Vantage Health Plan. Vantage Medical Home HMO Plan. Check what matters most
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1 Vantage Health Plan Vantage Medical Home HMO Plan Check what matters most 2018
2 Welcome to Vantage Dear OGB Member: Vantage Health Plan will continue to be a health plan option for eligible OGB Members in If you are a current Vantage Medical Home HMO Member and you would like to keep your plan with the same covered dependents for the 2018 plan year, you do not need to do anything. Your coverage will continue for the 2018 plan year. If you are not currently a Vantage Medical Home HMO Member and would like to enroll for 2018, see below for enrollment options: LaGov employees* Change/update your elections through Louisiana Employees Online (LEO) or contact your HR department. Non-LaGov employees* - Change/update your elections at info.groupbenefits.org or contact your HR department. Non-Medicare retirees - Change/update your elections at info.groupbenefits.org, contact OGB, complete the paper enrollment form, or submit a signed letter to OGB. *Paper enrollment forms are not accepted from Active employees. All eligibility and enrollment processing is handled by agency HR Departments and/or OGB. OGB customer service can be contacted at (800) NOTICE: Annual Enrollment ends November 15, Please don t wait to make your 2018 plan selection! If you have any questions about the Vantage Medical Home HMO Plan, please call our Member Services Department at (318) or toll-free at (844) or visit us online at We look forward to serving you. Thank you, William J. Justice Director of Marketing and Member Services 2
3 Check what matters most Vantage benefits include: $ monthly premium for employee-only coverage $20 primary care office visit copays or $10 primary care office visit copays through Affinity Health Network (AHN) Reduced copays for certain other services through Affinity Health Network (AHN) No referrals Annual wellness exam 100% covered Prescription drug plan with $5 copay for low-cost drugs - no deductible $0 copay for low-cost drugs through Saint John Pharmacy mail order (90-day supply) Worldwide emergency coverage Vision and Preventive Dental Coverage Great local customer service The search tools on our Vantage website, will allow you to find a provider or a retail pharmacy or to search for prescription drugs covered by Vantage. If you have any questions, please contact Vantage Health Plan at (318) or toll-free at (844) For the hearing impaired, please call toll-free TTY (866) Member Services is available Monday through Friday from 8:00 a.m. 6:00 p.m. CST. Thank you for considering Vantage Health Plan. We look forward to serving you! 3
4 Benefits for 2018 BENEFIT MONTHLY PREMIUM* Enrollee Only $ Enrollee + 1 (Spouse) $ Enrollee + 1 Child(ren) $ Family $ IN-NETWORK COVERAGE 4 IN-NETWORK MEDICAL DEDUCTIBLE IN-NETWORK MEDICAL OUT-OF-POCKET MAXIMUM OFFICE VISITS: MEDICAL HOME-PRIMARY CARE PROVIDER (MH-PCP) SPECIALIST WELLNESS AND PREVENTIVE CARE LAB SERVICES MAJOR DIAGNOSTIC TESTS X-RAY AND OTHER HOSPITAL OUTPATIENT SERVICES OUTPATIENT SURGERY SERVICES EMERGENCY ROOM INPATIENT HOSPITAL PHYSICIAN PROFESSIONAL FEES RADIOLOGIST / PATHOLOGIST / ANESTHESIOLOGIST PRESCRIPTION DRUGS No deductible VISION SERVICES: Vision Benefits Routine Vision Exam Glasses and Contacts PREVENTIVE DENTAL SERVICES: Routine Preventive Cleaning, Exam and an Annual X-ray Specialist copay for one routine eye exam per year Glasses/Contacts - 50% coinsurance for 12 pairs of contacts or 1 pair of glasses per year, not subject to deductible; maximum benefit of $100 for adults. Preventive Dental Benefits Actives & Retirees after 3/1/15 Retirees prior to 3/1/15 Individual $400 $0 Individual + 1 $800 $0 FAMILY $1,200 $0 Individual $3,500 $2,000 Individual + 1 $6,000 $3,000 Family $8,500 $4,000 $20 copay per visit or $10 copay at AHN per visit $45 copay per visit or $35 copay at AHN per visit 100% covered 100% covered $50 per test or $0 per test at AHN 100% covered $100 copay or $50 copay at AHN $200 copay per visit - waived if admitted $100 copay per day, $300 maximum copay per stay 100% covered after deductible 100% covered after deductible Tier I Mail Order (90-day supply)... $0 Copay at AHN Tier I... $5 copay Tier II... $20 copay Tier III... $50 copay Tier IV... $80 copay Tier V... $150 copay $45 copay per visit or $35 copay at AHN per visit 50% coinsurance; $100 maximum benefit for adults 100% coverage at Vantage Allowable Out-of-Network Benefits are available. See Cost Share Schedule. *Rates listed at 75% participation rate; For a complete list of rates at all participation levels, please visit info.groupbenefits.org 100% coverage for one routine dental exam and cleaning every 6 months and an annual x-ray, not subject to deductible
5 Vantage Wellness The Vantage Wellness Program is designed to encourage members to stay healthy. Wellness Program participants have unlimited access to the tools and resources online at Wellness.vhpla.com. Participants can communicate with Wellness Coaches, Registered Dietitians, and Tobacco Cessation Coaches by phone, , or the Affinity Health Management Center. What s Available? Free Nutritional Counseling Free Diabetes Counseling Free Tobacco Cessation Counseling* Free Access to Online Wellness Resource, including an online exercise log and educational videos Free Smart Phone App Free Annual Wellness Exams Free Reward Opportunities *Qualifying members participating in the Tobacco Cessation Program may receive free Chantix. Chantix must be prescribed by a physician. Vantage 5
6 IN-NETWORK PROVIDER SEARCH You can search for a Medical Home-Primary Care (MH-PCP) or other providers from our extensive list of In-Network providers. In-Network Providers cannot balance bill Members. Visit and follow the steps listed below, or call our Member Services Department at (318) or toll-free at (844) to select your MH-PCP. 1 Step One Select OGB Medical Home HMO and then Find a Provider. 2 Step Two Click I m Looking Around followed by Employer Groups. 3 Step Three Enter your zip code, then proceed to search for the type of Provider you need. Affinity providers can also be located by clicking on the Affinity Health Network logo. Hours of Operation Hours of Operation: Monday - Friday 8:00 a.m. 6:00 p.m. 6
7 NETWORK PROVIDERS Vantage has several provider network options for OGB Medical Home members. All members have in-network coverage with Vantage standard network and Affinity Health Network providers. Members living in certain parishes in southern Louisiana also have in-network coverage with Verity Health Network providers. See the network summaries below or call the Vantage Member Services department at (318) or toll-free at (844) for more information about our provider networks. Vantage s standard network In-Network Cost Share Reduced Cost Share on many covered services In-Network Cost Share on all other services Verity Health Network Providers Regional network In-Network Cost Share Members who live in the following parishes may access the Verity network and the Vantage standard network: Acadia, Ascension, Assumption, East Baton Rouge, East Feliciana, Evangeline, Iberia, Iberville, Lafayette, Lafourche, Livingston, Pointe Coupee, St. Helena, St. James, St. Landry, St. Martin, St. Mary, Terrebonne, Vermilion, West Baton Rouge and West Feliciana parishes. These parishes are also highlighted in the Verity map to the left. Residency and access is determined by the member s primary address in Vantage s records. Vantage Medical Home HMO members are covered anywhere in the world for emergency care at in-network benefits. 7
8 Vantage Locations Monroe 122 St. John Street Monroe, LA Shreveport 855 Pierremont Road, Suite 109 Shreveport, LA Baton Rouge 5778 Essen Lane, Suite B Baton Rouge, LA For Information On Other Locations: Hours of Operation Hours of Operation: Monday - Friday 8:00 a.m. 6:00 p.m. Contact Phone Numbers: (318) or Toll Free (844) Website: memberservices@vhpla.com OGB APPROVED VHP1921_APPROVED
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