Coming Soon: Avera MyChart

The Avera Health Plans member portal is transitioning to Avera MyChart on May 30. MyChart gives you one secure place to view health information and health insurance member benefits together. You’ll be able to:

  • Schedule care more easily.
  • Connect virtually with providers.
  • Manage care for family members.
  • Access your digital insurance card.
  • Pay premiums and medical bills.
  • Access the new provider directory.
  • Manage preauthorization requests.
  • Message Avera Health Plan and Avera providers securely.

What You Need to Do

  • On May 30, Avera MyChart will be available for all members. Your login won't transfer automatically, so you'll need to create a new account. If you're also an Avera patient, you will create one account for both the health system and health plan. We'll provide more information on how to do this soon.
  • If your patient medical record or insurance plan information was shared with other people who help manage your health care, you must reestablish proxy access. We'll provide steps on how to do that soon.

What to Expect

Plan and benefit access for dependents on your insurance plan will be automatically established in your new member portal. There, you'll be able to find all the things you'd expect from your health insurance plan — such as your explanation of benefits (EOBs), coverage details, preauthorizations and more. Here are the important details individual and family insurance plan members need to know:

  • If you have an off-exchange plan, your electronic funds transfer (EFT) for premium payments will continue in MyChart. However, the date your autopay processes will change from the 5th of the month to the 26th of the month prior. This means you will have two premium payments in May, as your June premium payment will be paid on May 26.
    • Your payment method will not change if you enrolled in your plan through the Marketplace or your employer.

ID Numbers and Prescription Plans

  • You will get a new member ID number, and these cards will be digital only. These will be accessible in your portal and have only the subscriber's name going forward.
  • You must share your new member ID with non-Avera providers at your next appointment to ensure visits are submitted to insurance. The update will be automatic with Avera providers.
  • Prescription numbers also will change and must be provided to pharmacies as soon as possible to ensure refills are not declined.
  • You can manage refills and other tasks in the MyChart app if you use an Avera Pharmacy.

Provider and Location Network Lookup

You’ll have access to a new directory to look up providers and locations in and out of your network.

Care and Scheduling Options

You’ll benefit from combined access to Avera MyChart if you are also a patient with access to patient information, online scheduling and other patient information.

  • Schedule with your primary care provider in Avera MyChart.
  • Use telehealth services.
    • Avera Health Plans Virtual Visits 24/7 anywhere in the United States
    • Avera on-demand virtual services as an Avera patient seeking care in the Avera service care
  • Schedule your yearly mammogram.
  • See recent lab work, pay bills, message your provider and see upcoming appointments.

Network Provider FAQ

You always have the option to use any provider, but it’s important to know how choices can impact your health care costs.

What’s an in-network provider?

To help manage health care costs, you can get discounts on services and medical procedures when you receive care from Avera Health Plans in-network providers. These include physicians, hospitals, facilities and other health care providers participating in our network.

These in-network benefits are available with more than 2,000 primary care physicians and 4,300 specialists and other health care providers available in your region.

What’s an out-of-network provider?

Out-of-network providers are physicians, hospitals and health care providers not participating in the Avera Health Plans network. If you receive medical care from an out-of-network provider, you’ll pay more for those services. Because this balance will not go toward your in-network deductible, you’ll pay more overall throughout the year.

Want to see in-network providers for your plan?

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Update Your Health Coverage

We get it. Change happens. It’s important to let us know when you need to make updates to your plan. You can download, fill out forms and submit them to us.

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What Coverage Includes

Learn how to navigate health care, understand your coverage, get details on pharmacy benefits and more.

Coverage  Pharmacy Benefits

Need to Pay Your Premium?

Check out convenient online and auto pay options and more ways to pay your monthly insurance premium. 

Payment Options

What's in the Member Portal?

The member portal – online and the app – are your go-to locations for details about your insurance policy, coverage, claims and more. Here are just some of the things you can find in the member portal:

Summary of Benefits

Review the Summary of Benefits and Coverage to learn about co-pays and other charges you’re responsible for – as well as pharmacy tier levels and benefit restrictions for out-of-network services.

Certificate of Coverage

Access the Certificate (Evidence) of Coverage or Individual Insurance Policy for details on:

  • Included and excluded benefits and services
  • Pharmacy benefits and management procedures
  • How to submit a claim for covered services
  • How to obtain services for primary care, specialty care, behavioral health care and hospital services
  • How to get care when you live out-of-network
  • How to submit a complaint
  • And more!

Additional Portal Features

  • Process claims and see explanation of benefits (EOBs).
  • Learn about pharmacy benefits including checking drug costs, viewing your prescription history, tracking your drug spend and more.
  • View the provider directory for your specific plan.
  • See if your plan includes wellness benefits including fitness discounts.
  • Learn about our well-being portal.

New Here?

Welcome! See what to expect as you become a new member and what to do once your policy application is approved.

New Members

Member ID Cards

You and each of your covered dependents (spouse and/or children) will receive a member identification (ID) card. Here’s what you need to know about your card, when you’ll get your first one and how to get a replacement.

ID Card Info

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Need Something Else?

We have more tools ready at your fingertips. Get answers to common questions, find forms for updating your plan and much more. Just visit our member resources.

Member Resources Member Portal

Or contact our Customer Care team.