Vision ID card.
     
Effective 1/1/22, dependents are covered on this Guardian vision plan until age 26.

Guardian Vision Plan Summary  (PDF)

Guardian Participating Providers (PDF) - Please note that Twin Tiers Eye Care has chosen to end participation in this plan effective 8/31/22.

CSEA 

CSEA PLATINUM 12 VISION PLAN


F
- CSEA PLATINUM 12 VISION INFORMATION:
      
(for CSEA, CSEA Health Center or Sewer District Union Employees only)
     
Effective 7/1/2020 CSEA Platinum 12 Vision (EBF) has changed their eligibility rules for this vision plan.  Please contact CSEA Platinum 12 (EBF) directly for more information and directions on how to add dependents to this policy.  These eligibility rules only apply to this vision plan.

Platinum 12 Vision Plan Summary (PDF)
Vision Participating Providers