Important Update
As of May 11, 2023, the United States Federal Government has declared an end to the COVID-19 Public Health Emergency (PHE) and the National Emergency (NE). With this ending, comes updated policies in relation to COVID testing and immunizations and coverage determinations.
In terms of Medicaid coverage, all states including South Dakota are redetermining if patients who received Medicaid or Children’s health Insurance Program (CHIP) in the past are still eligible. For many people, the state will use electronic records and other programs to determine your eligibility. If not, they will send you a renewal form.
Health Insurance and You - Medicaid Redetermination Virtual Event
If you’re on Medicaid and losing coverage due to the PHE ending, watch a pre-recorded special event to help you understand your health insurance options. Watch recording (15 minutes)
Avera Health Plans offers coverage for COVID-19 treatment. Learn about coverage details and options – and get answers to questions.
COVID-19 Vaccines
Please continue to stay up-to-date on the latest vaccine developments, current eligibility and other resources on the COVID-19 vaccine information page.
COVID-19 Treatment Coverage
In-network COVID-19 vaccines and boosters will continue to be paid at 100% with no member cost share.
COVID-19 Treatment Coverage and Outpatient Services
Since Oct. 1, 2021, services for the treatment of COVID-19 – including outpatient services for post COVID-19 treatment – have been paid as normal plan benefits. Examples include occupational therapy, physical therapy and durable medical equipment. This will not change with the ending of the national emergency and public health emergency declarations on May 11, 2023, related to the COVID-19 pandemic.
COVID-19 Office Visits
Office visits, urgent care or emergency room visits for the diagnosis or suspected diagnosis of COVID will be paid as normal plan benefits effective May 12, 2023.
At-Home COVID-19 Test Reimbursement
With the end of the national emergency and public health emergency declarations on May 11, 2023, related to the COVID-19 pandemic, the requirement for private insurance companies to cover COVID-19 tests without cost sharing, both for over-the-counter and laboratory tests, will end. Effective May 12, normal plan benefits will apply for all at-home COVID-19 tests for Avera Health Plans members. Tests may be applied to your health plan benefits if ordered by a participating provider. Over-the-counter tests are not covered under normal plan benefits.
Over-the-counter at-home COVID-19 tests can continue to be purchased using a Health Savings Account (HSA), Flexible Spending Account (FSA) or Health Reimbursement Account (HRA).
Attention COBRA Eligible Members
The government has announced the end of the COVID-19 National Emergency. The end of the COVID-19 National Emergency means that the additional time you were given to pay your COBRA premiums or to elect COBRA coverage will return to normal timeframes starting on July 11, 2023.
Throughout the COVID-19 National Emergency, the following COBRA deadlines were extended by the earlier date of one year, or July 10, 2023.
- The 60-day COBRA election deadline; and
- The 45-day deadline to make a first COBRA premium payment and the 30-day deadline for subsequent COBRA premium payments.
If you received COBRA election paperwork in the past year, but prior to July 10, 2023, you may have additional time to meet the associated deadline for enacting your rights. We recommend you return your COBRA election paperwork to us as soon as possible. The one-year extension is applied on a rolling basis to each individual’s deadline. If you make a COBRA election with a retroactive effective date, you will be responsible for paying COBRA premiums retroactive to the reinstatement date of your benefits.
Tips for Shopping for Insurance if You No Longer Qualify for Medicaid
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