Vantage Health Plans

Essential Gold 1600

Plan Overview

Medical Deductible
  • Individual: $1,600
  • Family: $4,800
  • Per Person: $1,600
Prescription Drug Deductible
  • Individual: $600
  • Family: $1,800
  • Per Person: $600
Combined Medical and Drug Out of Pocket Maximum
  • Individual: $7,500
  • Family: $15,000
  • Per Person: $7,500

Office Visit

Primary Doctor
  • CoPay: $30.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Benefit Explanation: Office visit copay, if applicable, covers most services perfomed in an office setting that do not require pre-authorization.
Specialist
  • CoPay: Not Applicable
  • CoInsurance: 20.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: Office visit copay, if applicable, covers most services perfomed in an office setting that do not require pre-authorization.

Prescription Drug Information

Preferred Brand Drugs
  • CoPay: Not Applicable
  • CoInsurance: 20.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: Quantity limits, authorizations and step therapy limits may apply.
Non Preferred Brand Drugs
  • CoPay: Not Applicable
  • CoInsurance: 20.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: Quantity limits, authorizations and step therapy limits may apply.
Generic Drugs
  • CoPay: $30.00
  • CoInsurance: Not Applicable
  • Covered: Covered
  • Benefit Explanation: Quantity limits, authorizations and step therapy limits may apply.
Specialty Drugs
  • CoPay: Not Applicable
  • CoInsurance: 50.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: Specialty drugs may be limited to a thirty (30) day supply. Quantity limits, authorizations and step therapy limits may apply.

Inpatient Coverage

Hospital Services
  • CoPay: Not Applicable
  • CoInsurance: 20.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: Copays, if applicable, are per day for first three days only.
Inpatient Services
  • CoPay: Not Applicable
  • CoInsurance: 20.00% Coinsurance after deductible
  • Covered: Covered

Emergency and Urgent Care

Emergency Room
  • CoPay: Not Applicable
  • CoInsurance: 20.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: The ER Copay is waived if the visit results in an inpatient admission.
Urgent Care Facility
  • CoPay: Not Applicable
  • CoInsurance: 20.00% Coinsurance after deductible
  • Covered: Covered

Maternity

Labor and Delivery Hospital Stay
  • CoPay: Not Applicable
  • CoInsurance: 20.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: Minimum stay of 48 hours
Pre and Postnatal Office Visit
  • CoPay: $30.00
  • CoInsurance: Not Applicable
  • Covered: Covered

Vision

Routine Eye Exams For Children
  • CoPay: Not Applicable
  • CoInsurance: 20.00% Coinsurance after deductible
  • Covered: Covered
  • Limit Quantity: 1
  • Limit Unit : Visit(s) per Year

Major Dental Care

Routine Dental Checkups for Children
  • CoPay: Not Applicable
  • CoInsurance: No Charge
  • Covered: Covered
  • Limit Quantity: 2
  • Limit Unit : Visit(s) per Year
Routine Dental Checkups for Adults
  • CoPay: Not Applicable
  • CoInsurance: No Charge
  • Covered: Covered
  • Limit Quantity: 2
  • Limit Unit : Visit(s) per Year
  • Benefit Explanation: Covers exam and cleaning
Basic Dental Care - Adult
  • CoPay: Not Applicable
  • CoInsurance: No Charge
  • Covered: Covered
  • Benefit Explanation: An added benefit. Combined $1,000 maximum coverage per benefit period for Adult Basic and Major Dental Care.
Basic Dental Care - Child
  • CoPay: Not Applicable
  • CoInsurance: 50.00%
  • Covered: Covered
Major Dental Care - Adult
  • CoPay: Not Applicable
  • CoInsurance: No Charge
  • Covered: Covered
  • Benefit Explanation: An added benefit. Combined $1,000 maximum coverage per benefit period for Adult Basic and Major Dental Care.
Major Dental Care - Child
  • CoPay: Not Applicable
  • CoInsurance: 50.00%
  • Covered: Covered
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