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 the 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?

Log into Portal

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 and fill out forms. Be sure to ask your employer to review and sign off on the following form(s) before submitting to Avera Health Plans.

See All Forms

What Coverage Includes

Discover the information you need to make educated health care decisions, maximize your coverage, control your health care costs and be inspired to live a healthier life. 

Coverage Pharmacy Benefits COVID-19 Coverage

Did you know? Depending on your specific plan's benefits, you may be able to take advantage of value-added services. To learn more about which value-added services are available to you, talk with your employer. These services may include:

  • COBRA benefits
  • Employee Assistance Program (EAP)
  • Flexible Spending Account (FSA)
  • Health Savings Account (HSA)
  • My Recovery Chemical Dependency Treatment Program
  • Diabetes Prevention Program
  • Tobacco Cessation Program
  • Fitness membership

Popular with Members

Check out our Member Guide (pdf) and these resources:

Coverage Questions

See More

Pharmacy Benefits


Well-Being Program


Flex & Health Savings Account

See more

Member App

See More

Virtual Visits

See More

Member Forms

See More

Health Insurance Glossary

See More

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.

Learn More

Your Trusted Partners in Health

Connecting you to health topics that interest you, learn about health plans and find guidance to stay healthy.

Read More Blog Stories

Need Something Else?

See all of our member resources online.

Member Resources Member Portal

Or contact our Customer Service team.

Our Website Uses Cookies

This website uses cookies to give you the very best experience. Your continued use of this site is considered permission by you to use cookies in this manner. Please review our Privacy Commitment and Notice for terms of use, the types of cookies we use and more information about the data we collect. Please note, if you navigate from our website to a third-party site of any kind, that website has its own terms and conditions.