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File a Claim

 

Medical Claim

To file a medical claim download the Medical Claim Form on Sanford’s online portal. Complete the form including a signature and date. Then, mail the completed form to the address on the form.

To check the status of a claim, visit Sanford’s online portalor call the Member Services desk at 1-800-499-3416.

Prescription Coverage

When filing a Prescription Drug Claim, choose your preferred method.

If you are an active employee or a pre-Medicare retiree:

  • Fill out a Prescription Drug Form on Sanford’s online portal.
  • Call the Member Services desk at 1-800-499-3416.

If you are a Medicare retiree:

  • Log on to Express Scripts Inc.
  • Contact Express Scripts Inc. at 1-855-315-4569 to check on the status of a claim.

 

To submit a life insurance policy claim, contact the NDPERS office to report the death. Upon notification, NDPERS will research the life insurance coverage and send necessary paperwork to you or your beneficiary.

 

Delta Dental is NDPERS dental insurance provider. All claims should be submitted within 12 months of the date of service.

  • If your dentist is a participating dentist, the claim form will be available at the dentist's office.
  • If your dentist is nonparticipating, claim forms are available by calling Delta Dental of Minnesota National Dedicated Service Center at (800) 448-3815.
  • You can also obtain the form online

The Plan also accepts the standard American Dental Association (ADA) claim form used by most dentists.

The dental office will file the claim form with the Plan; however, you may be required to assist in completing the patient information portion on the form (Items 1 through 14). The claim form should be mailed to:

Delta Dental of Minnesota
National Dedicated Service Center
PO Box 59238
Minneapolis MN 55459-9238

During your first dental appointment, it is very important to advise your dentist of the following information:

  • Your delta group number: 537482
  • Your employer (group name): North Dakota Public Employees Retirement System (NDPERS)
  • Your identification number (your dependents must use your identification number)
  • Your birthday and the birth dates of your spouse and dependent children

If you have any questions on the claims submission process, contact Delta Dental at (800) 448-3815.

 

Superior Vision is NDPERS vision insurance provider. If needed, download and complete the Member Reimbursement Claim form and mail it to Superior Vision along with a copy of the itemized invoice showing the provider’s name and address.

 

To file an online claim for your Flex Spending Account, visit WageWorks and log on to your account. Select the type of claim and enter the information as requested.

For additional filing options, refer to the FlexComp Reimbursement Options.

 

ASIFlex is the third party administrator for the RHIC program and will maintain RHIC accounts and reimbursements. To learn more, refer to the RHIC Program Overview.

If you have questions on how to file a claim, refer to the Claim Processing Guidelines.

Claim forms must be sent to ASIFlex. Direct deposit is strongly encouraged.