COBRA Administration Updates

As a reminder, as of May 1, 2025, SHP no longer administers COBRA for small groups through WEX upon their renewal. Clients are now responsible for the COBRA administration fee and must work directly with WEX to ensure proper setup for the upcoming plan year.

For assistance, clients can contact WEX directly:

• Phone: 1(877)-765-8810
  
• Email: employerservices@wexhealth.com

The New Plan Member (NPM) file, previously sent to WEX to automatically add new members to the LEAP portal, was discontinued in February. Some groups may need to manually add new hires retroactively.

Changes to COBRA invoicing, group structure identification
Now that the health plan no longer administers COBRA for our large and small groups, clients will notice some changes to the invoicing process. 

How to find COBRA elections on the invoice 
COBRA elections submitted after May 1 will not be pulled out separately; instead, they are now noted on the invoice under the elected plan. 

COBRA elections submitted before May 1 will continue to be indicated as noted below until the member has exhausted the COBRA plan.

Employees who elect COBRA can call Sanford Health Plan’s customer service team with questions about benefits and enrollments; all other questions should be directed to their HR or COBRA administrator.

If a client needs to identify a COBRA member for reconciliation, they can request a copy of their census from their account manager or they can retrieve that information from their COBRA administrator. 

Please note: The health plan will no longer provide alternative IDs to WEX for new group onboarding or renewals; instead, the activation date and employer group will be provided, as noted here:

 

Here are some answers to commonly asked questions: 

Q: What has happened?
A: Effective May 1, 2025, Sanford Health Plan no longer administers COBRA for large or small groups. Instead, in alignment with industry best practices, groups that choose to elect COBRA coverage will work directly with a COBRA administrator to execute this highly regulated program.

Q: Why are we making this change?
A: COBRA administration is highly regulated and best done through WEX or vendors with specific expertise in that area.

Q: What does this mean for our clients?
A: Clients offering COBRA coverage will now work directly with WEX or another COBRA administrator.

Other changes include:

• The health plan will not provide a New Plan Member (NPM) file to the COBRA administrators.
• The health plan will no longer provide alternative IDs for new group onboarding or renewals; this is specific to WEX.
• All groups will need to sign new contracts at renewal.

Q: What other changes will clients notice?
A: COBRA elections submitted after May 1 are now noted on the invoice under the elected plan. COBRA elections submitted before May 1 will continue to be noted under the “COBRA Group” heading until the member has exhausted the COBRA plan, or the member’s plan is discontinued upon renewal.

Q: How do clients know who is on COBRA?
A: Clients can request a copy of their census from their account manager, or they can retrieve that information from their COBRA administrator.

Q: Who should employees contact with questions about COBRA?
A: Employees who elect COBRA can call Sanford Health Plan’s customer service team with questions about benefits and enrollments; all other questions should be directed to their HR or COBRA administrator.

Please reach out to your account manager if you have any questions. Thank you!

 

Online Invoicing Now Available

We're excited to announce that Sanford Health Plan now offers the convenience of online invoicing through our myEnrollment Portal! This new feature will help make managing your invoices easier and more efficient.

Please note that with this update, invoices will no longer be sent via email each month. If you choose not to sign up for myEnrollment access, you will continue to receive your invoice by mail. We encourage you to give this new feature a try for a quicker and more convenient invoicing experience!

Learn more about how to get started.

 

Updates to Preferred Vendor for Diabetic Test Strips

Effective June 1, 2025, the OneTouch brand of diabetic testing supplies will no longer be included on Sanford Health Plan’s formulary. Instead, the Contour brand will be on the covered drug list. 

Members across all lines of business were notified of the upcoming change in a letter sent March 18 and directed to contact their providers for updated prescriptions. If a member does need to continue with the OneTouch brand of supplies, a prior authorization can be submitted through the provider portal. Please reach out to your account executive with any questions.

 

Employer Group Name or TIN Changes

To ensure uninterrupted service and accurate processing of claims, we kindly ask that you notify Sanford Health Plan immediately if you experience any of the following changes:

• Tax Identification Number (TIN) updates
• Employer Group Name changes
• Mergers or acquisitions
• Leadership or ownership transitions

Keeping us informed of these changes helps maintain accurate records and avoid any delays or disruptions.

 

Expanded MMR Vaccine Coverage in North Dakota

In response to the measles outbreak in North Dakota, Sanford Health Plan is expanding coverage of the measles, mumps and rubella (MMR) vaccine for vulnerable populations in the state. Those vulnerable populations include:

• Infants from 6-11 months
• High-risk adults, including college students and health care workers, who have not previously received the vaccine
• Others as advised by their clinical teams

This expanded coverage applies to all lines of business offered in North Dakota and will remain in effect until the measles outbreak concludes. We are monitoring the situation and will continue to adapt coverage in our region in alignment with CDC and ACIP recommendations.

 

New North Dakota Insulin Cap Legislation

House Bill 1114 (HB1114) has been passed by the North Dakota Legislature and signed into law by Governor Armstrong. This legislation establishes a $25 monthly cap on insulin and related supplies for members covered under fully insured large group health plans, including NDPERS.

Key Details:

• Effective Date: August 1, 2025
  
• Applies To: Fully insured large group plans that are delivered, issued, executed, or renewed on or after this date

The North Dakota Insurance Department (NDID) has provided clarification regarding implementation. The law will apply to plans based on their renewal or issuance date. This means that groups renewing prior to August 1, 2025 will not be subject to the new cap until their next renewal date after the effective date.

For example, a plan renewing on July 1, 2025, would not be subject to the $25 insulin cap until its July 2026 renewal.

Please reach out if you have any questions about how this may affect your group’s benefits or timelines.

 

Increases to 2026 HSA, HDHP limits

Last week, the Internal Revenue Service (IRS) released inflation-adjusted limits for health savings accounts (HSAs) and high deductible health plans (HDHPs) for 2026:

HSA Contribution Limits for 2026:

• Self-only coverage: $4,400 (up from $4,300 in 2025)
• Family coverage: $8,750 (up from $8,550 in 2025)
• Catch-up contributions (age 55 and older): An additional $1,000 (unchanged)

HDHP Minimum Deductibles for 2026:

• Self-only coverage: $1,700 (up from $1,650 in 2025)
• Family coverage: $3,400 (up from $3,300 in 2025)

HDHP Maximum Out-of-Pocket Limits for 2026:

• Self-only coverage: $8,500 (up from $8,300 in 2025)
• Family coverage: $17,000 (up from $16,600 in 2025)