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 2026 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 brokeradminservices@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.

MEDICARE ADVANTAGE PLANS

MINIMUM CMS ERRORS & OMISSIONS (E&O) REQUIREMENTS
In accordance with CMS guidelines, agents must maintain active Errors & Omissions (E&O) coverage at all times while appointed and registered to sell Medicare Advantage products.

The E&O policy must:

• Cover negligence, errors or omissions, misrepresentation and inaccurate advice or services related to Medicare enrollment.
• Be active and maintained without lapse.
• Cover the agent while licensed to sell insurance in at least one U.S. state.
• Be provided to the Health Plan upon request or during an audit.

If an agent’s E&O policy lapses, the agent must immediately cease assisting consumers and may not resume activity until coverage is reinstated.

FEDERALLY FACILITATED MARKETPLACE PLANS

MINIMUM CMS ERRORS & OMISSIONS (E&O) REQUIRMENTS
In accordance with CMS guidelines, agents must maintain active Errors & Omissions (E&O) coverage at all times while registered to assist consumers with Marketplace enrollment.
The E&O policy must:

• Cover negligence, errors or omissions, misrepresentation and inaccurate advice or services related to Marketplace enrollment.
• Remain active without lapse.
• Cover the agent while licensed to sell insurance in at least one U.S. state.
• Be provided to the Health Plan upon request or during an audit.

If an agent’s E&O coverage lapses, the agent must immediately cease assisting consumers until coverage is reinstated.