Know the Difference
In-network and out-of-network are common health insurance terms but do you know how they benefit you? Understanding the meaning and how it relates to your plan can help.
This infographic will help guide you in learning what you pay, what insurance pays, and how to get the most from your plan.
We can help you find an in-network provider or make sure your current facility or provider is in-network.
- Call our Service Center toll-free at 1-888-322-2115, 8 a.m. to 5 p.m. CT, Monday through Friday.
- Log into you member portal and search the provider directory.
Welcome to Avera Health Plans!
Whether you purchased Avera Health Plans insurance on healthcare.gov or through an agent, you’re in the right place.
Take time to review the comprehensive health coverage, benefits and resources you have through Avera Health Plans. You’ll 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.
If you're a recent Avera Health Plans applicant or new member, the first step is to learn more about your health plan, including when to expect your member ID cards.
What does my insurance cover?
Because each health plan is unique, the best way to find out what your insurance covers is to log in to your secure member portal or MyHealthPlan mobile app.
If you’re a new user, register for your account here. You'll need your member ID number and group number (both found on your member ID card) to log in and create a username and password. If your policy is effective, but you haven’t received your member ID card yet, you can call 1-888-322-2115 to request the information you need to register.
Once you're logged in, you'll be able to view information specific to your plan, including:
Individual Health Insurance Policy (IND)
Explains your policy including services and procedures that are covered or not covered by your health plan
Explanation of Benefits (EOB)
Provides information about your claims and how they were processed and paid
Summary of Benefits and Coverage (SBC)
Identifies what your costs will be and provides other benefit-related information
While online, you can also:
For guidance and answers to your health insurance questions, talk with one of our experts by calling 1-888-322-2115, Monday - Friday, 8 a.m. - 5 p.m. (CT) or email us.
Benefits of Your Individual Health Plan
When you're an Avera Health Plans member, you receive more than just health insurance. You also benefit from having access to value-added services, such as:
Maximize Your Health Insurance
Schedule Your Annual Wellness Exams
A yearly checkup with your primary care provider or family doctor is vital to your long-term wellness. Most plans include one preventive medicine visit every 12 months at no cost when seeing an in-network provider.
A typical annual wellness exam may include:
- Blood pressure testing
- Cholesterol check every five years; glucose panel every three years
- Height and weight check, including BMI
- Hemoglobin check (for women)
- Individual review of results with a health care professional
- Urinalysis (for women)
To ensure your yearly checkup is covered at no cost to you, your provider must be in-network and must also use specific office codes. Print and bring these Preventive Medicine Visit codes to your checkup to make sure it is covered 100 percent.
It’s important to note that 100 percent coverage only applies to a routine preventive diagnosis. Any other diagnosis made during the appointment would apply to a copay and/or deductible and coinsurance.
In addition, some of our new plans include two additional free visits with your primary care provider. Log in to your member portal and view your Summary of Benefits and Coverage to find out which specific services are covered by your plan.
Take Advantage of Covered Preventive Services and Immunizations
Don't let a minor health problem become a major health problem. Take advantage of your free preventive wellness checkups and other preventive services and immunizations. Learn more about which preventive services (en Español) are covered and which immunizations are recommended for children and adults.
Talk to Your Physician
To receive the best possible care, be prepared for your all of your appointments and don't be afraid to ask questions before, during and after your visits.
Your Avera Network Advantage
As an Avera Health Plans member, you benefit from having access to our wide network of providers, a variety of hospitals - including Avera Medical Group and many independent providers in our region - and medical specialties.
To receive health services at the lowest cost to you, choose an in-network provider by logging in to your member portal and searching the provider directory.
Update Your Health Coverage Information
Need to update information related to your health plan? You can download, fill out and submit forms found here: