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Learn About Our Networks
Individual – Simplicity Plans

This plan is offered to residents in SD and ND. The network for this plan consists of over 20,000 providers, including the MultiPlan national network (when traveling). You can choose to see any licensed provider for covered services without a referral, whether the provider is in-network or out-of-network. Remember that you will pay more if you seek services from a provider not listed in this directory.

Individual – Sanford TRUE Plans

This plan is offered to individuals in counties where we have ensured a robust focused provider network is available. The Sanford TRUE plans are offered at a lower cost since eligible individuals agree to use a more focused network of Sanford Health providers and facilities. You can choose to see any licensed provider in the Sanford TRUE network for covered services without a referral. For routine or non-emergent medical services outside of the TRUE focused provider network, you will need prior approval to receive in-network benefits. This plan does not have out-of-network benefits.

Individual – North Dakota Medicaid Expansion

This plan is offered to members covered by North Dakota (ND) Medicaid Expansion only. As of January 1, 2018, the network for this plan consists of contracted providers and pharmacies who have completed enrollment with the state of ND Medicaid Program and are located within the defined ND Medicaid Expansion (NDME) service area. This plan does not have out-of-network benefits.

NDME Medical service area: includes providers located in North Dakota and counties that border North Dakota in Montana, Minnesota, and South Dakota. NDME Pharmacy service area: includes pharmacies located in North Dakota, South Dakota, Minnesota, and Montana.

Medicare – Medicare Select Supplement

This plan is offered to residents in approved counties within SD, ND, MN and IA. The network for this plan consists of facilities for your non-emergency, inpatient hospital and outpatient surgical procedures (Part A services only). You can choose to see any licensed provider within the network for covered services without a referral.

Medicare – Medicare Select Supplement Vision & Hearing Discount Program

The network for this plan consists of providers participating in this discount program.

Medicare – Medicare Standard Supplement

This plan is offered to residents in approved counties within SD, ND, MN and IA. There is no network with the Sanford Supplement plan. You have access to any provider or health care facility that accepts Medicare.

Medicare – Heart of America Cost Plan

This plan is offered to Medicare members in approved zip codes within ND. The network for this plan consists of providers in approved zip codes in ND and ALL Sanford providers in the region.

Group – Sanford Employee Group Plan

This plan is offered to individuals employed at Sanford Health only. This plan does not have out-of-network benefits.

Group - Simplicity/Commercial Large & Small

This plan is offered to members with group coverage in SD, ND, MN and IA. The network for this plan consists of over 20,000 providers, including the MultiPlan national network (for use when traveling). Members enrolled in these plans can choose to see any licensed provider for covered services without a referral. Remember that you will pay more if you seek services from a provider not listed in this directory.

Group – Sanford PLUS

This plan is offered to individuals in counties where we have ensured a robust focused provider network is available but also gives members the option to use providers in our broadest, Simplicity network. The Sanford PLUS plans are offered at a lower cost since eligible individuals agree to use a more focused network of Sanford Health providers and facilities in exchange for lower copays and coinsurance. But members also have the flexibility to use the broadest, Simplicity network at a higher cost share. You can choose to see any licensed provider in the Sanford PLUS or Simplicity network for covered services without a referral. Remember that you will pay more if you seek services from a provider not listed in the Sanford PLUS or Simplicity networks.

Group – Sanford TRUE

This plan is offered to individuals in counties where we have ensured a robust focused provider network is available. The Sanford TRUE plans are offered at a lower cost since eligible individuals agree to use a more focused network of Sanford Health providers and facilities. You can choose to see any licensed provider in the Sanford TRUE network for covered services without a referral. For routine or non-emergent medical services outside of the TRUE focused provider network, you will need prior approval to receive in-network benefits. This plan does not have out-of-network benefits.

Group – Heart of America Employer Coverage

This plan is offered to residents of ND. The network for this plan consists of providers surrounding the Minot and Rugby area, and ALL Sanford providers in the region. You can choose to see any licensed provider for covered services without a referral. Remember that you will pay more if you seek services from a provider not listed in this directory.

Group – North Dakota Employees Retirement System (NDPERS)

This plan is offered to members employed with NDPERS ONLY. The network for this plan consists of both PPO and Basic networks, including the MultiPlan national network (when traveling).

Group – Northern Plains Insurance Pool (NPIP)

This plan is offered to members employed with schools in the Northern Plains Insurance Pool (NPIP). The network for this plan consists of over 20,000 providers, including the Multiplan national network (for use when traveling). Members enrolled in this plan can choose to see any participating provider for covered services without a referral. Members who seek services from a provider not listed in this directory will incur additional out of pocket costs.