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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) $10 AHN/$25 $10 AHN/$25 $10 AHN/$25 $10 AHN/$25
Co-Payment - Specialist (In-Network) $35 AHN/$50 $35 AHN/$50 $35 AHN/$50 $35 AHN/$50
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) No Maximum No Maximum No Maximum

No Maximum

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 $5
Tier 2 Non-Preferred Generics $20
Tier 3 Preferred Brand $50
Tier 4 Non-Preferred Brand $80
Tier 5 Specialty $150

Vantage

1-888-823-1910

Visit Vantage

8:00 a.m. - 8:00 p.m.

Monday - Friday

Pharmacy Benefits

1-866-704-0109

OGB

1-800-272-8451

visit ogb

8:00 a.m. - 4:30 p.m. 

Monday - Friday 

 

Forms & Resources

Health Insurance and Dependents can only be changed during Annual Enrollment or due to a Qualifying Life Event.

insurance eligibility

list of qualifying events

BENEFITS JOB AIDs AND FORMS

2021 MEDICAL PREMIUMS FOR ACTIVE EMPLOYEES

2021 MEDICAL PREMIUMS FOR RETIREES

2021 HEALTH PLAN COMPARISON

2021 Vantage Medical Home HMO SUMMARY OF BENEFITS AND COVERAGE

cost share schedule

member certificate of coverage

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