As an appointed retail agent with Sanford Health Plan there are various terms and conditions related to oversight for our Medicare Advantage (MA) and Federally Facilitated Marketplace (FFM) individual lines of business. Retail agents are considered delegated or downstream entities on behalf of Sanford Health Plan and shall participate in any oversight or monitoring as described in the retail agent agreement. Sanford Health Plan monitors agent performance through various areas of quality of service, compliance with regulations, policies, and procedures on a routine basis to ensure compliance and areas for process improvement. The monitoring periods for the 2024 calendar year will occur in April and August.

Sanford Health Plan will select a random sampling of agents during these active monitoring periods and here is the process that will be followed:

• An email will come to you from sales@sanfordhealth.org and the subject line will read SHP COMPLIANCE ALERT.
• These notices to brokers randomly selected during the monitoring period will always be released on a Monday.
• The email will provide specific information we are requesting along with the deadline to respond and provide necessary documentation.
• Monitored agent will have 10-business days to provide the requested information from the email notification.
• If required information and documentation is not provided within 5-business days of the deadline, a one-time email reminder will be sent.
• If monitored agent does not respond within the 10-business days of the deadline, a corrective action plan will be implemented.

ALIGN (MA)

Broker compliance and oversight monitoring items selected for Align Medicare Advantage product compliance for the 2024 calendar year have been outlined below.

Scope of Appointment: Per CMS guidelines the scope of appointment must be agreed upon by the Medicare beneficiary prior to any face-to-face personal/individual marketing appointment. Agents and brokers can document the scope of appointment in writing via a scope of appointment form or by recording a phone call in advance of the appointment. The salesperson is bound to only discuss those products that have been agreed upon by the beneficiary during that appointment. If other products need to be discussed, at the request of the beneficiary, a second scope of appointment form must be completed for the new product type and then the marketing appointment may be continued.

Record Retention: Per CMS guidelines delegated or downstream entities on behalf of an MA-PD issuer (Sanford Health Plan) are required to retain all Medicare documentation and maintain evidence for at least 10 years. This includes any required documentation collected at the time of enrollment.

FEDERALLY FACILITATED MARKETPLACE PLANS

Broker compliance and oversight monitoring items selected for Simplicity and Sanford TRUE on-exchange individual product compliance for the 2024 calendar year have been outlined below.

Consumer Consent: Per CMS guidelines you must obtain the consent of an individual, employer, or employee prior to helping them apply for financial help and/or enrolling in a Marketplace qualified health plan (QHP). At a minimum, the consent should acknowledge that you have informed the individual, employer, or employee of the functions and responsibilities that apply to your role in the Marketplace. There is no standard format or process for obtaining the consent or for maintaining its record, however brokers do need to ensure they document how they meet the consent requirement.

Record Retention: Per CMS guidelines delegated or downstream entities on behalf of an issuer (Sanford Health Plan) participating in the Federally Facilitated Marketplace (FFM) are required to retain all necessary documentation and maintain evidence for at least 10 years. This includes any required documentation collected at the time of enrollment.