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 your 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 type of health insurance plan(s) offered and the differences between them.
  2. Review the providers in each network and be aware of the differences between them.
  3. Consider the premiums.

To learn more about how each plan works, review the FAQs at the end of this page. If you have a specific question not addressed, submit your questions to one of our coverage specialists online here.

Your employer has chosen to offer multiple plan and network options. Some benefits may be different depending on which option you choose. The information below explains some of the key differences between the plans and which network is utilized which each.

 

Explore Your Plan Options

 

Signature Series Plan

  • Offers the Broad Provider Network
  • As a broader network plan option, these plans will have a higher monthly premium compared to Sanford PLUS tiered-network options.
  • If you seek a variety of in-network providers (both Sanford Health and non-Sanford Health), these plans may be a great option for you to control your in-network copays, deductibles and maximum out-of-pocket costs.
  • This plan is a great option for those with planned surgical or hospital procedures scheduled with non-Sanford providers within the next 12 months.

 

Sanford PLUS Plan

  • Offers the Tiered Provider Network
  • As a tier-network plan, these plans will have a lower monthly premium than the Signature Series plan options.
  • Offers lower copays, deductibles, coinsurance, and maximum out-of-pocket amounts if you see Sanford providers (Tier 1)
  • Allows flexibility to access providers within Tier 1 and Tier 2 without referrals or authorizations
    • Note: Tier 2 providers will require higher copays, deductibles, coinsurance, and maximum out-of-pocket amounts for those visits
  • If you seek a variety of Sanford providers, the Sanford PLUS plans may be a good option for you to control your in-network costs and reduce your monthly premiums.
  • You must reside in an eligible zip code to elect this plan.
    • Check your eligibility here.

To learn more about how each plan works, review the FAQs at the end of the page.

Have Questions?

We're ready to help you find the best health insurance plan for your needs.
Submit Questions

Frequently Asked Questions

No. 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.
Our Sanford PLUS plans utilize the Tiered Network for in-network provider access. The Sanford PLUS plan options have both in-network and out-of-network coverage. The difference between these plans compared to the Signature Series plans is you would have 2 levels (Tier 1 and Tier 2) of in-network providers to choose between to access your care. If you choose a provider from Tier 1, your costs, such as co-pays, deductible, co-insurance, and out-of-pocket maximum, will be lower. For full plan details, reference the Summary of Benefit and Coverage (SBC) documents on this page. These plans allow you the flexibility to see any provider either in-network tier (Tier 1 or Tier 2) 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.
On both of these plans urgent and emergent situations are covered at the in-network benefit level. Since the Sanford PLUS plans have both Tier 1 and Tier 2 in-network coverage, urgent and emergent situations will always fall under the lowest cost-share for our members, the Tier 1 benefit level.
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. On our Sanford PLUS plans, if Mayo Health System is prior authorized for services at an in-network level those will be applicable to the Tier 2 in-network cost-share amounts.
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. Exceptions are not able to be made for a Tier 2 provider to apply to Tier 1 in-network cost-share amounts, except for emergent situations.
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.
If you are eligible based on the zip code in which you reside, this means you can also have your college dependent eligible for this plan as well, but you will want to ensure this is a good fit. For a college student who is outside our services 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, but note all of these providers will be at a Tier 2 in-network cost-share, not Tier 1. For urgent and emergent situations, coverage will always fall under the lowest cost-share for our members at Tier 1.