Hawley Public Schools

Explore Your Plan Options with Sanford Health Plan

Sanford Health Plan would like to take this opportunity to introduce you to our integrated system of care. Due to ongoing circumstances requiring social distancing, we wanted to customize a virtual experience for you. You’ll get a better understanding of who we are, what we have to offer and a simplified way to engage with our team. We truly appreciate the opportunity to earn your business. Have a question not answered on this page? Submit here.

 

Provider Network Options

Search our provider networks to find the best fit for you.
Broad Network Tiered Network

Choose the Right Plan

Our employee decision guide makes it easy to choose the right health plan. It puts all the information you need to know about Sanford Health Plan in one place. The 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

Prescription Drug Coverage

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. The formulary includes information about which benefit tier would cover a particular medication.

 

View Formulary
Prescription Drug Coverage

Drug Pricing Tool

Use 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 access to 24/7 online care. 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’re dedicated to the health and safety of our members. That’s why all preventive care and screening services are 100% covered under our plans if you’re using an in-network provider. Follow our preventive health guidelines to take advantage of these services.

 

Download the Guidelines
Preventive Health Screenings

Frequently Asked Questions

Does having Sanford Health Plan insurance mean I can only visit Sanford Health providers and facilities?

Not necessarily. We offer a variety of plan options and provider networks for members to choose from. With the provider networks Hawley Public Schools has chosen, you have the flexibility to see not only Sanford Health providers and facilities at an in-network level, but you also have access to a comprehensive network of independent providers and facilities at a regional and national level.

What’s the difference between the two provider network options Hawley Public Schools is offering?

Broad Network: This network consists of over 25,000 providers within the Dakotas, Minnesota and Iowa in addition to a national network. To search for in-network providers, click here. Select the Through My Employer dropdown. Choose the Signature Series (Broad Network) option. Then, enter the city, state and mile radius you'd like to search.

Tiered Network: This network consists of over 25,000 providers within the Dakotas, Minnesota and Iowa in addition to a national network. It is split into two tiers of in-network providers. Learn more about the tiers below. To search for in-network providers, click here. Select the Through My Employer dropdown. Choose the Sanford PLUS (Tiered Network) option. Then, enter the city, state and mile radius you'd like to search.

  • Tier 1 includes Sanford Health providers and facilities across the Dakotas, Minnesota and Iowa. This tier will have the lowest in-network member cost-share.
  • Tier 2 includes the Broad Network of providers as described above that expands beyond the Sanford Health care system, including access to the national network. This tier will have the highest in-network member cost-share.

How does the Signature Series Plan work, and which provider network does it use?

Our Signature Series Plan uses 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 near the top of this page. These plans give you the flexibility to see any provider, either in-network or out-of-network, without a referral. For example, if you want to see a cardiologist, which is classified as a specialty provider, you can do so without a referral.

How does the Sanford PLUS Plan work, and which provider network does it use?

Our Sanford PLUS Plans use 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 is you would have two 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 copay, deductible, co-insurance and out-of-pocket maximum, will be lower. For full plan details, refer to the Summary of Benefit and Coverage (SBC) documents on this page. These plans give you the flexibility to see any provider in either the in-network tier (Tier 1 or Tier 2) or from out-of-network without a referral. For example, if you want to see a cardiologist, which is classified as a specialty provider, you can do so without a referral.

What are some important factors I should consider when choosing a plan?

Signature Series Plan considerations:

  • These plans will cost more than the Sanford PLUS options.
  • These plans offer a broader provider network and equal member cost-share for in-network benefits. For example, if you had a $20 copay for a primary care provider visit and saw either a Sanford Health provider or an independent provider from within our network, the copay would be the same.
  • If you plan on seeking a variety of in-network providers outside the Sanford Health care system, the Signature Series Plan may be the best option for you to control your in-network cost-share. 
  • If you have diabetes, you will likely have medical equipment that Sanford Health does not currently offer under Tier 1 cost-share. We encourage you to enroll in our Signature Series plans to minimize your maximum out-of-pocket exposure, even if most of your provider care is within the Sanford Health care system.
  • If you already have planned surgical or hospital procedures scheduled that are not a part of the Sanford Health care system within the next 12 months, we encourage you to enroll in a Signature Series Plan.

Sanford PLUS Plan considerations:

  • These plans will cost less than the Signature Series options.
  • These plans offer a tiered provider network. Member cost-share for in-network benefits will vary based on the in-network provider being seen for services. For example, you may have a $20 copay for a primary care visit with a Tier 1 Sanford Health provider, but a $40 copay for a primary care visit with a Tier 2 independent provider from within our network.
  • Tier 1 and Tier 2 providers are still considered and calculated under your in-network benefits, but the cost-share will be different depending on if Tier 1 or Tier 2 providers and facilities are used.
  • These plans allow you the flexibility to access providers within Tier 1 and Tier 2 without any referrals or authorizations.
  • If you seek a variety of in-network providers within the Sanford Health care system, the Sanford PLUS Plan may be the best option for you to control your in-network cost-share and also reduce your monthly premium costs. 
  • If you don’t frequently use health care services at this time or are open to making some provider changes and mainly access the Sanford Health care system, this can be a good option for you to control your in-network cost-share and also reduce your monthly premium costs.

How are urgent and emergency care services covered under both plans?

On both of these plans, urgent and emergency services are covered at the in-network benefit level. Since the Sanford PLUS Plan has both Tier 1 and Tier 2 in-network coverage, urgent and emergency situations will always fall under the lowest cost-share for our members, the Tier 1 benefit level.

Does the Mayo Health System participate in your provider networks?

Sanford Health Plan does have a contract with the Mayo Clinic Health System. In order for our members to access the Mayo Clinic Health System at an in-network level, they must receive prior authorization from the Sanford Health Plan. On our Sanford PLUS plans, if you receive prior authorization for services at the Mayo Clinic Health System, services will be applicable to the Tier 2 in-network cost-share amounts.

I don’t see my provider or facility in the provider networks. Do I have any options for an exception?

Sanford Health Plan recognizes the importance of a relationship between a patient and a provider. 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 planned surgery, current cancer care, late pregnancy care, 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 a provider who does not participate with us for yearly physicals or routine medical care.

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

High cost for medications should not keep you from taking prescriptions essential to your health. The IRS allows certain drugs 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, use our Drug Pricing Tool. 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 drug costs significantly compared to a traditional co-pay plan.

How do I know if my prescription drugs will be covered, and is there a network of pharmacies that 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 main pharmacy that does not participate in our network at this time is Walgreen’s.

I’ve noticed that copay plans have certain benefits for lab and X-ray services done in an office visit setting that fall under a copay. How does this work?

This is a unique coverage option that so many of our members appreciate, especially families. This benefit incorporates basic lab and X-ray services (metabolic panel, strep culture, X-rays, certain minor surgical procedures, etc.) done in an office visit setting on the same date of service as the office visit to all be covered under what we call an ‘all-inclusive copay’ scenario.

This can work two different ways: 

  • If the clinic does the services and also bills out of their clinic location, you will pay one copay for these covered services. For example, if you have a $20 office visit copay for a primary care appointment and during that visit the provider wants to test you for strep throat, the additional service will still fall under your $20 office visit copay. 
  • If the clinic does the services and bills out of their hospital location, you will pay two copays for these covered services. For example, if you have a $20 office visit copay for a primary care appointment and during that visit the provider wants to test you for strep throat, the additional service will be an additional $20 copay.

My annual deductible and maximum out-of-pocket cost reset on Jan. 1, 2020. Will I lose any of those costs I have already incurred if we choose to move to Sanford Health Plan on July 1, 2020?

No. Sanford Health Plan will receive two data files from your current insurance company so we can credit you all applicable cost-share amounts you have already incurred in 2020 before your new policy with Sanford Health Plan begins.

How do virtual care benefits work with Sanford Health Plan?

Virtual care is offered on all of our plans. Every member has convenient access 24-hours a day, 7 days a week, with holidays included. Members on our copay plan options can access both our e-visit and video visit services with a $0 copay, while those members on our High Deductible Health Plan options have cost-share for these services anywhere between a $20-49 (depending on the plan chosen). Learn more here.

What is the Advantage Discount Card Program?

This is an additional value-added benefit you will receive once you become a member of Sanford Health Plan. You will receive this discount card in the mail. It 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 the National Independent Health Club Association (search for participating fitness centers by visiting nihca.org). A member and their covered spouse can each receive up to $20 a 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 set up this value-added benefit.

If you have any other questions specific to Hawley Public Schools health insurance offerings, submit your questions here.