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Sanford Health Plan

Online Account Terms and Conditions

IMPORTANT! PLEASE READ CAREFULLY. BY CREATING AN ACCOUNT, YOU ACCEPT ALL TERMS AND CONDITIONS OF THIS AGREEMENT.

By accepting the terms and conditions, you acknowledge that the account you created is for yourself under your own Sanford Health Plan Member ID and you agree to keep the information in your account confidential and maintain the security of your user ID and password.

GENERAL PROVISIONS: Sanford Health Plan hereby grants to you the right to use and view your Sanford Health Plan account subject to the terms and conditions of this Agreement. Sanford reserves the right to modify the terms and conditions of this Agreement at any time, and such modifications shall be effective immediately upon posting the modified Agreement.

SCOPE: mySanfordHealthPlan is available for you to view your benefits, check your claim status, view your personal information and, in some cases, make updates to that information.

SITUATIONS THAT AFFECT YOUR ACCOUNT: You must notify Sanford Health Plan in any change in status due to qualifying events (for example divorce or separation). If your coverage terminates, you will have access to your account for one year after the termination effective date. If you are entitled to continuation of coverage (COBRA), you may receive a new Member ID number and will be able to open a new account.

You will not need to enroll your under-age dependent(s) if you have one family or two-person contract. The health plan contract holder (subscriber) will be able to view account information for his/her self and also any under-age dependents (17 years old and younger). Sanford Health Plan uses one registration for each adult-age member (18 years and older). If your family has multiple adult-age dependents (including children and spouses), then each adult-age dependent will need to enroll in order to obtain access to their own insurance information.

NOTICE: The information contained in your Sanford Health Plan account and the information you have provided is for your personal use. You are responsible for the accuracy of any information you enter into your account and you represent that the information entered is accurate and complete.

DISCLAIMER OF WARRANTY: Sanford Health Plan makes reasonable efforts to maintain the accuracy of the information contained in your account. However, the information sources are not always subject to immediate verification and Sanford Health Plan does not guarantee benefits through your account. You account information is an estimate of your benefits based on the enrollment and eligibility information Sanford Health Plan has on file as of today's date. You assume the risk of (and Sanford cannot and does not guarantee or warrant that use of your Sanford Health Plan account and your input or retrieval of information will be free from) infection or viruses, worms, or other code that manifests contaminating or destructive properties to the information provided.

LIMITATION OF LIABILITY: In no event shall Sanford be held responsible or liable in any way for any indirect, direct, incidental, special, punitive, or consequential damages or costs whatsoever resulting from or related to the information you supplied in your Sanford Health Plan account. No guarantee of system availability is provided under this arrangement and Sanford Health Plan shall not be responsible for any periods of system down time which Sanford Health Plan or any entity acting on Sanford Health Plan's behalf for web hosting purposes or other maintenance services determines in its sole judgment may require for system maintenance or which occur for any reasons beyond their control.

PRIVACY & CONFIDENTIALITY: Sanford Health Plan will keep any information that we collect via your account confidential. The data you provide us is used to process the services in which you have requested and is only accessed by authorized personnel. All information to which a Member has access by utilizing your Username and Security Password shall be deemed confidential information. All Users agree to maintain the confidentiality of such information in accordance with Federal and state laws.

SECURITY: Each User shall comply with the following rules:

1. User IDs and passwords shall not be shared with any other individual or Users. Passwords shall not be posted or exposed to the view of others and should be constructed in a manner so as to maintain the confidentiality of each authorized individual.

2. Automatic log on processes, such as PF KEYS or BAT FILES are not to be used unless they require manual input of the User ID or password.

3. Passwords should not be saved in the system.

4. User shall ensure at all times that no visual display of any confidential information shall be visible to the general public or unauthorized personnel.

5. Access to a www.sanfordhealthplan.com interactive web application as described in these terms and conditions shall only be available and utilized by authorized individuals which Sanford Health Plan's Security Administrator has been notified of in writing, as changes occur and also from time to time.

We will notify you of whether the information you are providing is being submitted through a secure or unsecured site. (When you come across a web page that is secured, your browser will likely display a "closed lock" or other symbol to inform you that SSL has been enabled. The web address should also now start with "https://" rather than "http://". In a nutshell, SSL allows a secure connection between your web browser and a web server. This secure information "tunnel" is being widely adopted by numerous companies for client services.)

Sending an email directly to an email address that is found on our web site is not considered secure. We have identified areas of the web site that are secure and encourage you to only submit highly sensitive and/or personal information through those sites.

The information that is gathered through our web site is not shared with any entities outside of Sanford Health Plan, unless you have specifically authorized us to share that information or if law requires it.

AUDIT RIGHTS: Sanford Health Plan may decide to review certain of its Users regarding the use of the www.sanfordhealthplan.com interactive web applications by Users and to examine supporting documentation, records and associated information regarding same. Users shall cooperate with any such audits.

TERM AND TERMINATION : These terms and conditions shall be effective upon acceptance and shall continue in force and effect unless the account is terminated or shall terminate immediately upon User's violation(s) of these terms and conditions or any other Security Administration policies communicated to User in writing or electronically.

MISCELLANEOUS:

1. Eligibility and benefit information do not constitute authorization of claim payment. These terms and conditions are not intended to supersede any other contract between Sanford Health Plan and another party. All other member and provider contractual limitations, including but not limited to, prior approvals, precertification and referrals must be handled separately as defined in the Member and Provider Information offered by Sanford Health Plan. Appropriate penalties as defined in those contracts shall apply for failure to meet these obligations.

2. Any computer hardware and/or software purchased by User to obtain access tohttp://www.www.sanfordhealthplan.com or to a www.sanfordhealthplan.com interactive web application shall be the sole financial responsibility of User or the entity to which they are affiliated. Sanford Health Plan shall not be responsible in any way for any of the software or hardware equipment in the event that this agreement is terminated or the access provided hereunder is otherwise removed or restricted in any way. In addition, User is responsible for ensuring that the hardware and software they have purchased is compatible with any www.sanfordhealthplan.com interactive web application. Any costs associated with providing this access, including but not limited to the charges for the ongoing use of telecommunications lines, internet service providers, or the like shall be borne by the User. In addition, Sanford Health Plan shall not have any liability whatsoever for any incidental or consequential damages related to providing the access or the use of information under the terms of this agreement.

3. User represents and warrants that he/she has the authority to access this information on behalf of his/herself and the authority to agree to these Terms and Conditions. User shall indemnify and hold Sanford Health Plan harmless for any loss, cost, or expense, including but not limited to reasonable attorney's fees directly related to the User's improper use of a www.sanfordhealthplan.com interactive web application, access to confidential information contained therein, User's release of confidential information to any unauthorized individuals or entities or User's breach.

4. To the extent that User is authorized to enter or correct information in one of Sanford Health Plan's computer systems via a www.sanfordhealthplan.com interactive web application, User agrees that he/she is responsible for the accuracy of any information submitted. User understands that Sanford Health Plan or one of its accounts shall rely upon such information in making decisions related to the administration of health benefit plans such as eligibility determinations and, thus, will use commercially reasonable efforts to ensure the accuracy of the information provided. User further understands that changes made to membership information such as date of birth corrections or address changes may cause Sanford Health Plan to make changes to premium rates at the next billing cycle or renewal date.

5. If any provision of this agreement should become prohibited by or irrelevant by applicable state or Federal law or determined invalid or unenforceable by a court of competent jurisdiction or any other governmental or regulatory authority with jurisdiction over the parties hereto such provisions shall be ineffective to the extent of such prohibition, without invalidating the remainder of the provision or remaining provisions of this agreement.

6. The confidentiality obligations and the indemnification obligations shall survive the termination of this agreement.

Privacy Statement

At Sanford Health Plan, we vow to keep any information that we collect via our web site confidential. This includes your name, address, email address and other information that you disclose. The data you provide us is used to process the services in which you have requested and is only accessed by authorized personnel. The use of information we collect by the web site includes but is not limited to:

· Communications describing the providers participating in Sanford Health Plan's health plan network.

· Communications describing the products and services, and payment for products or services, provided by or included in a plan of benefits.

· Communications regarding health-related products and services that are available only to Sanford Health Plan, that add value to, but are not part of, the plan of benefits, including communications regarding wellness programs or disease management programs which are available without additional charge to members.

We will not send you email correspondence about Sanford Health Plan, including newsletters and other communication, unless you have specifically requested that information.

We will notify you of whether the information you are providing is being submitted through a secure or unsecured site.
(When you come across a web page that is secured, your browser will likely display a "closed lock" or other symbol to inform you that SSL has been enabled. The web address should also now start with "https://" rather than "http://". In a nutshell, SSL allows a secure connection between your web browser and a web server. This secure information "tunnel" is being widely adopted by numerous companies for client services. From credit card purchases to online banking transactions.)

Sending an email directly to an email address that is found on our web site is not considered secure. Members or visitors concerned about the security of email communications to the Health Plan are advised to communicate via telephone to our Member Services Department. Member Services Representatives can be reached Monday through Friday between the hours of 8 a.m. to 5 p.m. CST at (605) 328-6800 or toll free at (800) 752-5863.

The information that is gathered through our web site is not shared with any entities outside of Sanford Health Plan, unless you have specifically authorized us to share that information or if law requires it.

Please note that additional web sites are linked through our web site as a convenience for our users. Sanford Health is not responsible for the privacy practices on other sites and when you leave our web site, we encourage you to be aware and read the privacy statements of those sites to ensure your privacy and confidentiality.

By using our web site, you consent to the collection and use of your information by Sanford Health as detailed in our Website Privacy Statement. If we ever make changes to our Website Privacy Statement, we will post any changes on this page so that you are constantly aware of the information we collect and the ways in which we use it.

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice applies to Sanford Health Plan. If you have questions about this Notice, please contact our Member Services Department at (800) 752-5863. You may also email your questions to memberservices@sanfordhealth.org.

This Notice describes how we will use and disclose your health information. The terms of this Notice apply to all health information generated or received by Sanford Health Plan, whether recorded in our business records, your medical record, billing invoices, paper forms, or in other ways.

 

HOW WE USE AND DISCLOSE YOUR HEALTH INFORMATION: We use or disclose your health information as follows: (In Minnesota we will obtain your prior consent):

  • Help manage the health care treatment you receive : We can use your health information and share it with professionals who are treating you. For example, a doctor may send us information about your diagnosis and treatment plan so we can arrange additional services.
  • Pay for your health services : We can use and disclose your health information as we pay for your health services. For example, we share information about you with your primary care physician to coordinate payment for those services.
  • For our healthcare operations: We may use and share your health information for our day-to-day operations, to improve our services, and contact you when necessary. For example, we use health information about you to develop better services for you. We are not allowed to use genetic information to decide whether we will give you coverage and the price of that coverage. This does not apply to long term care plans.
  • Administer your plan: We may disclose your health information to your health plan sponsor for plan administration. For example, your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge.

We may share your health information in the following situations unless you tell us otherwise. If you are not able to tell us your preference, we may go ahead and share your information if we believe it is in your best interest or needed to lessen a serious and imminent threat to health or safety:

  • Friends and Family : We may disclose to your family and close personal friends any health information directly related to that person's involvement in payment for your care.
  • Disaster Relief : We may disclose your health information to disaster relief organizations in an emergency.

We may also use and share your health information for other reasons without your prior consent:

  • When required by law : We will share information about you if state or federal law require it, including with the Department of Health and Human services if it wants to see that we're complying with federal privacy law.
  • For public health and safety : We can share information in certain situations to help prevent disease, assist with product recalls, report adverse reactions to medications, and to prevent or reduce a serious threat to anyone's health or safety.
  • Organ and tissue donation : We can share information about you with organ procurement organizations.
  • Medical examiner or funeral director : We can share information with a coroner, medical examiner, or funeral director when an individual dies.
  • Workers' compensation and other government requests : We can share information to employers for workers' compensation claims. Information may also be shared with health oversight agencies when authorized by law, and other special government functions such as military, national security and presidential protective services.
  • Law enforcement : We may share information for law enforcement purposes. This includes sharing information to help locate a suspect, fugitive, missing person or witness.
  • Lawsuits and legal actions : We may share information about you in response to a court or administrative order, or in response to a subpoena.
  • Research : We can use or share your information for certain research projects that have been evaluated and approved through a process that considers a patient's need for privacy.

We may contact you in the following situations:

  • Treatment options : To provide information about treatment alternatives or other health related benefits or Sanford Health Plan services that may be of interest to you.
  • Fundraising : We may contact you about fundraising activities, but you can tell us not to contact you again.

YOUR RIGHTS THAT APPLY TO YOUR HEALTH INFORMATION: When it comes to your health information, you have certain rights.

  • Get a copy of your health and claims records: You can ask to see or get a paper or electronic copy of your health and claims records and other health information we have about you. We will provide a copy or summary to you usually within 30 days of your request. We may charge a reasonable, cost-based fee.
  • Ask us to correct your health and claims records: You can ask us to correct health information that you think is incorrect or incomplete. We may deny your request, but we'll tell you why in writing. These requests should be submitted in writing to the contact listed below.
  • Request confidential communications: You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. Reasonable requests will be approved. We must say "yes" if you tell us you would be in danger if we do not.
  • Ask us to limit what we use or share: You can ask us to restrict how we share your health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say "no" if it would affect your care.
  • Get a list of those with whom we've shared information: You can ask for a list (accounting) of the times we've shared your health information for six years prior, who we've shared it with, and why. We will include all disclosures except for those about your treatment, payment, and our health care operations, and certain other disclosures (such as those you asked us to make). We will provide one accounting a year for free, but we will charge a reasonable cost-based fee if you ask for another within 12 months.
  • Get a copy of this privacy notice: You can ask for a paper copy of this Notice at any time, even if you have agreed to receive it electronically. We will provide you with a paper copy promptly.
  • Choose someone to act for you: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • File a complaint if you feel your rights are violated: You can complain to the U.S. Department of Health and Human Services Office for Civil Rights if you feel we have violated your rights. We can provide you with their address. You can also file a complaint with us by using the contact information below. We will not retaliate against you for filing a complaint.

Contact Information:

Sanford Health Plan

Member Services Department

PO Box 91110

Sioux Falls, SD 57109-1110

1-800-752-5863

OUR RESPONSIBILITIES REGARDING YOUR HEALTH INFORMATION: We are required by law to maintain the privacy and security of your health information.

· We will let you know promptly if a breach occurs that may have compromised the privacy or security of your health information.

· We must follow the duties and privacy practices described in this Notice and offer to give you a copy.

· We will not use, share, or sell your information for marketing or any purpose other than as described in this Notice unless you tell us to in writing. You may change your mind at any time by letting us know in writing.

CHANGES TO THIS NOTICE: We may change the terms of this Notice, and the changes will apply to all information we have about you. The new Notice will be available upon request and on our website www.sanfordhealthplan.com.

EFFECTIVE DATE: This Notice of Privacy Practices is effective September 23, 2013.

NOTICE OF ORGANIZED HEALTH CARE ARRANGMENT FOR SANFORD HEALTH PLAN: Sanford Health Plan and Sanford Health Plan of Minnesota have agreed, as permitted by law, to share your health information among themselves for the purposes of treatment, payment, or healthcare operations. This notice is being provided to you as a supplement to this Notice of Privacy Practices.

Legal

All content is for educational purposes and is not to be used as the basis for treatment of any condition or illness or as a substitute for a physician's advice. This site does not constitute an attempt to practice medicine nor does it establish a doctor-patient or hospital-patient relationship.

While the site attempts to remain current, health care information changes rapidly and thus the site should not be relied upon as comprehensive or error-free. The web site reserves the right to change this disclaimer or other terms and policies from time to time.

Answers to your health questions via the web site are provided by medical professionals at Sanford Health based upon a limited inquiry without the benefit of a thorough medical examination. You should not use this information to diagnose or treat health problems or as a substitute for a physician's examination and advice. The interchange herein does not establish a doctor-patient or hospital-patient relationship.

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Tell Us About Yourself

Insurance terms are confusing. Let us help make sense of it all.

Purchasing through Sanford Health Plan or the Marketplace, let us explain the differences

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Tell Us About Yourself

Insurance terms are confusing. Let us help make sense of it all.

Purchasing through Sanford Health Plan or the Marketplace, let us explain the differences

Sanford Health Plan offers two different provider network products in your area. Select what option that best fits your needs.

Click here to search our provider directory. If your doctor does not display, they most likely are not a participating provider with Sanford Health Plan. Feel free to continue the Plan Picker tool if you are still interested in what options Sanford Health Plan has to offer. If not, we appreciate you using our Plan Picker!

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