Creditable Coverage Reminder
Employers offering group health plans with prescription drug coverage to individuals who are also eligible for Medicare Part D must comply with certain disclosure requirements as outlined by the Centers for Medicare & Medicaid Services (CMS).

They must disclose, for example, if their prescription drug coverage is at least as good as the Medicare Part D coverage – or if their coverage is "creditable". These disclosures must be provided on an annual basis and at certain other designated times.

The annual federal Medicare Part D “Notice of Creditable or Non-Creditable Coverage” notice must be sent to employees by October 14, 2025.

Here's how the process works:

1. Send the Medicare Part D Notice of Creditable or Non-Creditable Coverage to your employees and COBRA participants by October 14, 2025 (if you need a list of COBRA participants, please let us know).
2. Make sure the notice is included in all new hire packets.
3. Complete and submit the Disclosure to CMS form electronically.

Download the following items:

• Memo: this document explains your tasks and how to determine if your plan is "creditable" or "non-creditable". The attached memo includes both the 2025 and 2026 "non-creditable" plans.
• Non-creditable coverage notice: if your plan is "non-creditable", you will send CMS Form 10182-NC.
• Creditable coverage notice: if your plan is "creditable", you will send CMS Form 10182-CC.
• Medicare coverage form: send this document with the Creditable Coverage notice. Only individuals that have Medicare coverage need to complete and return this form to ensure that we are correctly coordinating their health insurance benefits.

Important to note: if you offer two plans and their creditability is different, you need to provide the appropriate notice to the plan selected by your employee.

NOTE: This material is not considered legal advice. If you offer additional prescription drug benefits, please seek information from the appropriate carrier.

834 File Submission Reminders (for Large Groups)

• Submission Window: December 1–5, 2025
• Files submitted after this window may result in processing delays and possible member disruption.
• Please review event dates, effective dates, and all enrollment data carefully to avoid billing or coverage issues.

Health Equity Updates
Beginning in October, groups completing their January 2026 Health Equity renewals will use the Health Equity Portal to manage enrollments, changes, terminations, and other updates. Once your renewal is submitted, a Health Equity Implementation Specialist will connect with you to provide guidance and support.
For self-learning, the following step-by-step resources are available:

• Health Savings Accounts Enrollment Training
  
• Reimbursement Accounts Enrollments Training

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 December 2, 2025. 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.

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.

*North Dakota Exception: Plan Year 2026 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 our drug pricing tool which automatically syncs to our formulary to search prescriptions and costs. You can access our drug pricing tool online.

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.

We look forward to supporting you and your employees through a successful open enrollment season. Please don’t hesitate to reach out to your Account Executive with any questions or if additional support is needed.