Broker Compliance Monitoring Alert 2026
As an appointed agent with Sanford Health Plan, you are considered a delegated or downstream entity acting on behalf of the Health Plan and are required to participate in any oversight or monitoring activities as outlined in our agreement.
Sanford Health Plan conducts routine monitoring of agent performance across key areas, including quality of service, regulatory compliance and adherence to established policies and procedures. These activities are designed to ensure ongoing compliance and to identify opportunities for process improvement.
For the 2026 calendar year, monitoring activities will occur during the months of April and August.
During each active monitoring period, our team will select a random sample of appointed agents for review. The following process will be followed:
- Agents selected for monitoring will receive an email with the subject line “SHP Compliance Alert” from brokeradminservices@sanfordhealth.org.
- Compliance alert emails will always be issued on a Monday.
- The email will outline the specific information and documentation being requested and will include a response deadline of 10 business days.
- If the required information and documentation are not received within five business days following the initial deadline, a one-time reminder email will be sent.
- If the agent does not respond within 10 business days following the deadline, a corrective action plan will be initiated in accordance with our agreement.
We appreciate your timely cooperation in supporting these oversight activities.
Broker compliance and oversight monitoring items for the 2026 calendar year related to Medicare Advantage products are outlined below.
Pre-enrollment prospect checklist
Agents must complete a Pre-Enrollment Prospect Checklist prior to enrolling a Medicare Advantage beneficiary. All items must be reviewed in full, and the agent must confirm that the beneficiary understands each component before proceeding with enrollment.
At a minimum, the checklist must include:
- Confirmation of Medicare eligibility (enrollment in both Part A and Part B)
- Education on the differences between Original Medicare and Medicare Advantage and a clear explanation that enrollment in the Medicare Advantage plan replaces Original Medicare
- Beneficiaries must continue to pay Medicare Part B premium
- Provider networks and directory
- Drug coverage (if MAPD)
- Benefits, premiums, and/or copayments/coinsurance along with subject to change on January 1 of each year.
- Plans allow beneficiaries to see providers outside of our network (non-contracted providers). We will pay covered services provided at the out-of-network benefit level as long as the provider accepts Medicare
Documentation of this review must be maintained in accordance with CMS and plan requirements.
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
CMS does not require a specific Pre-Enrollment Prospect Checklist; however, does require the below to be discussed prior to enrolling a Federally Facilitated Marketplace (FFM) individual.
At a minimum, the discussion must include verification of:
- Current health insurance status
- Whether employer-sponsored coverage is offered and available
- Medicare eligibility status
- Qualification for a Special Enrollment Period (SEP), if applicable
- Applicable SEP eligibility timeline
- Review available health plans (metal levels, coverage tiers)
- Explain network restrictions and provider access
- Clarify covered benefits
- Discuss any additional out-of-pocket costs
All items must be reviewed in full, and the agent must confirm that the individual understands each applicable component before proceeding with enrollment.
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.