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Health Insurance

All retirees over age 65 or those who become eligible for Medicare prior to the age of 65 are required to enroll in Medicare Part A and Part B in order to participate in the º£½Ç³Ô¹ÏÍø retiree health insurance plan. 

Retirees over 65 years old and/or Medicare-eligible are enrolled in the . For assistance, visit the Excellus Group Medicare Advantage PPO Plan website or call 1-877-883-9577.

Excellus Group Medicare Advantage PPO Plan

While the plan will continue to be administered by Excellus, the Excellus Group Medicare Advantage PPO plan encompasses Medicare Parts A, B, and D under the Advantage plan. The Excellus Group Medicare Advantage PPO plan continues to follow Medicare guidelines.  

Explanation of Benefits (EOB): Those enrolled in the Excellus Group Medicare Advantage PPO plan will receive one EOB for their claims. 

Evidence of Coverage

Excellus Group Medicare Advantage PPO plan Deductible

• $0 deductible for in-network services
• $500 deductible for out-of-network services

2026 Maximum Out of Pocket

• Maximum out-of-pocket for in-network providers: $2,500
• Maximum out-of-pocket for a combination of in-network and out-of-network providers: $8,000

Prescription Drugs

Prescription drug coverage is available through the Excellus Group Medicare Advantage PPO Plan.

Coverage Cost

• 2026 Maximum out-of-pocket: $2,100
• Copays: $10/$45/$90

Medications Processed under Part D

Part D helps cover the cost of prescription drugs picked up at the pharmacy, including many recommended shots or vaccines. Prescription copays are subject to the formulary-based copay tier.

Medications Processed under Part B

Part B drugs are medically necessary outpatient prescription drugs administered by a medical provider, in a hospital setting, an infusion center, or even at home, and usually not self-administered.

Examples include chemotherapy, radiation, macular degeneration eye shots, osteoporosis injections, and biologic injections. These types of drugs are covered under Medicare's medical benefits and, under the new Group Advantage plan, will be subject to up to a 20% coinsurance.

Please note: GLP-1’s specifically prescribed for weight loss diagnosis are not a covered prescription drug

Mail Order Service

Mail order service is available through or .

Diabetic Information

Available to retirees over age 65 and/or on the Excellus Group Medicare Advantage PPO Plan.

Glucometers or blood glucose monitors

Excellus Group Medicare Advantage PPO Plan members have access to glucometers for a $0 copay for the preferred Abbott brand. 
Visit or call Abbott Diabetes Care at (800) 680-6850 and provide offer code DX6JW01W to get a free meter

Continuous Glucose Monitor (CGM) Cost: 

• $5 copay for Dexcom G6/G7, FreeStyle Libre 2/3 or Freestyle Libre CGMs
• $5 copay for each 30-day supply of CGM supplies

Hearing Aids

Hearing aid benefits are available to those enrolled in the Excellus Group Medicare Advantage PPO Plan.

Hearing aid benefits are provided by . The plan includes coverage for 80 batteries per aid for non-rechargeable models; members must use a TruHearing provider. Hearing aid copays do not count towards your maximum out-of-pocket amount.

or call 1-855-205-5519 to schedule an appointment.

Vision

Vision care is available through the Excellus Group Medicare Advantage PPO Plan or the VSP plan.

Excellus Group Medicare Advantage PPO Plan Benefits

• Routine eye exams: Once per calendar year
• In-network providers: $20 copayment per visit
• Out-of-network providers: $25 copayment per visit
• Eyeglasses (lenses and frames) or contact lenses: Reimbursement for up to $100 for in- and out-of-network providers.

Submitting Claims

Retirees should provide their Excellus ID card with the VYM subscriber ID to the service provider. The service provider can submit the claim directly to Excellus. For any services not submitted at the time of service, retirees may submit a claim to Excellus for reimbursement.

VSP Benefits

Retirees also have the option to enroll in a VSP plan and pay VSP directly for their coverage. Visit the to learn more and enroll, or call 800-785-0699.

Standard Plan

• Eye exam: Every 12 months, $15 copay
• Frames: Every 12 months, $25 copay. $150 allowance for a wide selection of brands, $170 allowance for featured frame brands.
• Lenses: Every 12 months for single vision, lined bifocal, and lined trifocal lenses. Enhancements, including progressive lenses, anti-glare, light to dark tinting, may be extra.
• Contacts: Every 12 months, $150 allowance

EasyOptions Plan

• Eye exam: Every 12 months, $15 copay
• Frames: Every 12 months, $25 copay. $150 allowance for a wide selection of brands, $170 allowance for featured frame brands.
• Lenses: Every 12 months, single-vision, lined bifocal, and lined trifocal lenses. Enhancements, such as progressive lenses, anti-glare, light to dark tinting, may be extra.
• Contacts: Every 12 months, $150 allowance
• Upgrades: You may choose one upgrade
  • Fully covered non-line bifocals, fully covered light to dark tint, increase frame allowance to $230, increase contact lens allowance to $230.

Claim Processing and Excellus ID Card

• Under the Excellus Group Medicare Advantage PPO Plan, Excellus administers all Medicare benefits, including Parts A, B, and D.
• Members present only their Excellus Group Medicare Advantage PPO plan card for medical, hospital, and prescription services.
• The new subscriber ID number begins with VYM.

Submitting Claims and Payment

Claims are submitted by your in-network provider directly to Excellus, and Excellus pays the claim. Once a member enrolls in a Medicare Advantage plan (Part C), that Medicare Advantage plan—Excellus, in this case—becomes the primary payer. With Medicare Advantage, original Medicare does not pay first, nor does it share in the billing sequence. The Medicare Advantage is an alternative way to receive your government-mandated benefits.

Medicare Part A or B claims will no longer be separated from the cost of services, and members will only see what Excellus has paid.

All Medicare Supplement and Advantage plans, including the º£½Ç³Ô¹ÏÍø Group Medicare Advantage plan, require that you continue enrollment in Medicare Parts A and B and continue to pay your premiums. With Medicare Advantage, your Medicare premiums are collected by Medicare and directed to the insurer, Excellus, to help cover the cost of services paid by the plan.

For more information regarding alternate options for Medicare plans, contact:

Gail Manfredo
Benefit Consultant
Alera Group
315-794-3090
gail.manfredo@aleragroup.com

Health Insurance

All retirees under the age of 65 and or not Medicare eligible are eligible to maintain enrollment within the coinsurance plan.

Coinsurance Plan

Continues to be administered by Excellus. 

Office visit cost shares

• In-network: 20% coinsurance
• 2026 maximum out of pocket for Medical: single $2,500; family $5,000
• Out-of-Network: 30% coinsurance after deductible
• 2026 Single Deductible: $750
• 2026 Family Deductible: $2,250

Prescription Drugs

Prescription drug coverage is available through .

Cost

• Tier 1: $10
• Tier 2: $40
• Tier 3: $60
• Tier 4: $75 (specialty and GLP-1 for weight loss)
• 2026 Maximum out-of-pocket for pharmacy: In-network single $2,000, family $4,000
• Out-of-Network single $2,500, family $5,600

Vision

Vision benefits are available through VSP. 

VSP Benefits

Retirees have the option to enroll in a VSP plan and pay VSP directly for their coverage. Visit the to learn more and enroll, or call 800-785-0699.

Standard Plan

• Eye exam: Every 12 months, $15 copay
• Frames: Every 12 months, $25 copay. $150 allowance for a wide selection of brands, $170 allowance for featured frame brands.
• Lenses: Every 12 months for single vision, lined bifocal, and lined trifocal lenses. Enhancements, including progressive lenses, anti-glare, light to dark tinting, may be extra.
• Contacts: Every 12 months, $150 allowance

EasyOptions Plan

• Eye exam: Every 12 months, $15 copay
• Frames: Every 12 months, $25 copay. $150 allowance for a wide selection of brands, $170 allowance for featured frame brands.
• Lenses: Every 12 months, single-vision, lined bifocal, and lined trifocal lenses. Enhancements, such as progressive lenses, anti-glare, light to dark tinting, may be extra.
• Contacts: Every 12 months, $150 allowance
• Upgrades: You may choose one upgrade
  • Fully covered non-line bifocals, fully covered light to dark tint, increase frame allowance to $230, increase contact lens allowance to $230.