COVID-19 Information for Members, Employers and Agents
Member Coverage and Benefits
The following member coverage and benefits information is in response to the current COVID-19 pandemic.
We know this is a confusing time and you have lots of questions. We're here to help you navigate your insurance coverage. For questions, please call the Customer Care Team at 1-888-322-2115, Monday-Friday, 8 a.m. - 5 p.m. CT.
If COVID-19 testing is ordered by a provider, it will be covered 100%, including related office visit, whether it happens in a physician's office, urgent care center, or emergency department.
Avera Health Plans will waive members' cost-share related to the treatment of COVID-19 (co-pay, coinsurance and deductible) when seeking care from an in-network provider through June 30, 2020.
Avera Health Plans will waive the member cost for all applicable telehealth services effective March 17, 2020, through June 30, 2020. This policy is subject to change and review as federal guidance evolves. Members receiving applicable telehealth services from participating providers during this period will have their normal cost-share waived regardless if the telehealth visit is directly related to COVID-19 or not.
Avera providers are utilizing virtual visits for the safety of our members/patients during this pandemic. Here are some resources to help you be prepared for your virtual visit.
Flex Spending Accounts and Health Savings Account Benefits
Changes to your current election(s) may be possible depending on your individual situation during the COVID-19 pandemic. Please contact the DASFLEX Team at 605-322-4542 if you have any questions or would like to discuss your options.
Over-the-counter medications and menstrual products are now permanently included as eligible expenses. Please reference the IRS list of eligible expenses for more information.
Prescription Drugs Coverage in Response to COVID-19
We want to ensure our members have access to their needed prescription drugs while social distancing is encouraged.
- We are waiving early refill limits on maintenance drugs to allow access to an additional 30 day supply.
- If your prescription allows, please consider getting a 90-day supply.
- We're allowing a maximum 60-day supply of any specialty medication. Please note, two specialty co-pays will be required.
- Depending on where you live, you may also have the option of home delivery at no additional cost.
Please call your pharmacy for additional details.
Personal Health Services Frequently Asked Questions
My surgery at Avera has been cancelled/postponed/moved. My doctor said I can have it at "X" facility. Can I move it there?
Avera is following the recommendations set by the Centers for Disease Control. The recommendations are to postpone non-emergent elective procedures in order to limit patient risk of complications from COVID-19 after surgery and preserve the necessary personal protective equipment that will be needed to protect the public. Avera is following those recommendations.
Why are other hospitals still doing surgeries?
At Avera Health Plans, we are following guidance made by the local, state, and federal health officials in regards to the current public health emergency. Please know all decisions like this are not made lightly and are done with the safety of our members in mind.
I want to cancel my surgery because I am scared of being the hospital right now. What can I do?
We recommend you talk to your provider to determine if it is safe for you to wait based on individual situation.
Can my doctor still pre-authorize my surgery?
Absolutely. Our team is prepared to continue to process requests for services that require pre-authorization according to our normal policies and procedures.
What if I have questions that are not answered here?
We know this is a confusing time and you have lots of questions. For questions regarding yoru chronic conditions, prescription drug and health questions, please call the Personal Health Services Team at 1-888-605-1331, Monday - Friday, 8 a.m. - 5 p.m. CT.
COVID-19 Resources and Health Care Information
Learn more about Avera facility closures, what to do if you are sick and tips for home isolation.
Sign up for AveraNow
Sign up from your desktop, download the app or call us at 855-269-3551.
Already registered for AveraNow? Login Here
Need technical assistance? Contact the AveraNow support team at 1-855-269-3551 or email us.
AveraNow Virtual Care and Triage Resources
Please call your physician or the COVID-19 hotline toll-free at 1-877-AT-AVERA if you are experiencing COVID symptoms.
We recommend logging into AveraNow virtual visits if you need to see a provider for simple issues like sinus infections or pink eye that are non-COVID-19 related. To encourage use of virtual visits, we are waving co-pays for all member plans through June 14.
- You can log in on your smartphone, tablet or laptop.
- Members with a coupon code should still use it. Your coupon code is on your member ID card or in your member portal.
- Members without a coupon code will not be charged a co-pay through the claims process.
For more information visit your employer portal, contact your agent or your Avera Health Plans Client Relationship Executive.
Employer Group Information
We understand the stress and worry that COVID-19 is bringing to your workplace. As your partner, we wanted to share some business resources we have developed to help you keep your staff and their families safe. Some portions of this business toolkit have been translated into various languages. Please reach out to your Client Relationship Executive to see what translated pieces are available to you.
Please know we are working with our employer groups challenged by economic disruptions. Employers have options when it comes to employee eligibility for coverage, leave of absence, and premium payment requirements and have placed additional FAQs within the agent quote portal.
During this time, we believe we must all do our part to limit the spread of COVID-19. We are working to keep our employees safe by following the guidelines for social distancing and working remotely from home when possible. We are maintaining essential functions at our office that cannot be done remotely.
We also encourage you to work from home and limit contact with clients as much as possible. We're providing you instructions on sending secure quotes and renewals to clients and potential clients for review and signature. Additional information is available in the Help section on our quote portal.