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Avera Health Plans Producer Supplies Request Form

To request additional supplies from Avera Health Plans, please use the form below or contact AHP Marketing Department Monday - Friday, 8:00 a.m. - 5:00 p.m. at 605-322-4545 or toll-free at 1-888-322-2115 CT.

  * Required Fields
Date Requested:
* Producer Name:
Agency Name:
* Address Line 1:
Address Line 2:
* City:
* State:
* Zip:
Attention:
* Phone:
Items and Quantities Requested:
 
 QuantityItem
Formulary List
Marketing Brochure
Group Quote Requests
Enrollment Application
Employer Participation App./ Subscription Agreement
Change Forms
SD & IA Benefit Option Grid
SD & IA Postcards
Avera Benefit Builder Flyer
Screening Partners Flyer
Care Partners Flyer
Other 
 

Group Products and Services

Visit the following links to learn more about some of AHP products and programs.