Vantage Medical Home HMO
Administered by Vantage Health Plan
The Office of Group Benefits (OGB) offers multiple health plans, including the Vantage Medical Home HMO. The Medical Home HMO is a traditional HMO offered by Vantage Health Plan. This plan provides coverage through the Affinity Health Networks and a standard provider network.
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
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.
| Medical Coverage | Single | Employee + 1 (Spouse or Child) | Employee + Children | Family |
|---|---|---|---|---|
| Deductible (In-Network) | $400 | $800 | $1,200 | $1,200 |
| Deductible (Out-of-Network) | $2,000 | $4,000 | $6,000 | $6,000 |
| Co-Payment - PCP (In-Network) | $20 AHN/$40 | $20 AHN/$40 | $20 AHN/$40 | $20 AHN/$40 |
| Co-Payment - Specialist (In-Network) | $45 AHN/$65 | $45 AHN/$65 | $45 AHN/$65 | $45 AHN/$65 |
| Co-Payment - PCP (Out-of-Network) | 50% coinsuranve; subject to Out-of-Network deductible | |||
| Co-Payment - Specialist (Out-of-Network) | 50% coinsuranve; subject to Out-of-Network deductible | |||
| Out-of-Pocket Maximum (In-Network) | $3,500 | $6,000 | $8,500 | $8,500 |
| Out-of-Pocket Maximum (Out-of-Network) | Unlimited | Unlimited | Unlimited |
Unlimited |
Prescription Coverage
The Vantage Medical Home HMO prescription drug benefit has five copayment levels. There is no prescription drug deductible.
| Tier | Member Responsibility |
|---|---|
| Tier 1 Preferred Generics | $0 AHN/$15 |
| Tier 2 Non-Preferred Generics | $40 |
| Tier 3 Preferred Brand | $75 |
| Tier 4 Non-Preferred Brand | $100 |
| Tier 5 Specialty | $150 |