Thank you to the MHA Nation for joining our health plan on Jan. 1, 2021. We’re so excited to have you on board!
You can find all the information you need to know here. Learn more about your benefits, coverage, provider network, pharmacy information and preventive health benefits below. You can also find an FAQ and a place to submit any questions you may have. Let’s get started on this wellness journey together.
With Sanford Health Plan, you have a partner and advocate for you and your health. We align with you and our providers to deliver a patient-centered plan that meets your needs for the right care and the right coverage.
To learn more about our coverage, review the FAQ at the bottom of this page. If you have a specific question that was not addressed, submit your questions to one of our coverage specialists online. Email an expert.
As a member, you have access to our Broad Provider Network.Broad Network
At Sanford Health Plan, we want to match you to the prescription drugs that are most beneficial to your health. See a list of all the drugs we cover. The formulary includes information about which benefit tier would cover a particular medication. Our Pharmacy Network is the same across all Sanford Health Plan options.3-Tier Formulary
Sanford Health Plan members have affordable access to 24/7 virtual care – holidays included. We offer three virtual care options, so you can see a provider from the comfort of home or without leaving work. Learn about e-visits, video visits and virtual exams at the link below.
View Virtual Care Options
At Sanford Health Plan, we are dedicated to the health and safety of our members. That is why all preventive care and screening services are covered at 100% under our plans if you are using an in-network provider. Flu shots are always fully covered.
Follow our preventive health guidelines to take advantage of these services.
Download the Guidelines
No. The Signature Series plans offer the Broad Network. This means you have the flexibility to see not only Sanford Health providers and facilities at an in-network level, but also have access to a comprehensive network of independent providers and facilities both regionally and nationally.
Signature Series plans utilize the Broad Network for in-network provider access. The Signature Series plan options have both in-network and out-of-network coverage. For full plan details, reference the Summary of Benefit and Coverage (SBC) documents. These plans allow you the flexibility to see any provider either in-network or out-of-network without a referral. For example, if you want to go see a Cardiologist, which is classified, as a Specialty Provider, you are able to do that without a referral.
Urgent and emergent situations are covered at the in-network benefit level. For full plan details, reference the Summary of Benefit and Coverage (SBC) documents.
Sanford Health Plan recognizes the importance of a relationship between a patient and his/her physician. As a new member seeking treatment, you may complete a Transition of Care Request Form. This form must be submitted to Sanford Health Plan within 30 days of the employer group’s initial effective date. The form is to be used by an individual member to request continuing care currently being received for a specific medical condition such as a planned surgery, currently receiving cancer care, you are in your 2nd or 3rd trimester of pregnancy, etc. with a provider (hospital, physician or any other health care professional) that does not participate with Sanford Health Plan. Completing this form does not guarantee authorization and it is not intended for a member who wants to continue with his/her provider who does not participate with us for yearly physicals and/or routine medical care.
Sanford Health Plan does have a contract with Mayo Health System. In order for our members to access Mayo Health System at an in-network level, they must receive prior authorization from Sanford Health Plan.
Sanford Health Plan has provided a link to the Formulary, which is a list of all the medications that are covered by the Plan, and at what applicable tier. We also provide a robust network of pharmacies our members can access both locally and nationally, the key pharmacy that does not participate in our network at this time is Walgreens.
Our virtual care is offered on all our plans and every member has convenient access 24-hours a day, 7-days a week, holidays included. Members on our copayment plan options can access both our e-visit and video visit services with a $0 copayment, while those members on our High Deductible Health Plan options will have cost-share for these services anywhere between a $20-49 (depending on the plan chosen).
Your health is important to us! We encourage our members to regularly visit a gym that participates with our fitness program through NIHCA (search for participating fitness centers by visiting nihca.org). A member and their covered spouse can each receive up to $20/month for visiting a participating fitness center a minimum of 12 days per month. Once you become a member, we will provide you with the tools to get set-up with this value-added benefit.
Yes, you should ask your doctor to submit a request to Sanford Health Plan to prior authorize your service with your new Sanford Health Plan insurance coverage. For a full list of services that need to be prior authorized, click here.
The Signature Series plans access the Broad Network. This means that when you are traveling, or have a college student residing outside of our service area, they can access our national network at an in-network level. We utilize a national network called MultiPlan and these providers can be searched in our provider directory tool no different from how you search local providers within South Dakota, North Dakota, Minnesota and Iowa.
The Signature Series plans access the Broad Network. This means that if you are an employee who resides outside the Sanford Health Plan footprint, you have access our national network at an in-network level. We utilize a national network called MultiPlan and these providers can be searched in our provider directory tool no different from how you search local providers within South Dakota, North Dakota, Minnesota and Iowa.