Welcome to Avera Health Plans

You may have questions about what happens after you submit an application or payment. Below are answers to questions around member ID cards, making a payment or where to find your benefits and services available to you.

Individual/Families F.A.Q.

How do I know if my application was processed correctly?

If you applied online through an agent, AveraHealthPlans.com or healthcare.gov, there is a timeframe that your application is being reviewed for accuracy and within a week.

A confirmation letter will be sent that includes your Summary of Benefits and Coverage, next steps to receive your ID card(s) and a payment coupon to mail your first month’s premium, if you have not provided payment during the application process.

Ready to make a monthly premium payment? Click here to find out six payment options.

I applied through healthcare.gov and want to update a recent change (address, salary, etc.), who do I call?

Any changes you have after you apply online, it is important to notify the Federal Insurance Marketplace (healthcare.gov) and login using the same password used when you applied. Or call 1-800-318-8596.

More information to help you know when to contact healthcare.gov about your life changes.

We apologize, but Avera Health Plans cannot make these changes for you. If you want to set up an appointment at one of our locations, we have experts that are happy to help you or assist with the call.

When will I receive my new member ID cards?

After we receive your first month’s premium, we'll mail your member identification card(s) within 10 to 14 business days after the payment is cleared.

If you are receiving health insurance through an employer, ID card(s) are mailed within weeks of processing the applications and setting up the plan benefits.

What should I do if I lose my ID card?

A temporary ID card can be requested on our website. You can also print off a temporary card. Select LOGIN on the top of the website. After you enter your username and password, look for the link "Click HERE to Order a Replacement ID Card." If you need further assistance, please call our Service Center 1-888-322-2115.

What if I don’t have a member ID card and need a prescription filled?

New member ID cards arrive 10 to 14 business days after we receive your first month’s premium payment. Your account is set up within the first 7 business days.

If you are receiving health insurance through an employer, ID card(s) are mailed within weeks of processing the employee applications and setting up the plan benefits.

Can I see where my claims are posting?

Yes. All of your claims will be available to you online after logging-in to the member portal. You can set it up in your profile (after you login) to receive an email when your claim is processed.

You can also download and login to our free MyHealthPlan mobile app for access to all your claims and claims of dependents under the age of 18.

How do I get access to Avera Health Plans mobile app MyHealthPlan?

Are you new in your community and have questions?

To find a primary care physician or questions about your health insurance, call our Service Center:

  • 605-322-4545 or toll-free at 1-888-322-2115
  • 8 a.m. to 5 p.m. CT, Monday through Friday.

Where can I find my member benefits?

Members can login to view their personal benefits and claims.

After you receive your member ID card(s), login online or through our MyHealthPlan mobile app which is also available to download on iTunes and Google Play. With this free app, you can access your in-network providers, claims, deductible balances, make monthly premium payments and more.

Member Login Instructions

Click here to login to our member portal.

Note: You'll need your member ID card to log in and create your new username and password.

Every dependent is encouraged to login. If dependents are over the age of 18 (spouses and adult children included), we'll need a signed agreement before access is provided to the subscriber.

Once logged in, you'll have access to:

  • Benefit resources on the benefits page (Certificate/Evidence/Outline of Coverage, Plan Descriptions, Policy Manuals, Summary of Benefits and Coverage and more.)
  • Claims processed and Explanation of Benefits (how and/or if the claim was paid)
  • Wellness Portal - free access to the online information and tools you need to make changes for a healthy lifestyle.

How do I make an address or phone number and/or name change to my plan?

If you applied through healthcare.gov, you must contact the Federal Marketplace at 1-800-318-2596 to make a change.

If you applied directly with Avera Health Plans or through your employer's plan, complete the member Change Form.

Medicare Supplement F.A.Q.

What is the difference between a Standard and a Select Plan?

Avera Health Plans is able to provide a Medicare Supplement Insurance plan with a great price because it is a type of Medigap policy that requires you to use hospitals and outpatient surgery centers within our network in order to be eligible for full insurance benefits - except in an emergency. Select plans can be any of the standardized Medigap plans. These policies generally cost less than other Medigap policies.

When do Medicare Supplement policyholders need a preauthorization?

If you have a Standard plan, you do not need a preauthorization to use any facility.

If you have a Select plan, you do not need a preauthorization if you use a facility listed in the Network Hospital Directory. If the facility is not listed in this directory, your physician will need to call for a preauthorization of services. This needs to be approved before you receive services at the out-of-network facility.

If you have questions regarding in-network facilities, please call our Service Center, 1-888-322-2115, 8 a.m. to 5 p.m. CT, Monday through Friday.

How does my Medicare Supplement Insurance Select plan work when traveling?

While traveling outside of the Avera Health Plans service area, services will be covered from the first day you receive services through the 90th day in one year (January - December). Travel must be for purposes other than the receipt of medical care.

If traveling within South Dakota, you may use any hospital or surgical center listed in the Network Hospital Directory. This restriction does not apply for Standard plans.

If I have a Select plan, can I continue to see my doctor?

Yes. You may see the physician of your choice. To receive full plan benefits when you need hospital services or services at an outpatient surgery center, your physician will need to have admitting privileges at a hospital or surgical center listed in the Network Hospital Directory. It is important that your doctor is referring you to another doctor who has privileges at these facilities.

How do I update my personal information?

If you need to update your personal information (such as name, address or phone), please fill out this Change Form and return it to Avera Health Plans.

Why should I set up an automatic bank withdrawal to pay my monthly premiums?

Your payment will always arrive on time - even if you are away from home. Never worry about coverage being discontinued because a check is lost in the mail. The service is free and you save money by not having to use your checks, stamps and envelopes.

How do I sign up for automatic bank withdrawal?

If you'd like to sign up for automatic bank withdrawal, please fill out this Automatic Bank Account Withdrawal Form and return it to Avera Health Plans.

When is my monthly premium taken out?

If you've signed up for automatic withdrawal, your premium is taken out the fifth day of every month.

How can I give a family member or my legal council access to my health information?

If you need to give someone access to your health information, please complete and sign the Health Access Form. Instructions on the form will provide you options to get the signed form to Avera Health Plans.

What should I do if I lose my ID card?

A temporary ID card can be requested on our website. You can also print off a temporary card. Select LOGIN on the top of the website. After you enter your username and password, look for the link "Click HERE to Order a Replacement ID Card." If you need further assistance, please call our Service Center 1-888-322-2115.

Order Replacement ID Card

What types of questions can the Service Center answer?

The Service Center is your resource for everything. If you have questions about the following, please call 1-888-322-2115:

a. Claims

b. Benefits

c. In-network providers

d. Preauthorization of procedures

If I have a Medicare Supplement Insurance policy and I am moving to a state other than South Dakota or Iowa what should I do?

Contact your insurance agent or Avera Health Plans, 1-888-322-2115, as soon as possible. There are timeframes that must be adhered to.