The network disruption between DakotaCare/Avera Health Plans and Sanford Health Plan on January 1, 2017 WILL NOT affect individual members of the South Dakota School District Benefits Fund.
“The partnership between ASBSD and Wellmark Blue Cross and Blue Shield of South Dakota gives the members of our health fund access to every hospital and 99 percent of providers in South Dakota and our members will not experience potential provider disruption in January,” ASBSD CFO Matt Flett said.
Flett noted agreements for individuals or school districts with coverage through a DakotaCare/Avera Health Plans or the Sanford Health Plan could have been reached for them to continue to use their current providers after January 1, but those would most likely utilize a “wraparound” or “rental” network – unless a direct contract is put in place – and will have to be accessed by each respective health plan to ensure individual members can continue to see their current provider as “in-network.”
“Reimbursement terms are not nearly as favorable for a wraparound network, as it will increase cost for that particular health plan, compared to a fully owned network like we have access to with Wellmark,” Flett said.
SDSDBF’s partnership with Wellmark allows for participation in a network 100 percent owned by Wellmark, as well as access to every hospital and 99 percent of providers in South Dakota.
Wellmark’s size and wholly owned network allows it to negotiate the best provider reimbursement terms for the health fund, savings it millions of dollars all while maintaining very broad access to its members.
“It is comforting to know our member districts and their staff, who work very hard every day to provide a quality education to South Dakota’s students, will not have to worry about disruptions to their healthcare coverage, which is vitally important to their families and themselves,” Flett said.