Avera Health Plans

What it reported doing in 2024

As an essential component of the avera health integrated delivery plan, avera health plans (ahp) provides coverage and conducts other activities that increase the health of the community in its service area. Ahp conducts substantially all of its activities within the service area of avera health but does conduct a small portion beyond the avera health service area to fulfill its mission of making a positive impact in the communities it serves by ensuring adequate rural health care is available. Ahp provides health insurance coverage to an underserved population including elderly and low income, high risk and medically underserved persons. Of the 70,500 total members served in 2024, 9,635 of these members were medicare supplement members and approximately 49% consists of individuals or employees of small groups. Approximately 17,743 members are individuals and more than 96.1% of the health care exchange enrollees in the individual category were eligible to receive an advance premium tax credit, which means they were below 400% of the federal poverty limit. Avera health plans is further distinguished from the for-profit plans by its participation in the federal health insurance exchange/marketplace. Ahp has affordable, community-rated premiums which are market competitive, and they do not cover ahp's costs including claims and administrative expenses. Net medical and pharmacy claims expense resulted in a medical income ratio (mir) average of 80.6% for 2024. Significant financial support by avera health (501(c)(3)) allows ahp to remain financially viable.ahp also sponsors health education open forums, open houses, and webinars that are open to the public.

Financial Efficiency

• Mission deployment rate: 83.6%; rating input score 84
• Program expense ratio: 87.6%; rating input score 88
• Fundraising efficiency: Limited

Transparency & Controls

• Consistency checks: 100%; rating input score 100; 68th percentile among comparable filings
• Pay-setting controls: 0 of 6 controls in place; rating input score 0
  • Compensation committee: Missing
  • Independent consultant: Missing
  • Other Form 990s reviewed: Missing
  • Written employment contract: Missing
  • Compensation survey or study: Missing
  • Board or committee approval: Missing
• Foreign activity oversight: Limited
• Grant itemization coverage: 100%; rating input score 100; 77th percentile among comparable filings
• Major donor itemization: Limited
• Related-party transparency: Limited

Accountability

• Independent voting board: 36.4%; rating input score 36; 11th percentile among comparable filings
• Governance controls: 7 of 9 controls in place; rating input score 78
  • Conflict-of-interest policy: Pass
  • Whistleblower policy: Pass
  • Document-retention policy: Pass
  • CEO compensation review process: Fail
  • Other executive compensation review process: Pass
  • Form 990 shared with the board: Fail
  • Board meeting minutes documented: Pass
  • Audit committee oversight: Pass
  • Independent financial-statement audit: Pass

Sustainability

• Operating margin: 4.5%; rating input score 54; 54th percentile among comparable filings
• Total-asset coverage ratio: 0.33; rating input score 11; 11th percentile among comparable filings
• Liabilities to assets ratio: 0.36; rating input score 49; 49th percentile among comparable filings
• Officer compensation ratio: 1.2%; rating input score 69; 69th percentile among comparable filings

Growth

• Program expense growth: 8.2% per year; rating input score 100; 65th percentile among comparable filings
• Revenue growth: 8.6% per year; rating input score 100; 71st percentile among comparable filings
• Asset growth: 6.4% per year; rating input score 100; 47th percentile among comparable filings