For off-exchange individual members requesting a Special Enrollment Period (SEP) due to loss of employer-sponsored coverage, Sanford Health Plan now requires an Employer Verification of Loss of Coverage SEP Validation Form before enrollment can be finalized.

What Brokers Need to Know

• The Employer Verification of Loss of Coverage SEP Validation Form is required when an enrollee reports a loss of employer-sponsored coverage as their qualifying event.
  Applications will remain in a pending status and will not process until the form is:
  
  • Completed
  • Returned
  • Reviewed and approved by Sanford Health Plan
• The member must select a plan within 60 days of the loss of coverage event, and all required SEP validation documentation, including employer verification, must be received by Sanford Health Plan within the same 60-day timeframe to avoid enrollment denial.

Who Completes the Form

• The employer or HR/benefits administrator must complete the form.
• Employees should not complete this form themselves.

How the Form is Returned

• Email: SHPBillingandEnrollment@SanfordHealth.org
• Mail: PO Box 91110, Sioux Falls, SD 57109
• Phone (questions): (800) 752-5863

Why This Matters
This verification is required to ensure compliance with federal SEP eligibility rules and to prevent enrollment delays for your clients.

If you have questions or need a copy of the form, please contact the consumer sales account management team at MA_IFPBrokerServices@securityhealth.org or (888) 712-4588 (option 3).