OGB Medical Home

2022 Medical Home HMO Plan Information

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

Enjoy Great Benefits Such As:
  • Primary Care Provider Office visit co-pay - $40; Specialist visit co-pay - $65
  • MRI, CAT Scans, and other Major Diagnostic Tests - $50 co-pay per test
  • Prescription Drug benefits included, No deductible
  • Inpatient hospitalization - $250 co-pay per day for first 3 days ($750 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
  • Preventive Dental covered 100%
  • Comprehensive Dental Coverage for adults and children - 50% co-insurance; $500 maximum benefit for all members

Affinity Health Network Reduced Copays

Prescription Drugs:
  • Tier I Drugs: $15 copay per 30-day fill
  • Tier II Drugs: $40 copay per 30-day fill
  • Tier III Drugs: $75 copay per 30-day fill
  • Tier IV Drugs: $100 copay per 30-day fill
  • Tier V Drugs: $150 copay per 30-day fill