OGB Medical Home

2017 Medical Home HMO Plan Information

The following benefits are available to OGB Medical Home members from Vantage's Tier I Provider Network. A more detailed list of services and costs can be found in the OGB Medical Home Plan Cost Share Schedule.

Enjoy Great Benefits Such As:
  • Primary Care Physician Office visit co-pay - $20; Specialist visit co-pay - $45
  • MRI, CAT Scans, and other Major Diagnostic Tests - $50 co-pay per test
  • Prescription Drug benefits included, No deductible
  • Inpatient hospitalization - $100 co-pay per day for first 3 days ($300 max per admit)
  • X-Ray services and other hospital outpatient services - 100% coverage
  • Lab services covered 100%
  • Radiologists, Pathologists and Anesthesiologists covered 100%, subject to deductible

Affinity Health Network Reduced Copays

Prescription Drugs:
  • Tier I Preferred Generics: $5 copay per 30-day fill
  • Tier II Non-Preferred Generics: $20 copay per 30-day fill
  • Tier III Preferred Brand: $50 copay per 30-day fill
  • Tier IV Non-Preferred Brand: $80 copay per 30-day fill
  • Tier V Specialty Drugs: $150 copay per 30-day fill