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Health Care Reform

Information on Health Care Reform

Information shared is a result of the Patient Protection and Affordable Care Act (PPACA) which was signed by President Obama on March 23, 2010.  PPACA, and the interim and final rules issued since PPACA’s enactment date, will affect the health plans of our members in their plan years beginning on or after Sept. 23, 2010.

In an effort to prepare you for these provisions, we will be providing you with health care reform information and updates that affect you and your family. Please continue to visit our website for future updates regarding health care reform.

NOTE: If you are insured under an employer-sponsored self-funded plan, some of these reform updates may not apply. Please contact your company’s Human Resources.

To learn more about the Healthcare Reform Bill, visit


Uniform Glossary of Health Coverage and Medical Terms

This uniform glossary has many commonly used terms, but isn't a full list. These glossary terms and definitions are intended to be educational and may be different from the terms and definitions in your plan. Some of these terms also might not have exactly the same meaning when used in your policy or plan, and in any such case, the policy or plan governs. 

Click here for your uniform glossary.

Grandfathered or Non-Grandfathered Health Plans

The Affordable Care Act (ACA) was passed on March 23, 2010. 

Grandfathered Plan: Employers (and individuals) could choose to keep their current health plan "grandfathered" by not changing their health insurance plan. Therefore, it is excused from having to comply with certain rules of the Affordable Care Act. This allows the plan to generally stay as it was before March 23, 2010. 

Non-grandfathered Plan:  An individual or employer group loses it grandfathered status if the health insurance plan benefits or cost structure is changed.

Helpful resource: Grandfathered Status

Annual Open Enrollment

Avera Health Plans offers an annual open enrollment period each year beginning July 1 through Aug. 14. This is for anyone under the age of 19 that applies for individual health insurance coverage in South Dakota. Avera Health Plans may issue a rate adjustment for some individual policies based on the health status of the individual applying for coverage.

Preventive Services

A list of preventive services Avera Health Plans wil cover for non-grandfathered health plans: