South Dakota health plan · 2025

Avera Direct $7500 HSA Eligible HDHP · 60536SD0060015

Avera Health Plans, Inc. offers this marketplace health insurance plan (Plan ID 60536SD0060015) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Expanded Bronze Plan type: HMO CSR: Limited Cost Sharing Plan Variation Issuer: Avera Health Plans, Inc.
Telehealth Data pending HSA eligible No Dental Child Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 63.00% (37.00% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$242 – $997

Before subsidies

Estimate after subsidies

Deductible

$7,500

$15000 per group

See deductible details

Max out-of-pocket

$7,500

$15000 per group

Review MOOP rules

Office visits

Primary care 0.00% Coinsurance after deductible
Specialist 0.00% Coinsurance after deductible
HSA Not eligible

Drug tiers

Generic 0.00% Coinsurance after deductible
Preferred brand 0.00% Coinsurance after deductible

View formulary tiers

$348 / mo before subsidies

≈ $4181 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1052 / mo before subsidies

≈ $12622 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1274 / mo before subsidies

≈ $15287 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$810 / mo before subsidies

≈ $9715 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

0.00% Coinsurance after deductible

Durable Medical Equipment

0.00% Coinsurance after deductible

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in South Dakota). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Limited Cost Sharing Plan Variation plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

0.00% Coinsurance after deductible

Durable Medical Equipment

0.00% Coinsurance after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 60536SD0060015
Coverage year 2025
State South Dakota
Issuer Avera Health Plans, Inc.
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 60536SD0060015-03
Available variants

Standard Off Exchange Plan · 60536SD0060015-00

Standard On Exchange Plan · 60536SD0060015-01

Open to Indians below 300% FPL · 60536SD0060015-02

Open to Indians above 300% FPL · 60536SD0060015-03
Last plan update Tue, 13 Aug 2024 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in South Dakota N/A
PCPs in South Dakota N/A
Telehealth support Data pending
Nationwide providers N/A

Provider network(s)

Providers South Dakota All US states
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

5,095 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 2,853
SPECIALTY 1,037
NON-PREFERRED-BRAND 825
PREVENTATIVE 380
Prior authorization Drugs
Required 861
Not Required 4,234
Step therapy Drugs
Required 30
Not Required 5,065
Quantity limits Drugs
Has Limit 1,573
No Limit 3,522

Customer highlights

What stands out for members

  • Issuer: Avera Health Plans, Inc. · Plan ID 60536SD0060015 · 2025 filing.
  • Disease management programs available: Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 60536SD0060015-03 (Open to Indians above 300% FPL) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Diabetes Education

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 8.0 Visit(s) per Year

Quantity Limit: Two certified diabetes education programs per member per lifetime, and eight visits per benefit year for follow-up training once patient has participated in a diabetes education program.

Exclusions: nan

Home Health Care Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: 60-visit limit per plan year for services from non-participating providers. One visit equals a maximum of 4 hours, including private duty nursing.

Laboratory Outpatient and Professional Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Age and frequency limitations may apply.

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Cardiac and pulmonary rehab services from participating providers are coinsurance after deductible and have a 36-visit maximum per plan year. Preauthorization required for all Applied Behavioral Analysis services.

Exclusions: nan

Rehabilitative Speech Therapy

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Cardiac and pulmonary rehab services from participating providers are coinsurance after deductible and have a 36-visit maximum per plan year. Preauthorization required for all Applied Behavioral Analysis services.

Exclusions: nan

Specialist Visit

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Urgent Care Centers or Facilities

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

In-network benefit for services outside of service area. When using Out-of-Network Provider inside service area you may contact the plan to determine if your visit qualifies for in-network benefits.

Exclusions: nan

X-rays and Diagnostic Imaging

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Cost sharing does not apply to certain preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).

Exclusions: nan

Dialysis

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Durable Medical Equipment

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: Certain durable medical equipment require preauthorization. No coverage for services without preauthorization.

Emergency Room Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 0.00% Coinsurance after deductible

nan

Exclusions: nan

Emergency Transportation/Ambulance

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 0.00% Coinsurance after deductible

nan

Exclusions: Preauthorization for non-emergency transportation. No coverage for services without preauthorization.

Hospice Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 185.0 Days per Year

nan

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: Preauthorization required. No coverage for services without preauthorization

Inpatient Physician and Surgical Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: Preauthorization required. No coverage for services without preauthorization

Mental/Behavioral Health Inpatient Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: Preauthorization required. No coverage for services without preauthorization.

Mental/Behavioral Health Outpatient Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Coinsurance will apply for services other than therapy performed in the office or any service at a facility.

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Outpatient Rehabilitation Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Cardiac and pulmonary rehab services from participating providers are coinsurance after deductible and have a 36-visit maximum per plan year. Preauthorization required for all Applied Behavioral Analysis services.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Radiation

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Skilled Nursing Facility

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 100.0 Days per Admission

100-day confinement limit is for services from participating providers. 60-day confinement limit for services from non-participating providers. Same confinement limit if readmitted with same diagnosis within 60 days.

Exclusions: nan

Substance Abuse Disorder Inpatient Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: Preauthorization required. No coverage for services without preauthorization.

Substance Abuse Disorder Outpatient Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Transplant

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Transplants are subject to Case Management.

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Visit(s) per 6 Months

nan

Exclusions: nan

Hearing Aids

Coverage details pending

nan

Exclusions: nan

Major Dental Care - Child

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Frequency limitations may apply.

Exclusions: nan

Prenatal and Postnatal Care

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Cost sharing does not apply to certain preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e. ultrasound).

Exclusions: nan

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Visit(s) per Year

One diagnostic exam per calendar year for children under the age of 19 from a VSP provider.

Exclusions: nan

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Age and frequency limitations may apply.

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Certain drugs require preauthorization. The preauthorization for the drug must be approved before the drug will be covered.

Exclusions: nan

Non-Preferred Brand Drugs

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Certain drugs require preauthorization. The preauthorization for the drug must be approved before the drug will be covered.

Exclusions: nan

Preferred Brand Drugs

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Certain drugs require preauthorization. The preauthorization for the drug must be approved before the drug will be covered.

Exclusions: nan

Specialty Drugs

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Certain drugs require preauthorization. The preauthorization for the drug must be approved before the drug will be covered.

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Treatment must be completed within 12 months of the injury.

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Visit(s) per 6 Months

nan

Exclusions: nan

Infusion Therapy

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Infusion therapy is covered when provided in the home (home infusion therapy).

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

Coverage details pending

nan

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

50.00%
Tier 1 in-network 50.00%
Out-of-network 100.00%

Frequency limitations may apply.

Exclusions: nan

Prosthetic Devices

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

nan

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Bariatric Surgery

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 1.0 Procedure(s) per Lifetime

Surgery must be medically necessary. Not all procedures classified as weight reduction surgery are covered. Prior approval for weight reduction surgery is required.

Exclusions: Preauthorization required. No coverage for services without preauthorization

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

One frame from the designated pediatric eyewear collection are covered.

Exclusions: nan

Gender Affirming Care

Coverage details pending

nan

Exclusions: nan

Habilitation Services

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Cardiac and pulmonary rehab services from participating providers are coinsurance after deductible and have a 36-visit maximum per plan year. Preauthorization required for all Applied Behavioral Analysis services.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Major lab and X-ray services may include PET scan, MRI, CT scan, SPECT scan, cardiovascular, nuclear medicine and MRA.

Exclusions: Some imaging requires preauthorization.

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

Plan refers to home skilled nursing as private duty nursing. Home skilled nursing is intended to provide a safe transition from other levels of care when medically necessary, to provide teaching to caregivers for ongoing care, or to provide short-term treatments that can be safely administered in the home setting.

Exclusions: nan

Reconstructive Surgery

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

Coverage details pending

nan

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

0.00% Coinsurance after deductible
Tier 1 in-network 0.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Variant attributes

Avera Direct $7500 HSA Eligible HDHP · Variant 60536SD0060015-03

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Limited Cost Sharing Plan Variation

HIOS Product ID

60536SD006

Metal Level

Expanded Bronze

Plan ID (Standard Component ID with Variant)

60536SD0060015-03

Plan Marketing Name

Avera Direct $7500 HSA Eligible HDHP

Plan Variant Marketing Name

Avera Direct $7500 AI/AN Limited Cost Share

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

60536

Issuer Marketplace Marketing Name

Avera Health Plans

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

SDN002

Out of Country Coverage

No

Out of Service Area Coverage

No

Out of Service Area Coverage Description

Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.

Service Area ID

SDS002

State Code

SD

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.629954131614064

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$0

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$0

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$15000 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$7500 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$7,500

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

SDF008

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$0

SBC Scenario, Having Diabetes, Limit

$0

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy

EHB Percent of Total Premium

1.0

First Tier Utilization

100%

Import Date

2024-08-13 20:01:38

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Level Exclusions

Abortion (except when the life of the mother is endangered), acupuncture, cosmetic surgery, dental care for adults, hearing aids, infertility treatment, long-term care, non-emergency care when traveling outside the United States, routine eye care for adults, and weight loss programs.

Plan Type

HMO

QHP/Non QHP

Both

Source Name

SERFF

Plan ID

60536SD0060015

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$15000 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$7500 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$7,500

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Individual

Not Applicable

Unique Plan Design

No

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in South Dakota?

Avera Direct $7500 HSA Eligible HDHP (60536SD0060015) is a Expanded Bronze HMO from Avera Health Plans, Inc. in South Dakota for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Avera Direct $7500 HSA Eligible HDHP support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Avera Direct $7500 HSA Eligible HDHP HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental add-ons: Child.

Vision add-ons: Child.

Does Avera Direct $7500 HSA Eligible HDHP support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Avera Direct $7500 HSA Eligible HDHP?

The issuer lists disease management resources for: Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy.

Is there out-of-country coverage for Avera Direct $7500 HSA Eligible HDHP?

No, out-of-country services are not covered for this plan.

Does Avera Direct $7500 HSA Eligible HDHP cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies. Details: Emergency or urgent care services are covered if traveling outside of our service area. No coverage for health services if you travel outside our service area for the purpose of seeking medical treatment.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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