Welcome to Quarter 4!

At Sanford Health Plan, we know this time of year can be busy for you and your employees. To help, we’ve compiled all the essential information you need as we approach the end of the calendar year.

In this issue, we introduce a new client operational guide to help you better understand processes and day to day questions you may have while working with Sanford Health Plan. Along with important annual reminders, like creditable coverage and out-of-area verification, we’ve included new and upcoming details that are crucial for you to know.

Client Operational Guide

We’ve updated our Client Operational Guide! It’s a helpful resource for understanding Sanford Health Plan processes and answering everyday employee questions. You can download the Client Operational Guide here. Printed copies are available at your request, just email us at sales@sanfordhealth.org, and we’ll send one to you.

Creditable Coverage

Sanford Health Plan is here to help you navigate the often-complex world of health insurance. With this in mind, here's your friendly reminder to send the annual federal Medicare Part D “Notice of Creditable or Non-Creditable Coverage” notice to your employees. You can read more about creditable coverage on this blog post.

Annual Out-of-Area Verification Form

Sanford Health Plan (SHP) is sending members who reside outside the SHP service area a reminder about the annual Out-of-Area Residence Form, which is due back to us by Dec. 2nd.

College students and dependents with a permanent residence outside the SHP service area need to have this form on file to ensure access to Multiplan’s nationwide network. As a reminder, members enrolled in a Sanford TRUE plan are not eligible.

Letters will be sent to affected members in mid-October. The form and letter are available for review. Once we receive the form, we allow 14 business days for processing and will notify members of a decision by mail.

Prior Authorization Network Exception

Members seeking out-of-network care must have an approved prior authorization for network exception for claims to process at an in-network benefit level.

The prior authorization for network exception, submitted by the referring provider, details why care cannot be provided within the network. Sanford Health Plan’s team of medical experts reviews the requests for medical necessity and then either approves or denies, notifying both the member and provider of the determination in writing. All out-of-network referrals, no matter the referral source, must go through this process.

Members can verify their network and view in-network providers by checking the online provider directory or by calling customer service at (800) 752-5863.

Weight Loss Drugs

A friendly reminder that weight loss drugs are an exclusion to our plans. These medications are exclusively indicated for the treatment of type-II diabetes. Any use other than diabetes, or situations where diagnosis cannot be confirmed, will require a prior authorization.

ND Exception: Plan Year 2025 ACA Plans – EHB Addition:

• Coverage for the use of GLP-1 drugs as therapy for prevention of diabetes and treatment of insulin resistance, metabolic syndrome, or morbid obesity.

• Sanford Health Plan will require prior authorization for these GLP-1 drugs and additional information on the process will be provided when available.

$5 Preventive Drug List for HDHP Plans

The $5 Preventive Drug benefit is offered in both our Large Employer Plans, ACA Small Group and Individual Products. Members must be enrolled in an HSA Qualified plan to be eligible for this benefit. Sanford Health Plan recommends you use the below drug pricing tool which automatically syncs to our formulary to search prescriptions and costs. You can access our drug pricing tool online.

Medicare Education for your Employees Approaching 65

As more of your employees approach the age of 65 and become eligible for Medicare, there is a lot of information to navigate regarding their options for health insurance. Your employees will likely have many questions about their coverage, and we’re here to help make sense of all the options. Did you know Sanford Health Plan can offer free Medicare education to your employees? We know you have a lot on your plate and we’re here to help! Learn more about your options, and take advantage of our free resources.

ID Cards

As a reminder, members can access their digital ID cards on their mySanfordHealthPlan account. This flyer is a helpful resource to help members understand the portal and the tools that it offers. If members are not able to access the portal, they should reach out to their account manager for assistance.