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.

Vantage plans fully cover and encourage routine preventive check-ups such as annual examinations, vaccinations, and OB/GYN screenings. For those members hoping to lose weight or quit smoking, Vantage offers counseling by a licensed nutritionist or tobacco cessation coach free of charge.

MEDICAL COVERAGE

 

Single

Employee
+ Spouse

Employee
+ Children

Family

Deductible (In-Network)

$500

$1,500

$1,500

$1,500

Deductible (Out-of-Network)

$1,500

$3,000

$3,000

$3,000

Co-Payment – PCP (In-Network)

$0*/$10

$0*/$10

$0*/$10

$0*/$10

Co-Payment – Specialist (In-Network)

$35*/$45

$35*/$45

$35*/$45

$35*/$45

Active Employee/Non-Medicare Retiree(Out-of-Network)

30%

30%

30%

30%

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)

Tier I: $3,000
Tier II: see below

Tier I: $9,000
Tier II: see below

Tier I: $9,000
Tier II: see below

Tier I: $9,000
Tier II: see below

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

None

None

None

None

*Benefits available for Affinity Health Network Providers

Tier I Providers
Most participating providers are Tier I providers. Members seeing Tier I providers pay the Tier I co-pays, co-insurance and deductibles as listed in the Certificate of Coverage. Verity HealthNet and the Affinity Health Network are Tier I providers for the Medical Home HMO plan. View providers in one of Vantage Health Plan’s networks at www.vantagehealthplan.com/OGBCommercial

Tier II Providers
Tier II providers are participating providers whose cost may be higher than other similar participating providers. Members who choose to see these providers will have to pay an additional twenty (20) % coinsurance in addition to their Tier I cost share. There is no out-of-pocket maximum for Tier II services. View Tier II providers at www.vantagehealthplan.com/Provider/TierIINetwork

 

PHARMACY BENEFITS

The Vantage Health Plan prescription drug benefit for active employees and retirees has five co-pay/coinsurance levels.

Tier

Member Co-Pay

Tier 1 Low Cost Generic

$3

Tier 2 Non-Preferred Generics

$10

Tier 3 Preferred

$45

Tier 4 Non-Preferred

$95

Tier 5 Specialty

33% coinsurance up to $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