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01/23/2008
Letter from Scott Kreiling
EmbarkSM and VantageSM are receiving a positive market response thanks to you and your clients, who have shown us that these new plans meet an important need in our communities. Our initial Embark and Vantage enrollment numbers confirm that these new self-managed plans offer real choice to employers and members alike.
Product highlights from our agent community
What makes Embark and Vantage different? See what our agent community says:
- Products provide client choice with a broad range of calendar-year deductibles, coinsurance maximums and coinsurance levels.
- Up-Front benefits allow members to predict the cost of routine care.
- Ground and air ambulance is covered to the nearest facility with no dollar maximum. Services are covered at the Category 1 level, after deductible.
- Emergency room visits and related services are covered at the Category 1 level, after deductible.
Platform reminders from late 2007
For detoxification and emergency room benefits, Asuris will pay Category 3 providers to our participating provider allowed amounts. Members will be covered at the highest, Category 1, coinsurance level when they see non-participating providers. They will be subject to balance billing for charges that exceed the allowed amount.
Spanish forms, a reformatted Dual Option Matrix, podcasts and Webcasts are now available!
If you are working with a client that has Hispanic employees and is considering Embark or Vantage, Spanish forms, such as the GMA, Employee Application and Employee Waiver, are available on the Asuris Web site. Also, for your staff training convenience, the dual option matrix, podcasts and Webinars that introduce Embark and Vantage and their optional products are now available. You can access these resources on the Agent Center.
New collateral available from your local representative
New Embark and Vantage collateral was developed in 2008 to incorporate new state mandates. These are available in print from your Asuris Sales contact. Please discard all 2007 benefit summaries and product brochures.
- The Employee Assistance Program (EAP) helps employees resolve problems with professional support. If you have a client that you think would benefit from this optional product, please take a look at the EAP employer flyer, a one-page document that outlines the services provided and offers a free trial.
- AspireSM, EnhanceSM and AchieveSM dental options complete a medical benefits package. The product brochure and folder are available now to help you discuss these options with your clients.
MAC A overview
The Maximum Allowable Cost (MAC A) policy governs how we cover a brand-name prescription medication when an exact generic equivalent is available. Many of you had questions and concerns about MAC A and how it relates to Embark and Vantage.
The intent of the MAC A policy is to encourage members to educate themselves about generics and to make them aware of the true costs of brands with generic equivalents. MAC A will apply only to those prescriptions for brands that have an exact generic equivalent. Only about 3% of all prescription claims through Asuris are for brands that have an exact generic equivalent available. This means that three times out of 100 (when there is a brand and an exact generic equivalent - not all prescriptions), a brand is used in place of its exact generic.
Only non-formulary brands would ever be subject to this policy. The member will never pay more than the total Asuris discounted cost of the brand. Coverage is calculated as the difference between the medication's allowed cost and the cost of the generic equivalent plus the member's copay/coinsurance, not to exceed the brand-name's total allowed cost. Here is an example:
$200 brand cost for Drug A
- $25 generic cost for Drug A
$175 difference between brand and generic cost
+$50 non-formulary brand copay for Embark/Vantage member on Rx-1 plan
$225 this amount is greater than the total cost of the brand medication
so the member would pay $200
In the example, only the member's $50 copay would apply to the out-of-pocket maximum and/or deductible. Under the MAC A policy, only the member's copay/coinsurance applies to the out-of-pocket maximum and/or deductible.
RegenceRx.com provides a listing of the most common non-formulary brands and their generic and preferred brand alternatives. Exact generic equivalents are noted by this symbol: †. If this symbol (†) appears next to the generic name, then its corresponding non-formulary brand would be subject to MAC A. See the listing online.
Pharmacists are required by law to offer the member a generic if one is available. Physicians are also aware of generic availability for brand products. Most physicians prescribe generic medications as a result. If they strongly feel that the brand is superior, they can submit documentation to us for an exception.
Group set-up
The significant volume of new and sell-over business created some challenges with group set-up, but we are working seven days a week to address the issues and resolve them rapidly. We have added staff to reduce the set-up time so that your clients receive their initial group bill and enrolling employees receive their member cards as quickly as possible.
We appreciate your assistance in submitting completed paperwork in a timely manner. Doing so will help minimize the end-of-month backlog so that we can deliver the service level your clients expect. Here are some tips for working with us to deliver timely group information for processing:
- Submit all required documents 15 days prior to the group's effective date to optimize response time:
- Fill out all document fields completely to minimize call-backs to request client information.
- Benefit accumulators (credit from prior carrier)—a one-time manual deductible credit will be given to members of new groups upon sales notification within 31 days of the effective date of the group (if applicable).
- Advise your client that binder checks are not required for Embark or Vantage groups. Asuris will bill your client after group set-up is completed.
- The Group Administrator's Manual for Embark and Vantage is available on the Employer Web site. It contains information about enrollment, billing, and appeals procedures.
Questions or need to contact us?
- Asuris Sales contact
- General Sales Line - (509) 922-8072 or 1 (888) 344-5593
- Agent Center
- Technical Support - 1 (877) 664-2450
- Registration - (206) 389-6692
- Customer Service
- Dedicated Unit - 1 (888) 367-2109
- Agent Numbers
- Broker Relations - (206) 389-6692
- Agent Desk - (503) 220-4783
- Commission
- Agent Desk/Finance - (503) 220-4737
2008 Jump Start program is live!
By selling Embark and Vantage, you have the opportunity to earn a Jump Start Bonus. For qualifying new or renewing groups that elect an Embark or Vantage plan, we'll say thank you with a little something extra. The ultimate reward is knowing that, with self-managed plans, your clients can make health a priority.
Thank you for your continued support and commitment to Asuris Northwest Health. As always, please contact us if you have any questions or comments.
Sincerely,
Scott Kreiling
Vice President of Sales
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