With MyWeighForward health plans, you’ll have access to health coaching and weight loss medications that can help you be successful long-term. These plans are now available in all networks, through on-exchange (through Marketplace.AveraHealthPlans.com) and off-exchange. Plans are available where individual and family plans and small and large group employer plans are available.
For Individual and Family Plans
MyWeighForward individual and family plans offer the same comprehensive coverage of our plans but with added benefits for those who need coverage for weight loss services and medications. Once enrolled in this plan, you can opt to be assessed for weight loss assistance.
- Work with health coaches through several paths based on your needs. This is a necessary step for authorization of GLP-1 medication coverage.
- As the only plan in the region that offers a plan specific to weight loss using GLP-1 medications, Avera Health Plans is leading the market in innovative weight loss strategies.
- Through health coaching, you’ll pair lifestyle changes with weight loss medications that fit you best, saving you on monthly costs.
2026 plan details are outlined in the summary of benefits and coverage below.
- ConnectPlus MyWeighForward $2000 (pdf)
- DirectConnect MyWeighForward $2000 (For Brown, Davison, Hanson, McCook, Hutchinson, Lincoln, McCook, Minnehaha, and Yankton counties) (pdf)
- ConnectPlus MyWeighForward $6000 (pdf)
- DirectConnect MyWeighForward $6000 (For Brown, Davison, Hanson, McCook, Hutchinson, Lincoln, McCook, Minnehaha, and Yankton counties) (pdf)
Get Quote Call 605-504-5483
For Employer Plans
Employers who want to promote long-term health for their employees can offer the MyWeighForward plan for those who need coverage of weight loss medications. These plans offer the same comprehensive coverage of our Direct Network plans. This plan can be offered as one of several plan options for employees.
- Our programs promote healthier lifestyles and happier, more engaged teams. Employee wellness can increase productivity and lead to lower health insurance costs long-term.
- Employees will have access to health coaching through a number of programs based on what is best for their needs to help sustain a healthy lifestyle long-term. This is a necessary step for authorization of GLP-1 medication coverage.
- As the only plan in the region that offers a plan specific to weight loss using GLP-1 medications, Avera Health Plans is leading the market in innovative weight loss strategies.
- Boost your team’s health and productivity with MyWeighForward plans. Our comprehensive weight management solutions can help your employees stay healthy and focused.
Plan details are outlined in the summary of benefits and coverage:
Get A Quote Call 605-504-5483
FAQ & Eligibility
Get answers to common questions about MyWeighForward plans.
Who is eligible for MyWeighForward?
Once enrolled, you may be eligible for weight loss medication if you:
- Have a body mass index (BMI) of 30 or higher
- Have a BMI of 27 or greater with at least one of the following:
- Hypertension
- Hyperlipidemia
- Obstructive sleep apnea
- Cardiovascular disease
- Type 2 diabetes
How do I enroll in health coaching?
After your coverage begins, you can enroll in the program by calling 605-504-5483 Monday – Friday, 8 AM to 5 PM CT or by email livenow@avera.org. LiveNOW staff will assign you a health coach and schedule an intake call.
Following your intake, you will be assigned to a service based on your needs. This may include a health coach or nurse. Your coach or nurse will ensure you follow the protocols of the program.
What are the program requirements?
You must complete one coaching session monthly with your health coach or nurse. You must meet with the coach once monthly for coverage of weight loss medications to continue. You may be assigned weight management medications as part of your coaching. You are not guaranteed coverage of a GLP-1 medication.
Avera Health Plans follows step therapy. If a GLP-1 medication is recommended after other prescriptions are unsuccessful, the GLP-1 would be covered if you meet clinical criteria and the medication is on our covered list of medications.
What is step therapy?
Step therapy uses the most cost-effective and safest drug available for a specific medical condition. To receive step therapy drugs, your provider must prescribe certain drugs before trying others. Step therapy programs require your provider to prescribe step 1 drugs before step 2 drugs.
A GLP-1 medication would be considered a step 2 drug and your prescriber would try step 1 options first. This means you may not be eligible for GLP-1 drugs if other options are successful.
What if I already take a weight loss medication with another provider?
If you are currently prescribed a GLP-1 prescription, your provider can submit a preauthorization request to Avera Health Plans. We will evaluate the request and determine if it meets approval criteria.
What does health coaching entail?
You can participate in a coaching program through several venues. These include:
- LiveNOW, a wellness program available through Avera Health Plans
- Virta, a program for people with obesity, pre-diabetes and type 2 diabetes available through Avera Health Plans
- Avera Comprehensive Weight Management, available within Avera Health at limited locations.
You’ll work with your health coach to create accountable goals and assess progress every month. During this time, you can talk about challenges in making lifestyle changes, how to overcome plateaus and quick tips to stay on track
What if I miss a health coach meeting?
If you miss a meeting and cannot reschedule it within the month, you must watch an online video and follow up with a health coach or nurse to confirm you viewed the video. Three attempts will be made to reach you after missing a meeting. At that time, you will be sent a closure letter. This means coverage may cease for weight loss-specific drugs unless you re-enroll in the coaching program.
Can dependents be part of this plan?
Yes, they can. Not all plan members need to use the weight loss services and coverage. The MyWeighForward program includes comprehensive coverage for preventive, emergent and other services. Please see plan information in the MyWeighForward summary of benefits and coverage.
