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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. The plan not only includes preventive benefits, it provides additional coverage which employees can use before meeting a deductible. These are called Embark's up-front benefits:
Every Embark plan also provides your employees with personal wellness programs that offer incentives and rewards for reaching individual health goals. |
Asuris HSA Healthplan 2.0 provides a comprehensive medical plan and a tax-free health savings account all rolled into one. 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. |
Available Plan Configurations
Benefit Summaries, Exclusions & Limitations
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
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.
Health CoachSM
A Health Coach can help your clients' employees set goals that are right —and realistic—for them in any health-related area. The program provides the motivation, the support, and the direction members need to take charge of health-related goals.
Your clients' employee is the one to set the goals, make appointments, and take personal action—they're what make the program so effective. Members will even receive Rewards points through myAsuris.com for completing the program.
CareEnhance®
A 24-hour nurse hotline staffed by registered nurses. CareEnhance 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.
Special Beginnings®
Our Special Beginnings maternity program helps mothers enjoy healthier pregnancies and deliver healthy babies. The program includes a full prenatal guide, as well as a support system for those important nine months.
Case Management
A medical illness or unexpected injury can quickly create stress and confusion. We hope your clients will never be confronted with a serious medical problem, but if they are, a Case Manager can help.
Case Managers are experienced, licensed health care professionals who provide support and guidance. In addition to our Case Managers assisting our members with existing medical conditions, our proactive team of Case Managers can help with early intervention options for future medical issues. Our Case Managers make sure your client's needs come first.
Disease Management
Asuris Disease Management offers early intervention and long-term management of chronic conditions. This can help reduce the need for expensive procedures, hospitalizations and emergency room visits. Our internal programs focus on the conditions with the most impact on our members’ quality of life.
Asuris Rare Disease Condition Management Program
The Asuris Rare Disease Condition Management Program, in collaboration with Accordant®, is a valuable service that provides a personal health care support system to members with rare, complex, chronic conditions. Members who are affected by select conditions have 24/7 access to specially trained nurses who can answer questions and provide guidance.
This program is designed to meet unique health care needs and help coordinate care by working with you, your doctors and designated family members to obtain the best possible care in the most efficient manner. Learn more at Accordant.com about the Rare Disease Condition Management Program.
Optional
Benefits
Your client can round out the benefits their employees will enjoy by adding optional plan benefits.
Pre-Deductible Spinal Manipulations
- available only with the unlimited upfront office visit option
- only applies to the 10 spinal manipulations benefit
- if selected, the deductible is also waived on outpatient mental health and chemical dependency services
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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Consumer-Directed Health Programs
Combine your Asuris medical product with one of our CDH programs to maximize savings potential and encourage smart consumerism. Learn more.