Avera Health Plans Forms & Brochures

Below is a list of forms and brochures that you may find useful. If you don’t see the information that you are looking for, please contact the Avera Health Plan Service Center at (605) 322-4545 or toll-free at 1 (888) 322-2115, 8 a.m. to 5 p.m. CT, Monday through Friday.

• Member Guide
• Avera Health Plans Brochure
• Avera HSA
• Change Form 
• Coordination of Benefits
• Automatic Premium Payments (ACH/EFT) Form
• Employer Participation Renewal Agreement
• Employee Assistance Program (EAP) Flyer
• Enrollment Application for Fully Insured
• Enrollment Application for Fully Insured - Spanish
• Flex Automatic Withdrawal EFT ACH Form
• Flexible Spending Account Brochure and Forms  
• Lab and X-ray Benefit Explanation
• My 365 Brochure - Online Personal Health Guide 
• Out-of-Area Residence Registration Form
• Student Verification Form
• Termination of Coverage Request Form
• Value-Added Services