Member Portal

Request an ID Card

Missing your ID Card? Simply request a new card and we’ll replace it.

Access Wellness Tools

Visit your personalized wellness portal for tips and tools for healthy living.

Check Benefit Balances

View your accumulators toward your deductible and out-of-pocket maximum.

View Claims

Check the status of your claims.

Find a Provider or Pharmacy

Find providers, pharmacies and specific pharmacy benefit information.

Pay My Premium

Pay your insurance premium online.

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Wellness

We’re here to help you reach your best health by providing the tools and support you need to take control.

  • Identify areas to target first through our online risk assessment tools.
  • Take control and manage your day-to-day health with online tools, educational programs and options for personalized coaching from our wellness team.
  • Live better while managing a chronic health condition with tools and support from our RN care managers.

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Get the Most From Your Health Insurance

    • ADVANTAGE Discounts card: Members receive discounted services through participating providers for dental, hearing, vision, and Profile by Sanford weight loss services
    • 10% off Sanford Wellness Center membership
    • 50% off Sanford by Profile membership ($150)
    • 10% off Vivaz Medical Spa products and services
    • 10% off cosmetic services at Sanford Dermatology
    • 10% off a consultation at Sanford Plastic Surgery
    • 10% off frames and contacts at Sanford Optical
    • Fitness Center discounts and reimbursements*
      *Certain restrictions may apply

Provider Directory

Find a primary care provider or specialist who’s covered by your insurance. Logging in to your member portal is the best way to find providers in your network.

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Pharmacy Information

Choose from a list of pharmacies that partner with Sanford Health Plan.
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Frequently Asked Questions

Doctor visit: Verify the physician or facility is participating with Sanford Health Plan, inform the clinic at check-in that you are currently enrolling with Sanford Health Plan.

Prescription: You will be required to pay for the prescription in full. Once you receive your ID card, the pharmacy may be able to re-process your claim if you provide your ID card within 10 days from the date that the prescription(s) was filled. If this is not possible, you will need to submit a claim form and send the prescription receipt to Sanford Health Plan for reimbursement. Claim forms are available from Sanford Health Plan.

SHP ID Card

Always remember, the identification card is to be used only by the person listed on the card. It may not be used by anyone else. Use of your card by another person is fraud and will be grounds for termination from the Plan. Should you need to replace a lost card, please call the Customer Service Department at (605) 328-6800, (800) 752-5863, or TTY/TDD (877) 652-1844 and we will send you a new one.

SHP ID Card

Always remember, the identification card is to be used only by the person listed on the card. It may not be used by anyone else. Use of your card by another person is fraud and will be grounds for termination from the Plan. Should you need to replace a lost card, please call the Customer Service Department at (605) 328-6800, (800) 752-5863, or TTY/TDD (877) 652-1844 and we will send you a new one.

A formulary is a list which identifies those prescription drug products which are preferred by the medical insurance plan for dispensing to you when appropriate. The list is reviewed and modified each year. You can find a list of the formulary drug names in your enrollment booklet along with a description of pharmacy management procedures.
Pharmacies that have contracted with Express Scripts, Inc., on behalf of Sanford Health Plan are considered to be participating pharmacies. You can find a listing of participating pharmacies. If you choose to go to a non-participating pharmacy, you will have to pay full-price for the prescription, rather than your copay.
For some medications including maintenance drugs or those that treat a chronic condition up to a 90 day supply is allowed. You will pay a copay for each 30 day supply received.
Contact the Pharmacy Management Department and a representative will review your charges with you.
 
To ensure you are receiving in-network benefit coverage, you are required to use the specific network tied to your plan. You can find participating providers here
Sanford Health Plan has contracted with other networks for those members who reside, travel or attend school outside the Sanford Health Plan service area.  If you have an additional network listed on your identification card, you may seek medical care from a provider that is participating with the additional network.  If these additional networks do not provide you with access to a needed provider, the Sanford Health Plan Access and Availability rules will apply.  Please refer to your Policy for details.  You can find the links to the additional networks available to you here or by calling Member Services at 1-800-752-5863.  If you have questions or do not have access to our website and would like to request a printed provider Directory, please call Member Services. IMPORTANT:  If you choose to go to a non-participating provider when in network access is available, your claims will be paid according to your out-of-network benefits.
Sanford Health Plan does not require a referral from your primary care physician to see a specialist who is in the network. If the specialist is NOT a participating provider, you must contact Sanford Health Plan to request authorization. If authorization is received, your benefits will be considered In-Network. Failure to obtain prior authorization may result in reduced coverage to the specialty services.
Sanford Health Plan has an after-hours voice mail service. If you use this voice mail service, it is very important to leave a message including your name, your ID number (as shown on your ID card), and a phone number where you can be reached. Your call will be returned the following business day. 
No, as long as the provider is considered an in-network Sanford Health Plan provider.
We prefer you call us so you can enroll in the Healthy Pregnancy Program. You will receive free information on pregnancy and prenatal care.
This depends on your benefit package. Most packages have some coverage for bariatric surgery; however specific criteria must be met. Prior authorization is also required along with a letter from your doctor.

Sanford Health Plan partners with a company called Optum. This company helps to research claims that may be work-related or accident-related, such as an automobile accident. Optum helps us determine who is responsible for your charges.  This process is called subrogation.

If you receive a call or letter from Optum requesting information on behalf of Sanford Health Plan, please know that all information will be held in strict confidence and used only to determine who should pay for your services. Please answer their questions promptly so your claims are not delayed or denied.

For more information or to submit information visit https://icc.optum.com.