Thank you for your continued partnership with Sanford Health Plan. Please review this communication for important information that you and your 834 vendor will need to know to ensure a successful January 2023 Open Enrollment (OE). Please share this communication with your 834 vendor contact.

Due to CMS regulations, all $2800 High Deductible Health Plan (HDHP) will automatically be terminated as of 12/31/2022. To ensure no lapse in coverage, the 2023 Open Enrollment (OE) file will need a new line of coverage for each affected member. This is considered a “Group Structure* Change” in the Sanford Health Plan system.

*Group Structure is a 10-character code that is specific to each plan and network option offered by the employer to the employees.

Option 1 or Option 2 outlined below will be determined when the Employer finalizes the 2023 renewal.

OPTION 1: Renewing with NO Group Structure Changes to plans offered in 2022

Continue to send weekly 834 files using the same Group Structures as you have in 2022. There is no need to send us a full 2023 OE file. Any changes made by your employees that will generate a new ID card (i.e. new subscribers, changing deductibles…) should be received at Sanford Health Plan by December 5, 2022 to ensure ID cards are received by January 1st.

• If your 834 vendor requires a full OE file, then refer to OPTION 2 for necessary information on how the 2023 OE full file must be submitted.
• Note: Adding or terminating plan and network options as well as automatically rolling from the $2800 HDHP to a $3000 HDHP is considered a Group Structure Change and will require a full 2023 Open Enrollment (OE) file. Refer to “With Group Structure Changes” below for instructions.

OPTION 2: Employer’s renewing WITH Group Structure Changes to plans offered in 2022

OE File Requirements

• Electronic enrollment files should be received in-house at Sanford HealthPlan (SHP) by Monday, December 5th to ensure ID cards arrive before January 1, 2023 for new subscribers and those making benefit or network changes.
• All OE files need to be a full file that include all members with active coverage in 2023 (Details for 2023 OE File outlined below) o Add OE to the beginning of the file name o OE_group_name_834_YYYYMMDD (i.e. OE_ABC_Company_834_20221205)
• Employer’s/834 vendors must notify their SHP Account Manager when the open enrollment file has been submitted and/or if any of the conditions below cannot be met.

Details for 2023 OE File

Members keeping the same benefit and network on January 1st

• 2022 Weekly File: Current plan year
  • Continue to send weekly 834 files through the month of December
  • Keep the original effective date
  • Do not include a termination date

• 2023 OE File: New plan year
  • Keep the original effective date
  • Do not include a termination date

Members changing benefit and/or network on January 1st

• 2022 Weekly File: Current plan year
  • Continue to send weekly 834 files through the month of December
  • Add a 12/31/2022 term date on weekly files for both members terminating and making deductible or network changes as a result of open enrollment. The 2023 OE file will capture the member’s new deductible and network elected
  • The term date must be submitted prior to the 2023 OE file submission
  • Continue to send the term date on the weekly files for the remainder of 2022

• 2023 OE File: New plan year
  • Send a new line of coverage including the 2023 group structure with a 01/01/2023 effective date for new members or members making benefit and network changes
  • Do not send 12/31/2022 term dates on the 2023 OE or 2023 weekly files .Members terminating coverage on January 1st
  • 2022 Weekly File: Current plan year o Continue to send weekly 834 files through the month of December
  • Send a 12/31/2022 term date on all weekly files for the remainder of 2022

• 2023 OE File: New plan year
  • Omit members terminating on 12/31/2022 from the 2023 OE file and all future 2023 weekly files

Examples

Member keeping benefit and network the same from 2022 to 2023

Member changing benefit and/or network from 2022 to 2023

Member terminating 12/31/2022 and not enrolling in 2023