Published on November 01, 2022

Debunking Myths About Narrow Network Health Plans

illustration of doctors using digital interface checking health data

Narrow network plans are growing in popularity as insurance providers look for ways to decrease cost for both businesses and members.

Why? Because a narrow network plan is often the most affordable option available for premiums – whether you need a plan for yourself, your business or your retirement years.

“We’re always looking for ways to offer lower premiums and out-of-pocket costs without sacrificing quality care and benefits,” said Jordan Anderson, Vice President of Sales and Account Management, Avera Health Plans. “Narrow network plans optimize our partnership with Avera to lower costs.”

Anderson explains how these plans work.

What is a broad vs. narrow network?

Narrow networks, also called select or channeled networks, have a smaller network of providers. They are often focused on location, standards of quality or a certain health system. Avera Health Plans narrow networks include providers within Avera Health as well as non-Avera clinicians to ensure network adequacy.

A broad network may include a larger geographical area or providers from several health systems in addition to independent clinics.

Why would insurers do this?

It allows the insurance provider to negotiate lower reimbursement rates for services with providers. This savings is passed to members via lower monthly premiums and out-of-pocket costs. With these lower costs, you still get the same robust benefits that other plans offer and a quality network of providers through Avera.

Myth: You have limited access to specialists.

Truth: A narrow network is not restrictive – the goal is still to provide you with comprehensive coverage. Here’s how it works:

  1. Options are narrowed by the number of providers available within a specialty area, not by eliminating entire specialties of care. You may have five oncology doctors to choose from versus eight.
  2. If a network doesn’t include a specialty area, you’ll still be covered by an out-of-network referral. These approved referral services will apply to in-network benefits.

What does Avera Health Plans offer?

We offer two plan types with a narrow network: Preferred and Direct Network plans. These plans are available to companies headquartered in Brown, Minnehaha and Lincoln counties.

Our Preferred Plans have a tiered structure. Tier 1 is a narrow network including Avera health providers and facilities. This tier will typically have lower out-of-pocket costs. Tier 2 offers coverage for the remainder of Avera Health Plans contracted providers and facilities, typically with higher out-of-pocket costs. This is a great transition plan to test the waters of a direct network These plans offer up to 15% average savings on premiums from a traditional network plan.

Our Direct Plans offer no out-of-network coverage with up to 20% savings from a traditional plan. This offers the highest cost savings benefit.

Both narrow network options include Avera owned and managed facilities.

Myth: You won’t be covered in an emergency while traveling.

Truth: Emergencies and urgent care visits are covered while traveling. This is true of all plans.

Myth: Your plan won’t be comprehensive.

Truth: Narrow networks allow you to pay a lower premium without skimping on benefits. This means value-added benefits will be the same as with other plans.

What benefits does Avera Health Plans offer?

Our narrow network plans offer the same added benefits other plans do, including:

  • $0 co-pays for preventive care
  • Membership discounts at select fitness centers
  • $0 co-pays* for virtual visits through our app
  • Free Employee Assistance Program (EAP) access to counseling sessions

Companies considering offering a narrow network option to employees can also add a variety of ancillary benefits including:

  • Dental and vision insurance
  • Short and long-term disability
  • Life insurance

Myth: Your care isn’t focused on prevention.

Truth: Since you are using a focused network that’s connected to the Avera system, your care is more seamless. The focus on preventive care can save on out-of-pocket costs over time because your provider gets to know you and can spot changes in your health sooner.

This connected care also means your records are within one patient portal. This can be important to ensure providers have the full spectrum of your health needs and prescription drugs.

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