PLATINUM GOLD SILVER BRONZE VANTAGE HEALTH PLAN HEALTH INSURANCE MARKETPLACE PLAN FINDER HEALTH PLAN
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1 PLATINUM GOLD SILVER BRONZE VANTAGE HEALTH PLAN HEALTH INSURANCE MARKETPLACE PLAN FINDER HEALTH PLAN
2 PICK YOUR PLAN Thanks, Vantage, for making it so easy! Vantage Platinum No deductibles and lowest copay amounts Vantage Gold with a medical-only deductible Vantage Silver Great plan for comprehensive coverage with reasonable out-ofpocket costs Vantage Bronze Pay nothing after you have met your deductible
3 2013 VANTAGE MARKETPLACE PLAN Finder BENEFITS VANTAGE MARKETPLACE PLATINUM (AAA011) Deductible None Medical Home Primary Care Physician (MH-PCP) $10 copay per visit $40 copay per visit Inpatient Hospital Radiologist / Anesthesiologist Outpatient Surgery Services Emergency Room Major Diagnostic Test (MRI, CT Scan, Stress Test, Bone Density Scan, Pet Scan and Others) X-Rays Home Health & Hospice Radiation & Chemotherapy Flu Shots Prescription Drugs Out-of-Pocket Maximum Dental Vision $750 copay per day for days 1-3 Covered 100% $500 copay $100 copay $100 copay per test 100% coinsurance up to $100 per day 20% coinsurance 20% coinsurance Covered 100% No Rx deductible No separate premium Low-Cost Generics: $3 copay Non-Preferred Generics: $15 copay Preferred Brand: $45 copay Non-Preferred Brand: $95 copay Specialty Drugs: 33% coinsurance $5,850 Individual; $11,700 Family This comparison is not a complete comparison.
4 VANTAGE MARKETPLACE GOLD (AAA012) VANTAGE MARKETPLACE SILVER (AAA013) $1,000 Individual; $2,000 Family $1,800 Individual; $3,600 Family $15 copay per visit $25 copay per visit $55 copay per visit $75 copay per visit $1,000 copay per day for days 1-3 $1,500 copay per day for days 1-3 Covered 100% Covered 100% $750 copay $1,000 copay $200 copay $300 copay $200 copay per test $300 copay per test 100% coinsurance up to $200 per day 100% coinsurance up to $300 per day 20% coinsurance 20% coinsurance 20% coinsurance 20% coinsurance Covered 100% Covered 100% No Rx deductible No separate premium Low-Cost Generics: $3 copay Non-Preferred Generics: $15 copay Preferred Brand: $45 copay Non-Preferred Brand: $95 copay Specialty Drugs: 33% coinsurance No Rx deductible No separate premium Low-Cost Generics: $3 copay Non-Preferred Generics: $15 copay Preferred Brand: $45 copay Non-Preferred Brand: $95 copay Specialty Drugs: 33% coinsurance $5,850 Individual; $11,700 Family $5,350 Individual; $10,700 Family
5 $4,350 Individual; $8,700 Family $60 copay per visit $90 copay per visit VANTAGE MARKETPLACE BRONZE (AAA014) VANTAGE VISION & DENTAL BENEFITS INCLUDED IN ALL PLANS Platinum, Gold and Silver Plans Specialist copay for one routine eye exam per year Children - 50% coinsurance for 12 pairs of contacts or 1 pair of glasses per year $100 for 12 pairs of contacts or 1 pair of glasses per year Bronze Plan Specialist copay for one routine eye exam per year Children - for 12 pairs of contacts or 1 pair of glasses per year Adults - 100% coverage for 12 pairs of contacts or 1 pair Platinum, Gold and Silver Plans 100% coverage for routine dental exams, 1 exam every 6 months (excludes cleaning) Children - Basic Dental Services (including cleaning and bitewing x-rays) and Major Dental Services - 50% coinsurance after applicable deductible Covered 100% Adults - 100% coverage for bitewing x-rays, 1 set of Bronze Plan 100% coinsurance up to $2,000 prescription drug out-of-pocket maximum $4,350 Individual; $8,700 Family 100% coverage for routine dental exams, 1 exam every 6 months (excludes cleaning) Children - Basic Dental Services (including cleaning and bitewing x-rays) and Major Dental Services - 0% coinsurance after deductible Adults - 100% coverage for bitewing x-rays, 1 set of
6 NEED MORE INFORMATION? Call us at or TTY at (for the hearing impaired) Ask a Vantage representative about a one-on-one home visit Visit our website at CONTACT DETAILS Phone & Website Toll-free: (888) TTY (866) (for the hearing impaired) Monroe Location 130 DeSiard Street, Suite 300 Monroe, LA Shreveport Location 855 Pierremont Road, Suite 109 Shreveport, LA Vantage Health Plan, Inc. has entered into an agreement with CMS to HEALTH PLAN the Health Insurance Marketplace. VHP721 R091913
Check What Matters Most.
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HUMANA INSURANCE COMPANY:
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07/01/ /30/2019 UMR: THE HERTZ CORPORATION:
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Important Questions Answers Why this Matters: In-network: $4,100 person /
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01/01/ /31/2018 HMO HDHP
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Important Questions Answers Why this Matters:
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You don t have to meet deductibles for specific services.
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limit. The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits.
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You don t have to meet deductibles for specific services.
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Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.summacare.com or by calling 1-800-996-8701. Important
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You don t have to meet deductibles for specific services.
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You don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019-12/31/2019 Highmark Health Insurance Company: Shared Cost Blue PPO Bronze 7500 Coverage
IU Health Plans: IU Health Traditional PPO Medical Plan OOA Coverage Period: 01/01/ /31/2016 Summary of Benefits and Coverage:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.myiuhealthplans.com or by calling 1.800.873.2022. Important
Important Questions Answers Why this Matters: What is the overall deductible?
Verizon HCN 815: Anthem BCBS Coverage Period: 01/01/2013 12/31/2013 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: You/You + Dependent(s) Plan Type: PPO This is only
$1,000 individual/$2,000 family innetwork. $3,000 individual/$6,000 family out-of-network.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2018-12/31/2018 AutoNation: Platinum Plan EPO Coverage for: Individual/Family Plan Type:
Important Questions Answers Why this Matters:
This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the policy or plan document at www.anthem.com/ca or by calling 1-855-333-5730. Important
You don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 01/01/2019-12/31/2019 Highmark Blue Cross Blue Shield: PPO Blue $1000 Coverage for: Individual/Family
You don t have to meet deductibles for specific services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: 10/01/2018-09/30/2019 Highmark Blue Cross Blue Shield: Community Blue PPO Coverage for: Individual/Family
What is the overall deductible?
SBC0157W091420170940 Summary of Benefits and Coverage: What this Plan Covers & What You Pay For Covered Services Coverage Period: Beginning on or after 10/01/2017 HUMANA HEALTH PLAN OF TX, INC/HUMANA INSURANCE