Consider Your Health Insurance Options with Sanford Health Plan

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 right health plan coverage.

Sanford Health Plan would like to take this opportunity to introduce you to our integrated system of care. Our employee decision guide makes it easy to choose the right plan by putting all the information you need to know about Sanford Health Plan in one place. Find the guide here to help you determine the best plan option for you in three easy steps:

  1. Review the benefits and features offered within the Signature Plan using the tabs and links provided below.
  2. Review the providers included within our network through the directory tools featured in the “Understand Provider Networks” section below
  3. Consider the monthly premium and your personal budget needs.

Have questions about your plan options not answered below? Submit your question to one of our coverage specialists online here.

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Frequently Asked Questions

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 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 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.
High costs for medications should not keep you from taking vital prescriptions essential to your health. The IRS allows certain medications to be available at a low cost without having to meet your deductible on a High Deductible Health Plan. These medications include many that treat common conditions and diseases such as high blood pressure, high cholesterol, depression, COPD, asthma, cancer, irritable bowel syndrome, and many more. Medications that are both considered preventive and on our list of covered drugs, only cost $5 for each 30-day fill at an in-network pharmacy. To find out if your prescriptions are covered as part of this benefit, search our Drug Pricing Tool through the link on this webpage. Simply enter your pharmacy, its location, and the name of your prescriptions for an estimate of the cost if you were to choose a High Deductible Health Plan. You may find many of your medications are covered as part of the Preventive Medication benefit. If they do not fall into the preventive category, you will see an estimate of the retail cost of the medication that would be applied to your deductible if you choose a High Deductible Health Plan. Many of our members choose a High Deductible Health Plan specifically because this benefit lowers their prescription drugs costs significantly compared to a traditional co-pay 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).
This is an additional value-added benefit you will receive once you become a member with Sanford Health Plan. You will receive this discount card in the mail which gives you access to discounts on various health care services including dental, vision, hearing and weight loss.
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.
No. Sanford Health Plan will receive 2 data files from your current insurance company so we can credit you all applicable cost-share amounts you have already incurred in this calendar year prior to your new policy with Sanford Health Plan.
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.