Transition of Care Request

We understand transition can cause uncertainty. We're here to help.

Complete this request if:

Your employer has contracted with Sanford Health Plan and you have not yet enrolled or are within 30 days of when your health insurance became effective and a provider you currently see is not in the network.

Questions?

Contact your Welcome Team (800) 843-8583

 

             OR:               

You currently have Sanford Health Plan insurance and have been notified in the last 30 days a provider will no longer be in the network for your chose plan.

Questions?

Contact the Customer Service Number on your ID card

 

And,

you would like care to be continued by this provider for you, a spouse, or a dependent who is/has:

  • in the 2nd or 3rd trimester of pregnancy
  • a surgery which is already planned
  • receiving cancer treatment
  • receiving transplant services
  • receiving services where it would be deemed harmful to transition at this point of treatment
  • a life threatening mental or physical illness
  • a physical or mental disability defined as an inability to engage in one or more major life activities, provided the disability has lasted or can be expected to last for at least one year, or can be expected to result in death
  • a physician's certification that there is an expected lifetime of 180 days or less (pursuant to Minnesota Statue 62Q.56)

This form should not be completed if you, a spouse, or dependent would like to continue with a provider who does not participate with Sanford Health Plan for yearly physicals and/or routine medical care.

Our teams listed above can help match you with a provider for these needs. If you meet the criteria above please submit your request below for consideration.

A letter explaining the outcome of your request will be mailed to you within 10 business days from when we receive your request.

Submit Form