How Your Health Insurance Helps You Stay Well

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“Our members are very savvy and they’re looking at factors beyond deductibles and co-pays,” said Jordan Anderson, vice president of sales with Avera Health Plans and DAKOTACARE. “People are looking at how their insurance company can help them achieve well-being goals. It’s an expectation – and one that can provide both the health plan and the member with benefits.”

Beyond the Co-Pay

With this in mind, Avera Health Plans in recent years has switched focus to a big-picture approach toward members' health. For example, Avera Health Plans has Personal Health Services, which includes health coaching, discounts to fitness facilities and help with managing a chronic disease or complex illness.

But it goes beyond the occasional check-in with a member about their health goals or chronic conditions. Personal health advocates focus on all issues that can affect members' health. This includes things that have nothing to do with health care, for example, living environment or lifestyle patterns.

Catching Health Concerns Faster

People who review their health plan benefits and seek out incentives and value-added aspects within their coverage plans are often healthier. In many cases, education, reminders and customer service support can help anyone stay ahead of the game in terms of health.

“We see preventive, no-cost services, which are required under the Affordable Care Act, as one of the keys to stopping what we call the ‘smoldering ember’ effect in a person’s health,” said Anderson. “A smoldering ember, if not noticed, can lead to a roaring fire. Preventive screenings, checkups and immunizations can tamp out those potential health issues before they grow unchecked and lead to substantial problems.”

Making the Most of Coverage

Customer-service professionals, as well as physicians, health coaches, pharmacists and nurses, make sure covered members are aware of their care.

“Our member health advocates get involved on many levels, such as when they can catch members before they are referred to out-of-network providers. They will see if an in-network provider could provide the service they need. That involvement can save members a lot of out-of-pocket cost,” said Cari Haug, RN, a Case Manager with Avera Health Plans Personal Health Services. “Our advocates also are an excellent resource for members who seek community resources, and they are well-versed on benefits. They answer coverage questions as well.”

Following the Data

Vigorous research and data evaluation can also help companies to be preemptive and support their members when it comes to prevention and well-being.

“We evaluate a tremendous amount of data as well as being thoughtful around the social determinants of health to make sure people are getting the proactive outreach they need in order to ensure the right care occurs at the proper time,” said Anderson. "In cases where people were recently diagnosed with chronic conditions, we might be the first outreach they make after speaking with their doctor. In that moment, we are prepared to provide the insight they need to adjust their lifestyle and best deal with the illness they face.

“We encourage every member to talk to either their employer or to call customer service so they can take preemptive steps, know their options and utilize all the services that come with their coverage,” Anderson said.

Talk with an agent to see what benefits are included in your plan to help you stay well. Get a quote from an Avera Health Plans agent today.