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Narrow Network Plans

Narrow network plans benefit both employers and employees who want quality care at the most competitive price possible. Our narrow network plans, called Avera Direct, include a variety of premium and deductible levels based on budget and needs.

To learn more, please read our eBook on narrow networks plans and request a custom quote.

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Perks of Our Narrow Network Options

  • Lower premium costs
  • Budget-friendly for employer and employee
  • Easy on the wallet for employee
  • Care options from in-network doctors and facilities
  • Coverage for emergency and urgent care outside of network

Budget-Friendly Health Insurance Solution

Narrow networks, also called select or channeled networks, are increasingly part of the solution to decrease premiums for both the employer and employee. Access additional coverage options—such as value-added services or ancillary products—based on the size of your company.

Value-Added Services

  • Virtual visits available at no charge for most plans1
  • Employee Assistance Program (EAP)
  • Fitness membership
  • Life insurance
  • Well-being program
  • COBRA service

Ancillary Products

Ancillary products can be offered in addition to the health insurance plan.

  • Dental insurance
  • Vision insurance
  • Short- and long-term disability
  • Critical illness
  • Life and AD&D insurance

Narrow Network Group Plans

With a narrow network group plan, the insurance provider can often negotiate lower reimbursements, which can mean lower costs for members.

Our narrow network plan options include the following:

Direct Plans

Our Direct Plans offer no out-of-network coverage. This plan includes Avera owned and managed facilities. Out-of-network coverage is only available for emergency and urgent care. Otherwise, employees pay the full cost of services when they choose an out-of-network provider.

  • Available to employer groups who reside in Minnehaha, Lincoln and Brown counties in South Dakota
  • $0 preventive care exams, screenings and immunizations
  • Includes providers within Avera Health as well as non-Avera clinicians to ensure network adequacy

Preferred Plans

This tiered plan provides the savings of a narrow network of Avera providers with the option to pay more on a second out-of-network tier of providers. It’s a great way for companies to try out narrow network but still offer employees an out-of-network option.

  • Available in Minnehaha, Lincoln and Brown counties in South Dakota
  • $0 for most in-network preventive care visits, screenings and immunizations
  • Includes a variety of independent providers and health systems across our footprint

Narrow Network FAQ

Are there restrictions with narrow network plans?

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.

How many providers are in-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.

What happens if my employees have coverage questions?

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.

Does a narrow network plan cover the cost for preventive care?

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.

Will my employees be covered outside of the network?

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.

Are virtual visits covered?

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.

1 For most members. Some limitations apply. NOTE: IRS guidelines indicate that members with HSA-eligible plans may be subject to tax penalties if they use the free virtual visits. If you have an HSA-eligible plan, you may use your HSA or Flex spending dollars.

The Pricing Power of a Narrow Network

Download this free resource to see how narrow networks work, coverage options and employer experiences to decide if it’s right for your business.

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Our local team is happy to help make sure you have the right plan for your health care needs and budget.

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Still have questions?

Our local team is happy to help make sure you have the right plan for your health care needs and budget. Find an Agent
You can also call our sales team toll-free at 855-692-8372.

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