This is a common misconception. Narrow network plans decrease premium costs, not access to health services. You get the same comprehensive specialty care, though the variety within each specialty area may change. Your insurance provider will fill in gaps of coverage as necessary.
If a member needs a health care service that’s not available in-network, they may be covered by an out-of-network prior authorization or referral from an in-network provider. Additionally, members are always covered for emergency or urgent care visits while traveling out-of-network.
The Avera network includes many providers and 60+ specialty areas across South Dakota and northwest Iowa. The vast network of specialists provides members with peace of mind that employees will be covered when they need it.
When necessary, your provider may refer members to specialists outside the network.
Employer groups are paired with a Client Relationship Executive to help with the details of their plan, while employees have access to Customer Care Representatives. Employees also get a host of services and added benefits to plans. Plus, our experienced customer care team is here to help answer coverage questions.
Yes. Most health insurance plans cover preventive health services as recommended. That means employees don’t pay for preventive care like physical exams, screenings and immunizations. This also includes cancer screenings, such as yearly mammograms and colonoscopies.
Coverage for emergency and urgent care situations is always a given and available when out-of-network for employees in specific counties. Otherwise, employees and dependents must reside in the coverage area to be eligible for in-network coverage.
Yes. Virtual visits are covered through the Avera Health Plans mobile app and are available with a $0 co-pay1. Virtual visits help employees quickly see a provider without needing to go to a clinic. This added convenience amounts to huge time savings for people not having to drive to and from the clinic and then wait to see the doctor.