Questions & Answers
Am I eligible to apply for AveraSELECT Medicare SELECT* plans?
In order to be eligible for AveraSELECT, you must be 65 years or older and enrolled in the Medicare Part A (hospital) and Part B (medical) of the Federal Medicare Program. If you are on Medicaid, you do not need this insurance plan or any other Medicare supplement.
Must I wait for any prior conditions to be covered?
No. Whether this is your first Medicare supplement policy or you are replacing another Medicare supplement policy, AveraSELECT plans have no waiting period for prior health conditions. Once your application has been approved, your coverage will begin immediately on the effective date of your policy.
Is there an open enrollment period?
Yes, open enrollment is that period of time when you cannot be denied coverage because of any prior health condition you may have. You will automatically be accepted for coverage if you are 65 years of age or better and apply for AveraSELECT during the first six months after you enroll in Medicare Part B.
Medicare Supplement Policy Guaranteed Issue
If you apply for an Avera Health Plans Medicare supplement policy no later than 63 days after termination from an M+C plan, a Medicare SELECT plan or ERISA plan, and submit a Certificate of Credible Coverage, you will automatically be issued an Avera Health Plans Medicare supplement policy.
Certificate of Credible Coverage is a certificate which indicates effective date and termination date of your prior coverage. You have a right to be provided with disclosure of your rights regarding guaranteed issue and products to which you are entitled.
What physician may I use?
You may see the physician of your choice. No referral slips are necessary. To receive full plan benefits when you need hospital services, your physician must have admitting privileges at a Network Hospital or be willing to refer you to one who does.
What hospital should I go to?
AveraSELECT plans offer full plan coverage only when you use a Network Hospital. Our Customer Service Center can confirm whether the treatment you require is available from a Network Hospital and, if not available, will assist you in locating a hospital that provides the necessary service. Utilizing our Customer Service Center prior to use of a non-Network Hospital lets you know in advance if your claim will be accepted.
What happens in an emergency or while I'm traveling?
In an emergency, take care of yourself as you and your physician feel is appropriate. AveraSELECT benefits will be paid at any Medicare-approved hospital or physician in an emergency, if the treatment you require is not available from a Network Hospital, or if you are traveling outside the service area (first 90 days of travel).
Can my policy be cancelled?
No. As long as you pay you premiums on time, your individual coverage cannot be canceled because of the size or number of claims you make. AveraSELECT Medicare SELECT insurance premiums may increase, but only if they are increased for all policies of the same class. You will be notified in advance of any rate increase.
What services are not covered by AveraSELECT Medicare SELECT* Plans?
AveraSELECT insurance plans do not cover expenses that are not covered by Medicare, except as indicated in the policy. For more information on what Medicare does and does not cover, see your Guide to Health Insurance for People with Medicare. Read your policy carefully.
If I become an AveraSELECT policyholder, do I need another supplement insurance plan?
No. When you become an AveraSELECT Medicare SELECT policyholder, you do NOT need another Medicare supplement. To avoid duplication of coverage and unneeded expense, our AveraSELECT Medicare SELECT insurance policy should replace any other Medicare supplement insurance you may have.
Who do I ask if I have more questions?
Whenever you have questions, just give us a call at 605-322-7373, toll free at 888-605-3229 or contact us online. We'll be happy to talk with you about your coverage.
* Network restrictions apply. Neither Avera Health Plans nor its agents are connected with Medicare or the state or Federal Government.
