VANTAGE MEDICAL HOME HMO

Vantage’s Medical Home HMO is a patient-centered approach to providing cost-effective and comprehensive primary health care for children, youth and adults. This plan creates partnerships between the individual patient and his or her personal physician and, when appropriate, the patient’s family. This plan includes a preferred provider network, Affinity Health Network (AHN), which has lower copayments covered services as indicated by AHN. This plan also includes Out-of-Network coverage.

MEDICAL COVERAGE

 

Single

Employee
+ Spouse

Employee
+ Children

Family

Deductible (In-Network)

$400

$800

$1,200

$1,200

Deductible (Out-of-Network)

$1,500

$3,000

$4,500

$4,500

Co-Payment – PCP (In-Network)

$10/$20

$10/$20

$10/$20

$10/$20

Co-Payment – Specialist (In-Network)

$35/$45

$35/$45

$35/$45

$35/$45

Co-Payment PCP (Out-of-Network)

50% coverage; subject to deductible

Co-Payment – Specialist (Out-of-Network)

50% coverage; subject to deductible

Out-of-Pocket Maximum (In-Network)

$3,500

$6,000

$8,500

$8,500

Out-of-Pocket Maximum (Out-of-Network)

None

None

None

None

In-Network Providers

Members seeing In-Network providers pay the In-Network copayments, coinsurance and deductible as listed in the Certificate of Coverage and Cost Share Schedule. The Vantage participating network consists of two networks:

  • A preferred provider network, Affinity Health Network (AHN), which has lower copayments for certain covered services as indicated by “AHN”, and
  • A standard provider network.

View providers in Vantage Health Plan’s networks at www.vantagehealthplan.com/OGBCommercial

 

PHARMACY BENEFITS

The Vantage Medical Home HMO prescription drug benefit has five copayment levels. There is no prescription drug deductible. You may view the Vantage Rx Formulary at: www.vantagehealthplan.com/OGBCommercial/Documents

Tier

Member Co-Pay

Tier 1 Preferred Generics

$5

Tier 2 Non-Preferred Generics

$20

Tier 3 Preferred Brand

$50

Tier 4 Non-Preferred Brand

$80

Tier 5 Specialty

$150

 

VANTAGE MEDICAL HOME HMO RESOURCES

OGB Customer Service

1-800-272-8451

8:00 AM – 4:30 PM CT Monday-Friday

Vantage Health Plan

www.vhp-stategroup.com/ogb

1-888-823-1910

8:00 AM – 8:00 PM CT, Mon – Fri

Pharmacy Benefits

1-866-704-0109

Provider Directory

2017 Schedule of Benefits

2017 Benefit Plan

Vantage Wellness

Benefit Comparison

Premium Rates