Health Insurance Network Options Offer Greater Access, Consumer Choice

In the group health insurance market, healthy competition, greater access to care and consumer choice are key drivers.

Avera Health Plans is launching TotalChoice plans that offer its broadest network available, including South Dakota’s major health systems and regional providers. TotalChoice plans also include a travel network for national coverage.

“Employer groups appreciate the focused, care system plans that Avera Health Plans has to offer, but they also value broad, open access plan options to offer consumer choice to their employees,” said Lisa Carlson, Vice President for Product Strategy & Development at Avera Health Plans.

TotalChoice starts with Avera’s own network and discounts, in addition to access that includes the majority of South Dakota providers. This broad network extends access while preserving Avera’s discounts and network management.

Changes in the state and regional health care market over the past several years led to decreased competition for broad network plans in South Dakota. “Avera Health Plans was very committed to figuring this out to give employers more options for their employee benefits,” Carlson said.

“For employers we can now quote our open access product alongside the focused network product,” Carlson said. Employers can pass that choice along to their employees through multiple options: Do they want to save premium and go with a direct, focused network plan, or do they want open access and choice across health systems?

Broad and Direct Networks

There are advantages to both broad networks and focused networks, depending on what the consumer is looking for, Carlson said.

Direct networks, also known as focused networks, typically offer lower premiums because reimbursement rates are negotiated with a smaller number of physicians. Another advantage is the seamless care experience of staying in the same health system. Direct plans also offer national coverage for urgent care and emergencies when traveling.

Broad networks allow for open consumer choice of physicians and specialists across health systems. For employees who want a broad network, offering this option supports talent attraction and retention, as health insurance is one of the most influential benefits for job seekers.

“It can be a competitive advantage, especially in tight labor markets,” Carlson said. “If a prospective employee or new employee is already established with a health care provider, it may be seen as a loss if they have to switch providers when getting a new job.”’

Out-of-pocket costs depend on the plan design and service type – not the network name. Preventive care, like annual exams and colonoscopies, remains low to no cost under most plans. Fixed co-pays keep many services simple and predictable, regardless of network.

The Value of Consumer Choice

“A healthy market is one that offers plenty of consumer choice. Our goal is to bring competition to the group market so ultimately employers and the individual members get the best possible deal for health care coverage,” Carlson said.

January is often the time when employers start considering their health insurance for the next year – 2027 – because changing health insurance carriers can be a multi-month process, especially for large employers. Some employers renew employee benefits on a fiscal year timeline rather than the calendar year.

“Most employer groups have an agent or broker, and as agents introduce TotalChoice into the market, we’re getting really good feedback. We’ve seen increased quote activity and we’re expecting membership growth,” Carlson said.

Learn more about employer plans through Avera Health Plans.