Check What Matters Most. PLATINUM GOLD SILVER BRONZE VANTAGE HEALTH PLAN HEALTH INSURANCE MARKETPLACE PLAN FINDER
PICK YOUR PLAN Thanks, Vantage, for making it so easy! Vantage Platinum Best benefits that Vantage offers! No deductibles and lowest copay amounts Vantage Gold Low office visit and hospital copays 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
2015 PLAN Finder BENEFITS PLATINUM (AAA011) GOLD (AAA012) Deductible None $750 Individual; $1,500 Family Office Visit/ Medical Home-Primary Care Physician (MH-PCP) Office Visit / Specialist 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 (Outside Physician s Office) Home Health & Hospice Radiation & Chemotherapy $10 copay per visit $15 copay per visit, no deductible $30 copay per visit per visit, no deductible $300 copay per day for days 1-3 $600 copay per day for days 1-3 Covered 100% Covered 100% $200 copay $400 copay $100 copay $200 copay $100 copay per test $200 copay per test 100% coinsurance up to $100 per day 100% coinsurance up to $200 per day 20% coinsurance 20% coinsurance 20% coinsurance 20% coinsurance Flu Shots Prescription Drugs Covered 100% Rx Out-of-Pocket Maximum: $500 Individual; $1,000 Family Rx Out-of-Pocket Maximum: $900 Individual; $1,800 Family Medical Out-of-Pocket Maximum $6,100 Individual; $12,200 Family $5,700 Individual; $11,400 Family Dental Vision This comparison is not a complete comparison.
BENEFITS Deductible 2015 VANTAGE MAR Office Visit/ Medical Home-Primary Care Physician (MH-PCP) Office Visit / Specialist 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 (Outside Physician s Office) Home Health & Hospice Radiation & Chemotherapy Flu Shots Prescription Drugs Medical Out-of-Pocket Maximum Dental $2,900 Individual; $5,800 Family $6,600 Individual; $13,200 Family $25 copay per visit, no deductible per visit, no deductible $75 copay per visit, no deductible $80 copay per visit, no deductible $1,500 copay per day for days 1-3 0% coinsurance after deductible Covered 100% SILVER (AAA013) 0% coinsurance after deductible $1,000 copay 0% coinsurance after deductible $300 copay 0% coinsurance after deductible $300 copay per test 0% coinsurance after deductible 100% coinsurance up to $300 per day 0% coinsurance after deductible 20% coinsurance 0% coinsurance after deductible 20% coinsurance 0% coinsurance after deductible Rx Out-of-Pocket Maximum: $1,200 Individual; $2,400 Family $5,400 Individual; $10,800 Family $0 after the deductible BRONZE (AAA014) 100% coinsurance up to out-of-pocket maximum VANTAGE VISION & DENTAL BENEFITS INCLUDED IN ALL PLANS Adult and Children Vision Benefits 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 Adults - 20% coinsurance with a maximum benefit of $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 - 0% coinsurance after deductible for 12 pairs of contacts or 1 pair of glasses per year Adults - 100% coverage for 12 pairs of contacts or 1 pair of glasses per year with a maximum benefit of $100 Adult and Children Dental Benefits Platinum, Gold, and Silver Plans 100% coverage for routine dental exams and cleanings, 1 exam every 6 months Children - Basic Dental Services (including cleaning and bitewing x-rays) and Major Dental Services - 50% coinsurance after deductible Adults - 100% coverage for bitewing x-rays, 1 set of x-rays per year with a maximum benefit of $50 Bronze Plan 100% coverage for routine dental exams and cleanings, 1 exam every 6 months 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 x-rays per year with a maximum benefit of $50 Vision This comparison is not a complete comparison.
NEED MORE INFORMATION? Call us at (855) 545-3847 or TTY at (866) 524-5144 (for the hearing impaired) Ask a Vantage representative about a one-on-one home visit Come by our office Visit our website at www.vantagehealthplan.com/marketplace CONTACT DETAILS Phone & Website Toll-Free: (855) 545-3847 TTY (866) 524-5144 (for the hearing impaired) www.vantagehealthplan.com/marketplace Monroe Location 130 DeSiard Street, Suite 300 Monroe, LA 71201 Shreveport Location 855 Pierremont Road, Suite 109 Shreveport, LA 71106 Baton Rouge Location 5778 Essen Lane, Suite B Baton Rouge, LA 70810 Vantage Health Plan, Inc. is a Qualified Health Plan in the Health Insurance Marketplace. VHP721 R101714 NotApproved