How do I know if my application was processed correctly?
If you applied online through an agent, AveraHealthPlans.com or healthcare.gov, there is a timeframe that your application is being reviewed for accuracy and within a week.
A confirmation letter will be sent that includes your Summary of Benefits and Coverage, next steps to receive your ID card(s) and a payment coupon to mail your first month’s premium, if you have not provided payment during the application process.
Ready to make a monthly premium payment? Click here to find out six payment options.
I applied through healthcare.gov and want to update a recent change (address, salary, etc.), who do I call?
Any changes you have after you apply online, it is important to notify the Federal Insurance Marketplace (healthcare.gov) and login using the same password used when you applied. Or call 1-800-318-8596.
More information to help you know when to contact healthcare.gov about your life changes.
We apologize, but Avera Health Plans cannot make these changes for you. If you want to set up an appointment at one of our locations, we have experts that are happy to help you or assist with the call.
When will I receive my new member ID cards?
After we receive your first month’s premium, we'll mail your member identification card(s) within 10 to 14 business days after the payment is cleared.
If you are receiving health insurance through an employer, ID card(s) are mailed within weeks of processing the applications and setting up the plan benefits.
What should I do if I lose my ID card?
A temporary ID card can be requested on our website. You can also print off a temporary card. Select LOGIN on the top of the website. After you enter your username and password, look for the link "Click HERE to Order a Replacement ID Card." If you need further assistance, please call our Service Center 1-888-322-2115.
What if I don’t have a member ID card and need a prescription filled?
New member ID cards arrive 10 to 14 business days after we receive your first month’s premium payment. Your account is set up within the first 7 business days.
If you are receiving health insurance through an employer, ID card(s) are mailed within weeks of processing the employee applications and setting up the plan benefits.
Can I see where my claims are posting?
Yes. All of your claims will be available to you online after logging-in to the member portal. You can set it up in your profile (after you login) to receive an email when your claim is processed.
You can also download and login to our free MyHealthPlan mobile app for access to all your claims and claims of dependents under the age of 18.
How do I get access to Avera Health Plans mobile app MyHealthPlan?
Are you new in your community and have questions?
To find a primary care physician or questions about your health insurance, call our Service Center:
- 605-322-4545 or toll-free at 1-888-322-2115
- 8 a.m. to 5 p.m. CT, Monday through Friday.
Where can I find my member benefits?
Members can login to view their personal benefits and claims.
After you receive your member ID card(s), login online or through our MyHealthPlan mobile app which is also available to download on iTunes and Google Play. With this free app, you can access your in-network providers, claims, deductible balances, make monthly premium payments and more.
Member Login Instructions
Click here to login to our member portal.
Note: You'll need your member ID card to log in and create your new username and password.
Every dependent is encouraged to login. If dependents are over the age of 18 (spouses and adult children included), we'll need a signed agreement before access is provided to the subscriber.
Once logged in, you'll have access to:
- Benefit resources on the benefits page (Certificate/Evidence/Outline of Coverage, Plan Descriptions, Policy Manuals, Summary of Benefits and Coverage and more.)
- Claims processed and Explanation of Benefits (how and/or if the claim was paid)
- Wellness Portal - free access to the online information and tools you need to make changes for a healthy lifestyle.
How do I make an address or phone number and/or name change to my plan?
If you applied through healthcare.gov, you must contact the Federal Marketplace at 1-800-318-2596 to make a change.
If you applied directly with Avera Health Plans or through your employer's plan, complete the member Change Form.
If I go to the emergency room when I am on vacation am I covered?
We cover emergency room visits outside of the Avera network, when unexpected medically necessary and emergent situations come up that could put your health at risk. This applies for things like severe allergic reactions, fainting and chest pain. Keep you member ID card handy for these situations because you'll need to show it to staff.
Are my kids covered when they go to college?
We cover your college-age dependents if they study outside the Avera network. Fill out this form before your dependent goes to college and we'll extend a regional or national network to make sure they have coverage.
I need to visit a specialist and there isn't one in my network. What do I do now?
We cover second opinions and out-of-network specialists if there are no experts for the specialty you need in-network. We do everything we can to give you access to the doctors you need. But sometimes, there are special occasions that require out-of-network specialists. If we can't find an expert within the Avera network, we'll work with your referring physician to find an approved specialist.
Are only Avera doctors considered in-network?
Our network includes many independent providers and clinics. Our providers include Regional Health System in Rapid City or Brown Clinic in Watertown. To find in-network providers in your area just log into your member portal.