Coverage Updates & Information

During the COVID-19 outbreak, Sanford Health Plan is committed to providing you and your family with health care access.

COVID-19 testing is fully covered.
Sanford Health Plan will cover 100 percent of the cost of specimen collection and testing for COVID-19. Testing is covered when indicated as medically necessary by a qualified practitioner.

Office and ER visits for COVID-19 are covered.
Sanford Health Plan will cover office visits and ER visits at 100 percent when related to COVID-19 testing. If you have symptoms of COVID-19, call your provider for guidance.

What will Sanford Health Plan cover with regard to COVID-19 testing and treatment?
1. Testing: Members will not pay copays, deductibles or coinsurance for medically necessary tests to diagnose COVID-19. This includes the COVID-19 tests, anti-body tests, specimen collection, and any related rule out tests to make the COVID-19 diagnosis. There is no prior authorization requirement to review for testing, meaning your doctor does not have to ask us for the OK to test for COVID-19. Cost-share is waived for both in and out of network facilities. This policy will remain in effect for testing until the end of the Public Health Emergency (PHE), which is currently scheduled to expire January 20, 2021.

2. Testing-Related Visits: Members will not pay copays, deductibles or coinsurance with in-network providers for visits related to COVID-19, whether at a provider's office, urgent care clinic, emergency room or by telehealth. (Testing must be medically necessary, consistent with CDC guidance and at the direction of a doctor.) Cost-share is waived for both in and out of network facilities. This policy will remain in effect the end of the Public Health Emergency (PHE), which is currently scheduled to expire January 20, 2021. Treatment for COVID-19, including medications and inpatient admissions, are covered at the cost share according to the member’s plan. This includes anti-viral and anti-body treatment.

3. Vaccines: The vaccine itself will be provided by the government, so there will not be a charge for the vaccine. Sanford Health Plan will waive cost-sharing for administering the vaccine, meaning we will cover 100 percent. of the allowed amount. This includes the amount for the office visit to administer the vaccine.

All Sanford Health Plan members have access to virtual care.
During this COVID-19 outbreak, medically appropriate virtual care options are available to Sanford Health Plan members with all co-pays waived. Since COVID-19 is highly contagious, we encourage you to use virtual care options if possible instead of going to your provider’s office. Learn about your options.

We are extending prior authorizations for existing prescriptions.
While there are no current concerns about the availability of prescription drugs, the CDC and the American Red Cross recommend that households maintain at least a 90-day supply of any maintenance prescription drugs used by household members. To help you stay prepared, Sanford Health Plan is extending prior authorizations an extra 90 days for all existing maintenance prescriptions with prior authorizations that will expire in 90 days or fewer.

We’re taking steps to protect you from surprise medical bills.
Sanford Health Plan will cover all COVID-19 treatments, labs and diagnostics at an in-network rate whenever services are delivered at an in-network facility, even if the treating specialist is out-of-network.

What you need to know about COVID-19

Visit our COVID-19 page to get the facts about the disease and learn how to stay safe.