- Lower deductible plan.
- Fixed co-pays for medical services such as clinic and urgent care visits, and deductibles and coinsurance for services such as surgery and hospitalizations.
- Payment amounts vary based on the plan type.
When to choose? Consider a lower deductible plan if you know you will have significant health care expenses and want assurance you’ll have less out-of-pocket costs for services.
- Requires you to pay the full cost of health services and prescription drugs – except for covered preventive services – until you meet the deductible/out-of-pocket maximum specified in your plan.
- Covers all eligible health care expenses once the deductible/out-of-pocket maximum is met.
- With some plans, can be combined with a health savings account (HSA), allowing you to pay for certain medical expenses with money that’s tax-free.
When to choose? Consider this plan if you’re generally healthy and don’t expect significant health care expenses.
This is a health care facility, practitioner or provider with a signed agreement with Avera Health Plans to provide services to members.
- When health care providers and health insurance carriers work together, they will find the best pricing to reimburse you for health care services or procedures.
- That means you'll pay less for the care you need (which is exactly what you'll enjoy with an Avera plan).
- Even if you find a lower monthly premium with another health insurance company, you may end up paying more if they don’t have a wide network of providers who understand the benefits of working together – such as those affiliated with Avera Health.
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From preventive prescriptions to medicine for more advanced treatments, see how they’re covered.
Pharmacy Benefits & Tips to Maximize ThemPrescription Drug Lookup
Your premium is the amount you pay monthly for your health insurance coverage. Premiums do not figure into the out-of-pocket maximum.
Your out-of-pocket costs include expenses (such as deductibles, co-pays and coinsurance) for services that are not reimbursed by insurance. The out-of-pocket maximum is the most you pay for covered services in a plan year. After you’ve reached your out-of-pocket maximum, Avera Health Plans pays 100% of the costs for covered benefits.
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Co-pay is the fixed amount you pay for a covered health care service, such as a clinic or urgent care visit. Your co-pay can vary by the type of service – or whether you see a primary care doctor or a specialist.
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Deductible is the amount you would pay for health care services before your health insurance plan begins to pay. Some costs will be covered before you have to pay your full deductible.
Coinsurance is a percentage you’ll pay for covered health services after you met your deductible but before you reach your maximum out-of-pocket. For example, insurance pays 80% and you pay 20%.
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The first health care provider you should contact for treatment, primary care providers are typically family practice and internal medicine providers, OB-GYN providers and pediatricians.
Read 5 Reasons why you need a primary care provider
Preventive services are provided at no cost to you when delivered by an in-network provider. These include yearly checkups with your primary care provider or family doctor, preventive screenings and many immunizations.
Covered preventive services (in English) (pdf) | Servicios preventivos cubiertos (en Español) (pdf)
You can also see more terms in the uniform glossary.
