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WebbSanford Policy Health Plan MemE-REB-029 Telehealth Benefit Reimbursement APPROVED BY: ... Self-funded NDPERS Medicare Supplement/Select ND Medicaid Expansion Product/Plan Name Individual TRUE & ... 42 Formulary) prior to … WebbSanford Health Plan Prior Authorization List To receive coverage for services or equipment below, you must receive approval from the plan. Requests must be made at least three … WebbSanford Health Plan has a list (formulary) of FDA approved brand name and generic medications that are covered by the Plan. By following the formulary and using generic … galacticraft 4 server