Broad and Focused Network Plans:
For Small and Large Employers
Explore Your Health Insurance Options with Sanford Health Plan
Sanford Health Plan is your health care partner and advocate. 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.
Whether you’re a current member or are interested in joining our integrated system of care, easily navigate your options with these tools and resources.
Follow these steps to access all the information you need to consider when choosing the right plan that fits your needs, lifestyle and budget.
Step 1: Employee Decision Guide
Sanford Health Plan makes it easy to choose the right plan for you by putting everything you need to know about our plans in one place.
Download the Guide
Step 2: Choose a Provider Network
Broad Network - Large Employers
Sanford Health Plan’s Signature Series broad network expands beyond the Sanford Health system for access to providers and facilities within the Sanford Health Plan service area. To receive in-network benefits, see providers in this directory. Prior authorization for certain services is still required, regardless of where you receive care.
If you or a dependent live outside of the Sanford Health Plan service area complete an Out-of-Area Form to request access to the nationwide network. If access is approved, nationwide network providers and facilities will process at the in-network benefit level.
Broad Network - Small Employers
Sanford Health Plan’s Simplicity broad network is grouped into two tiers. Member cost share (copayments, deductibles, and coinsurance) is based on the tier of the provider from whom they receive care. Tier 1 Preferred (which has the lowest member cost-share) includes our large care system of Sanford Health providers and facilities. Tier 2 Affiliated (which has a higher member cost-share) includes a broad network that expands beyond the Sanford Health system for providers and facilities within the Sanford Health Plan service area. To receive in-network benefits, see providers in this directory. Prior authorization for certain services is still required, regardless of where you receive care. If you or a dependent live outside of the Sanford Health Plan service area complete an Out-of-Area Form to request access to the nationwide network. If access is approved, nationwide network providers and facilities will process under Tier 2 benefits.
Focus Network
The focused network includes over 2,200 providers. This network provides access to Sanford Health providers and facilities, plus some additional independent providers across the Dakotas, Minnesota and Iowa. You can choose to see any licensed Sanford Health provider for covered services without a referral for in-network coverage.
This plan does not offer out-of-network coverage except in urgent and emergency situations.
Sanford Health Plan Service Area
All counties in SD & ND, and approved counties in IA: Clay, Dickinson, Emmet, Ida, Lyon, O’Brien, Osceola, Plymouth, Sioux, and Woodbury. MN: Becker, Beltrami, Big Stone, Blue Earth, Brown, Chippewa, Clay, Clearwater, Cottonwood, Douglas, Grant, Hubbard, Jackson, Kandiyohi, Kittson, Lac Qui Parle, Lake of the Woods, Lincoln, Lyon, Mahnomen, Marshall, Martin, McLeod, Meeker, Murray, Nicollet, Nobles, Norman, Otter Tail, Pennington, Pipestone, Polk, Pope, Red Lake, Redwood, Renville, Rock, Roseau, Sibley, Stearns, Stevens, Swift, Traverse, Watonwan, Wilkin, and Yellow Medicine.
Step 3: Understand the Comprehensive Prescription Drug Coverage
We want to match you to the prescription drugs that are most beneficial to your health.
Refer to your employer plan documents to learn what formulary option is applicable to your coverage. A formulary includes information about which benefit tier would cover a particular medication. All plans offered by Sanford Health Plan offer the same pharmacy network.
- Explore Large Employer 3-Tier Formulary here
- Explore Large Employer 5-Tier Formulary here
- Explore ACA Small Employer Formulary here
If your employer offers an HSA, compare the costs of different prescription drugs using OptumRX. This pricing tool will help you estimate what you will pay for your prescriptions if you choose an HSA.
Step 4: Learn About Your Preventive Health Coverage
Our top priority is the health and safety of our members. That’s why all preventive care and screening services are 100% covered under our plans if you use an in-network provider.
Follow our preventive health guidelines to take full advantage of these covered benefits at no cost to you.
Download the Guidelines