Your Plan Payment: Monthly Premiums

A premium is the monthly amount that you pay for your health insurance plan. It's determined by where you live, your annual income and how many dependents you want to cover. In exchange, Avera Health Plans covers a set amount of health services based on your individual plan.

If you sign up for automatic withdrawal, your premium is taken out the fifth day of every month. Learn more on making your health insurance premium payment.

You pay a premium regardless of whether or not you've met your deductible for the year. Premiums also do not figure into your out-of-pocket maximum costs. Most of the time, your out-of-pocket maximum combines your co-pays, deductibles and coinsurance.

Your Plan Details: Summary of Benefits & Coverage

The Summary of Benefits and Coverage (SBC) is your go-to for all the information you need to know about your costs – such as co-pay, coinsurance, deductible and out-of-pocket maximums – and other benefit-related information.

To view your specific Summary of Benefits and Coverage, simply log in to the member portal, choose the Benefits tab and click on Summary of Benefits.

Your Member ID Card

As an Avera Health Plans member, you and your dependents will be able to access your insurance card online in the Avera MyChart member portal and in the Avera MyChart mobile app. See more about ID cards.

Preauthorizations – Do You Need Approval First?

In some circumstances, our approval – or preauthorization – is required before you receive a specific service, procedure, drug or medical supplies, before health insurance will provide coverage.

  • If you fail to receive a required preauthorization, you'll be responsible for paying the entire billed charge.
  • To find a list of services and medical equipment that require a preauthorization, log into the member portal or call 888-322-2115.
  • It's important to note that preauthorization does not guarantee benefits and that the preauthorization list is subject to change. Benefits are subject to all conditions of your individual health policy.

Health Plans Member Preauthorizations

  1. Your provider must call or fax us if you need a preauthorization.
  2. Our clinical review team will review the request and a letter will be mailed to you and your provider with the approval or reason for denial within 15 calendar days.
  3. If approved, the letter will list which specific services, procedures and/or drugs have been approved. Please read the letter carefully so you know what services your provider has been authorized to perform.

    Medicare Supplement Insurance Preauthorizations

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

    If you have a Select Medicare Supplement Insurance plan, you do not need a preauthorization if you use a facility listed in the Network Hospital Directory for AgilityPlus Select Plans or Network Hospital Directory for Select Plans (depending on the Medicare Supplement plan you’re enrolled in). If the facility is not listed in the 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.

    Urgent Preauthorizations

    If your situation is urgent – meaning that a delay could jeopardize your life, health or ability to regain maximum function or would cause severe pain that could not be adequately managed without the requested care or treatment – our clinical review team will respond within 24 hours.

    In the case that we are unavailable – such as on weekends, holidays or after business hours – your provider must contact us no later than two business days after you receive the services, supplies or procedures.

    Learn more about your health care coverage.

    Your Explanation of Benefits

    After each medical visit, you'll receive an Explanation of Benefits (EOB) in your member portal with information about how your claim was processed and how much you may owe. The EOB is not a bill or an invoice. You'll receive a separate invoice from your provider.

    Need Something Else?

    See all of our member resources online.

    Member Resources Member Portal

    Or contact our Customer Care team.

    © Avera Health Plans, All Rights Reserved. This is a solicitation of insurance. An Agent may contact you. A Plan G policy may not cover all of your medical expenses. Premiums can only increase if we raise the premium for all policies like yours in this state. Neither Avera Health Plans nor its agents are connected with Medicare or state or federal government. *Avera Health Plans may offer certain health support services/value-added services, for a fee or for no fee. These services and/or enhanced benefits are not an insured benefit and may be removed at any time. Product availability, features and pricing may vary by state due to local regulations and distribution differences. AVHP-1124101