Small Group Resources

Administrative quick guide
Oregon standardized group profile form
2020 Summary of benefit changes
2020 Underwriting guidelines
2020 Member enrollment, termination, change & waiver form
2020 Member enrollment, termination, change & waiver form - Spanish
2020 Group application
2020 Policy application addendum
2020 Renewal change form
2021 Underwriting guidelines
2021 Member enrollment, termination, change & waiver form
2021 Group application
2021 Policy application addendum
2021 Renewal change form

Certificate 

For plans with an effective start date in 2021, review the 2021 Certificate - Small Group Plans.

Some Services Require Authorization

Coverage of certain medical services and surgical procedures requires Samaritan Health Plans’ written authorization before the services are performed. Your provider can request prior authorization by phone, fax or mail. If for any reason your provider will not or does not request prior authorization for you, you must contact Samaritan Health Plans yourself. In some cases, additional information or a second opinion can be required before authorizing coverage. Review the 2021 Authorization List - Small Group Plans. 

Benefit Summaries

The deductibles and out-of-pocket maximums reflect costs for individuals using in-network providers. Costs will be higher when using out-of-network providers. Please refer to the plan documents for a full description of benefits.

Standards Plans

2021 Summary of Benefits and Coverage - Standard Bronze Plan
2021 Plan Summary - Standard Bronze Plan
2021 Summary of Benefits and Coverage - Standard Silver Plan
2021 Plan Summary - Standard Silver Plan

Tier 1 - 20% Coinsurance Plans

2021 Summary of Benefits and Coverage -  Platinum 500 Tier 1
2021 Plan Summary - Platinum 500 Tier 1
2021 Summary of Benefits and Coverage - Gold 1250 Tier 1
2021 Plan Summary - Gold 1250 Tier 1
2021 Summary of Benefits and Coverage -  Gold 2000 Tier 1
2021 Plan Summary - Gold 2000 Tier 1
2021 Summary of Benefits and Coverage - Gold 3150 Tier 1
2021 Plan Summary - Gold 3150 Tier 1
2021 Summary of Benefits and Coverage - Gold 4000 Tier 1
2021 Plan Summary - Gold 4000 Tier 1

Tier 2 - 30% Coinsurance Plans

2021 Summary of Benefits and Coverage - Gold 500 Tier 2
2021 Plan Summary - Gold 500 Tier 2
2021 Summary of Benefits and Coverage - Gold 1000 Tier 2
2021 Plan Summary - Gold 1000 Tier 2
2021 Summary of Benefits and Coverage -  Gold 1500 Tier 2
2021 Plan Summary - Gold 1500 Tier 2
2021 Summary of Benefits and Coverage - Gold 2500 Tier 2
2021 Plan Summary - Gold 2500 Tier 2
2021 Summary of Benefits and Coverage - Silver 5200 Tier 2
2021 Plan Summary - Silver 5200 Tier 2

Tier 3 - 50% Coinsurance Plan

2021 Summary of Benefits and Coverage -  Silver 6850 Tier 3
2021 Plan Summary - Silver 6850 Tier 3

HDHP Plan

2021 Summary of Benefits and Coverage - Silver 2800 HDHP
2021 Plan Summary - Silver 2800 HDHP
2021 Summary of Benefits and Coverage - Bronze 7000 HDHP
2021 Plan Summary - Bronze 7000 HDHP