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Asuris Embark® |
Asuris HSA Healthplan 2.0SM |
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Embark is ideal for people who want immediate access to care. It includes up-front preventive benefits that employees can use before meeting the deductible. Other highlights include unlimited office visits and the first $400 in diagnostic outpatient lab and X-ray services per person per year. There are seven Embark configurations that you can offer to your employees. |
HSA Healthplan 2.0 combines a comprehensive medical plan with a separate tax-free savings account. You and your employees will enjoy the extensive benefits you've come to expect from an Asuris health plan. Plus it's an easy way to save pre-tax dollars to pay for life's medical expenses. There are three HSA configurations that you can offer to your employees. |
Narrow it down: Review benefit summaries, exclusions and limitations.
Choose from 10 different plan configurations, each with a different combination of deductible, coinsurance, office visits and other elements. Benefit summaries effective January 1, 2013.
Embark
Embark Employee Select sample benefit summaries
These sample benefit summaries have been generated using one of the RX configurations available with Embark plans is Employee Select ($10/$35/$75 with OOP Max and $0 Brand Rx deductible). You may select a different RX option from the 12 available, but whichever option you choose must apply to all the Embark Plan Configurations you offer.
Asuris HSA Healthplan 2.0 sample benefit summaries
Available Plan Configurations
Pharmacy
Benefits
Pharmacy benefits are a standard part of the Embark plan design with four options to choose from.
Package Options |
Option 1 |
Option 2 |
Option 3 |
Option 4 |
Generic (not subject to deductible) |
$5 copay |
$7 copay |
$10 copay |
$10 copay |
Brand (formulary) |
$25 copay |
25% coinsurance |
35% coinsurance |
$35 copay |
Brand (non-formulary) |
$50 copay |
50% coinsurance |
50% coinsurance |
$75 copay |
| Out-of-Pocket Maximum* | $3,000 | $4,000 | $5,000 | no out-of-pocket-maximum |
*Copays and coinsurance apply to the out-of-pocket maximum. If an equivalent generic medication is available and a brand-name medication is chosen, the member is responsible for paying the applicable brand-name copay/coinsurance plus the difference in price between the equivalent generic medication and the brand-name medication not to exceed total retail cost. |
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Additional Options |
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Brand Deductible** (optional) |
$250 deductible (brand formulary / non-formulary) $500 deductible (brand formulary / non-formulary) **Brand deductible does not accrue to the member's out-of-pocket maximum. |
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Wellness Programs
Wellness programs are available to your clients' employees and their families at no additional cost. They are not insurance, but are being offered to help your clients' employees and their families take charge of their health.
Integrated Care Management
Integrated Care Management provides specialized, targeted attention and support for employees who need assistance in managing their care. A Personal Care Team of clinical experts is ready to assist employees and their families with an ongoing medical condition, or serious illness or injury. The program provides easy access to one-on-one support focused on closing care gaps. Learn more about the program.
24-hour nurse line
A 24-hour nurse hotline staffed by registered nurses. The nurse line is a great way for members to get medical questions answered without having to make an appointment with a doctor or visit an urgent care clinic. By explaining symptoms or concerns, members can get advice on what they can do on their own—or get a nurse’s opinion on whether they should see a doctor right away.
Asuris Advantages
Members-only discount program offers your employees savings from a number of nationally recognized, health-related companies.
Optional
Benefits
Your client can round out the benefits their employees will enjoy by adding optional plan benefits.
Unlimited Spinal Manipulations
- no benefit maximum
- Category 1 & 2, Category 3 may be subject to balance billing
Vision (exempt from medical deductible)
- 100% coverage for annual eye exam (Category 1 & 2, Category 3 is subject to balance billing)
- up to $150 in hardware annually
Dental Options
Two plans that offer something for everyone. Available as stand-alone, or paired with Embark.
- Dental Plan Information: EncoreSM & ExpressionsSM
Employer Assistance Program (EAP)
- 24-hour crisis assistance
- up to 4 face-to-face counseling sessions per incident
- legal and financial services
- read more
Exclusions
and Limitations to Coverage
These exclusions apply to the medical plans only and do not apply to the wellness programs.
Preventive Care
Preventive services and immunizations are covered according to guidelines set forth by the United States Preventive Services Task Force (USPSTF), Centers for Disease Control and Prevention (CDC) and Health Resources and Services Administration (HRSA).
Waiting Periods
No benefits are provided for treatment relating to a transplant until the member has been covered under this or a prior plan for six consecutive months. There is a waiting period that must be met prior to benefits being available for pre-existing conditions; groups with 1-50 eligible employees have a nine-month pre-existing condition waiting period and groups with 51 or more eligible employees have a three-month pre-existing condition waiting period. Members may receive credit from prior medical coverage. Pre-existing condition waiting periods do not apply to Members up to age 19.
Outside the Service Area
Members have the security of knowing they can access Blue Cross and/or Blue Shield (Blue Plan) providers across the country and worldwide through the BlueCard® Program. Plan benefits apply as described above, and members may receive discounts on their services.
General Medical Exclusions
Coverage is not provided for any of the following, including direct complications or consequences that arise from:
- Cosmetic/Reconstructive Services and Supplies except for reconstruction for functional injury and disease, to treat a congenital anomaly, and for breast reconstruction following a medically necessary mastectomy to the extent required by law
- Counseling in the absence of illness
- Custodial Care: Non-skilled care and helping with activities of daily living
- Dental Examinations and Treatments
- Fees, Taxes, Interest: Charges for shipping and handling, postage, interest, or finance charges that a provider might bill; except sales taxes for durable medical equipment and mobility enhancing equipment.
- Government Programs: Benefits that are covered, or would be covered in the absence of this plan, by any federal, state or governmental program
- Infertility except to the extent covered services are required to diagnose such condition
- Investigational Services: Treatment or procedures (health interventions) and services, supplies, and accommodations provided in connection with investigational treatments or procedures
- Medications without a Prescription Order
- Military Service Related Conditions: The treatment of any condition caused by or arising out of a member's active participation in a war or insurrection or conditions incurred in or aggravated during performance in the Uniformed Services
- Motor Vehicle Coverage and Other Insurance Liability
- Non-Direct Patient Care including appointments scheduled and not kept, charges for preparing medical reports, itemized bills or claim forms, and visits or consultations that are not in person, including telephone consultations and email exchanges
- Obesity or Weight Reduction/Control: Medical treatment, medication, surgical treatment (including reversals), programs, or supplies that are intended to result in or relate to weight reduction, regardless of diagnosis
- Orthognathic Surgery except for congenital conditions, temporomandibular joint disorder, injury, and sleep apnea
- Personal Comfort Items: Items that are primarily for comfort, convenience, cosmetics, environmental control, or education
- Physical Exercise Programs and Equipment including hot tubs or membership fees at spas, health clubs, or other facilities; applies even if the program, equipment, or membership is recommended by the member’s provider
- Private Duty Nursing including ongoing shift care in the home
- Riot, Rebellion and Illegal Acts: Services and supplies for treatment of an illness, injury or condition caused by a member’s voluntary participation in a riot, armed invasion or aggression, insurrection, or rebellion or sustained by a member while committing an illegal act or felony
- Routine Foot Care including treatment of corns and calluses and trimming of nails
- Routine Hearing Care: Routine hearing examinations, programs, or treatment for hearing loss including hearing aids (externally worn or surgically implanted) and the surgery and services necessary to implant them, except for cochlear implants
- Self-Help, Self-Care, Training, or Instructional Programs including childbirth classes, diet and weight monitoring services and instruction programs, including those to learn how to stop smoking and programs that teach a person how to use durable medical equipment or how to care for a family member
- Services and Supplies Provided by a Member of Your Family
- Services and Supplies That Are Not Medically Necessary
- Services to Alter Refractive Character of the Eye
- Sexual Reassignment Treatment and Surgery: Treatment, surgery, and counseling services for sexual reassignment
- Sexual Dysfunction: Regardless of cause, except for counseling provided by covered, licensed mental health practitioners
- Third-Party Liability Services and supplies for treatment of illness or injury for which a third party is or may be responsible
- Travel and Transportation Expenses other than covered ambulance services
- Work-Related Conditions except for subscribers who are owners, partners, or corporate officers and are exempt from state or federal workers' compensation law
This is a brief summary of benefits; it is not a certificate of coverage. All benefits must be medically necessary. For full coverage provisions, refer to the contract.
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