Simplicity Plans

for Small Employers

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 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.

 

Choose the Right Plan

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 guide. This guide includes three simple steps to help you choose a plan that fits your needs, lifestyle and budget.

 

 

 

 

Download the Guide
Choose the Right Plan

Understand Provider Networks

As a member, you have access to our Broad Provider Network.

 

 

Broad Network
Understand Provider Networks

Understand Prescription Drugs

At Sanford Health Plan, we want to match you to the prescription drugs that are most beneficial to your health. See a list of all the drugs we cover. A formulary includes information about which benefit tier would cover a particular medication. Pharmacy Network is the same across all Sanford Health Plan plan designs.

Simplicity & TRUE for Small Groups Formulary

 

 
 

 

Understand Prescription Drugs

Drug Pricing Tool

If your employer is offering a High Deductible Health Plan (HSA) option, we encourage you to check out our OptumRX pricing tool to compare the costs of different prescription drugs. This tool will help you estimate what you would pay for your prescriptions if you choose a High Deductible Health Plan.

 

 

Try the Drug Pricing Tool
Drug Pricing Tool

Virtual Care Access

Sanford Health Plan members have affordable access to 24-hour, 7-day-a-week virtual care – holidays included. We offer three virtual care options, so you can see a provider from the comfort of home or without leaving work. Learn about e-visits, video visits and virtual exams at the link below.

 

View Virtual Care Options
Virtual Care Access

Preventive Health Screenings

At Sanford Health Plan, we are dedicated to the health and safety of our members. That is why all preventive care and screening services are covered at 100% under our plans if you are using an in-network provider. Follow our preventive health guidelines to take advantage of these services.

  • Flu shots are covered at 100%

 

Download the Guidelines
Preventive Health Screenings

Have Questions?

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Frequently Asked Questions

Do I have to go to only Sanford Health providers and locations under Sanford Health Plan options?

No, the Simplicity plans offer the broad provider network. The broad network includes a comprehensive network of independent providers and facilities, both regionally and nationally.

Can I seek services from any provider with the Simplicity plan?

Yes, but services at some providers will apply to your out-of-network coverage. For details on in- and out-of-network coverage, review your Summary of Benefits and Coverage (SBC) documents.

How are urgent and emergent situations covered on the Simplicity plans?

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.

Does Mayo Health System participate in your Broad Network?

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.

What if I don’t see my provider or facility in the Broad Network, do I have any options for an exception?

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.

How does the HSA Preventive Medication benefit work with Sanford Health Plan?

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.

How do I know how my prescription drugs will be covered and is there a network of pharmacies I need to use?

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.

How does Virtual Care benefits work with Sanford Health Plan?

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).

What is the Advantage Discount Card Program?

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.

How does your Fitness Center Reimbursement Program work?

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.

As a new member to Sanford Health Plan, if our group renewal date is not January 1 will I lose any of those costs I have already incurred with our current health insurance carrier?

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.

If I have a service or procedure already prior authorized with my current insurance company do I have to prior authorize it 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.

How are the Simplicity plans handled from a provider network standpoint when I cover a dependent that is a college student who resides outside the Sanford Health Plan service area?

The Simplicity 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.

How are the Simplicity plans handled from a provider network standpoint if I am an employee who does not reside within Sanford Health Plan service area?

The Simplicity 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.