- Brokers
- Selling 2021 Plans
- Small Group
2021 Small Group Plans
Plans for 1 to 50 Employees
Samaritan Health Plans offers small group plans for Oregon businesses with 1 to 50 employees. Our integrated health plans and wellness programs help hold the line on your insurance costs by engaging employees and their families in maintaining and improving their health.
Our plans include:
- A local provider network.
- Free preventive services.
- Wellness services — includes a health assessment, biometric screening and online health courses (these services not available with Standard plans).
Standard Plans
| Benefit Type | Samaritan Oregon Standard Bronze | Samaritan Oregon Standard Silver |
|---|---|---|
|
Individual wellness assessment |
Not available with this plan | Not available with this plan |
|
Health risk screening |
Not available with this plan | Not available with this plan |
|
Health risk score and report |
Not available with this plan | Not available with this plan |
|
Personal health coaching |
Not available with this plan | Not available with this plan |
| Benefit Type | Samaritan Oregon Standard Bronze | Samaritan Oregon Standard Silver |
|---|---|---|
|
Deductible |
$6,550 per individual $13,100 per family (Combined medical and pharmacy) | $2,500 per individual $5,000 per family (Medical only) |
|
Out-of-pocket maximum |
$6,550 per individual $13,100 per family (Combined medical and pharmacy) | $7,350 per individual $14,700 per family |
|
Primary care |
0%, after deductible | $40, not subject to deductible |
|
Lifetime benefit maximum |
None | None |
|
Urgent care |
0%, after deductible | $70, not subject to deductible |
|
Specialist visit |
0%, after deductible | $80, not subject to deductible |
|
Emergency care |
0%, after deductible | 30%, after deductible |
|
Mental health and chemical dependency or substance abuse - Office visits |
0%, after deductible | $40, not subject to deductible |
|
Preventive care and services |
0%, not subject to deductible | $0, not subject to deductible |
|
Outpatient surgery - facility |
0%, after deductible | 30%, after deductible |
|
Outpatient surgery - professional |
0%, after deductible | 30%, after deductible |
|
Inpatient hospital |
0%, after deductible | 30%, after deductible |
|
Inpatient rehabilitative and habilitative care |
0%, after deductible | 30%, after deductible |
|
Skilled nursing facility care |
0%, after deductible | 30%, after deductible |
|
Radiology and labs |
0%, after deductible | 30%, after deductible |
|
High tech imaging |
0%, after deductible | 30%, after deductible |
|
Mental health and chemical dependency or substance abuse - Inpatient care and residential programs |
0%, after deductible | 30%, after deductible |
|
Physical therapy - rehabilitative or habilitative |
0%, after deductible | $40, not subject to deductible |
|
Occupational therapy - rehabilitative or habilitative |
0%, after deductible | $40, not subject to deductible |
|
Speech therapy - rehabilitative or habilitative |
0%, after deductible | $40, not subject to deductible |
|
Injectable drugs |
0%, after deductible | 30%, after deductible |
|
Ambulance - ground |
0%, after deductible | 30%, after deductible |
|
Ambulance - air |
0%, after deductible | 30%, after deductible |
|
Durable medical equipment - DME |
0%, after deductible | 30%, after deductible |
|
Home health care |
0%, after deductible | 30%, after deductible |
|
Hospice |
0%, after deductible | 30%, after deductible |
|
Hearing aids and cochlear implants |
0%, after deductible | 30%, after deductible |
|
Pediatric Vision routine exam |
0%, after deductible | $0, not subject to deductible |
|
Pediatric Vision hardware |
0%, after deductible, contacts and frames are each covered up to $150 per calendar year. Some lenses are at $0 after deductible. Call health plan for specific coverage and cost. | 0%, not subject to deductible, contacts and frames are covered up to $150 per calendar year. Some lenses are at $0 after deductible. Call health plan for specific coverage and cost. |
|
Transplants |
0%, after deductible | 30%, after deductible |
|
Alternative Care |
Not available with this plan | Not available with this plan |
|
Diabetes education |
$0, after deductible | $0, not subject to deductible |
|
Nutritional counseling |
$0, after deductible | $0, not subject to deductible |
|
Diabetic supplies |
$0, after deductible | $0, not subject to deductible |
| Benefit Type | Samaritan Oregon Standard Bronze | Samaritan Oregon Standard Silver |
|---|---|---|
|
Deductible |
$6,550 per individual $13,100 per family (Combined medical and pharmacy) | $0 per individual $0 per family |
|
Tier 1 - Preventive |
$0, not subject to deductible | $0, not subject to deductible |
|
Tier 2 - Generic |
0%, after deductible | $15, not subject to deductible |
|
Tier 3 - Preferred |
0%, after deductible | $60, not subject to deductible |
|
Tier 4 - Non-preferred |
0%, after deductible | 50%, not subject to deductible |
|
Tier 5 - High-cost specialty drugs |
0%, after deductible | 50%, not subject to deductible |
Health & Wellbeing Plans
| Benefit Type | Health & Wellbeing 2500/20 | Health & Wellbeing 3000/20 | Health & Wellbeing 5000/60 |
|---|---|---|---|
|
Individual wellness assessment |
$0 cost share | $0 cost share | $0 cost share |
|
Health risk screening |
$0 cost share | $0 cost share | $0 cost share |
|
Health risk score and report |
$0 cost share | $0 cost share | $0 cost share |
|
Personal health coaching |
$0 cost share | $0 cost share | $0 cost share |
| Benefit Type | Health & Wellbeing 2500/20 | Health & Wellbeing 3000/20 | Health & Wellbeing 5000/60 |
|---|---|---|---|
|
Deductible |
$2,500 per individual $5,000 per family (Combined medical and pharmacy) | $3,000 per individual $6,000 per family (Combined medical and pharmacy) | $5,000 per individual $10,000 per family (Combined medical and pharmacy) |
|
Out-of-pocket maximum |
$7,350 per individual $14,700 per family (Combined medical and pharmacy) | $7,350 per individual $14,700 per family (Combined medical and pharmacy) | $7,350 per individual $14,700 per family |
|
Primary care |
$50, not subject to deductible | $35, not subject to deductible | $60, after deductible |
|
Lifetime benefit maximum |
N/A | N/A | N/A |
|
Urgent care |
$100, not subject to deductible | $35, not subject to deductible | $120, after deductible |
|
Specialist visit |
$100, not subject to deductible | $70, not subject to deductible | $100, after deductible |
|
Emergency care |
30%, after deductible | $300, and 20%, after deductible | 50%, after deductible |
|
Mental health and chemical dependency or substance abuse - Office visits |
$50, not subject to deductible | $35, not subject to deductible | $60, after deductible |
|
Preventive care and services |
$0, not subject to deductible | $0, not subject to deductible | $0, not subject to deductible |
|
Outpatient surgery - facility |
30%, after deductible | $150, after deductible | 50%, after deductible |
|
Outpatient surgery - professional |
30%, after deductible | $150, after deductible | 50%, after deductible |
|
Inpatient hospital |
30%, after deductible | $750, after deductible | 50%, after deductible |
|
Inpatient rehabilitative and habilitative care |
30%, after deductible | $750, after deductible | 50%, after deductible |
|
Skilled nursing facility care |
30%, after deductible | 20%, after deductible | 50%, after deductible |
|
Radiology and labs |
30%, not subject to deductible | 30%, not subject to deductible | 50%, after deductible |
|
High tech imaging |
30%, after deductible | 30%, after deductible | 50%, after deductible |
|
Mental health and chemical dependency or substance abuse - Inpatient care and residential programs |
30%, after deductible | $750, after deductible | 50%, after deductible |
|
Physical therapy - rehabilitative or habilitative |
$100, after deductible | $70, after deductible | $60, after deductible |
|
Occupational therapy - rehabilitative or habilitative |
$100, after deductible | $70, after deductible | $60, after deductible |
|
Speech therapy - rehabilitative or habilitative |
$100, after deductible | $70, after deductible | $60, after deductible |
|
Injectable drugs |
30%, after deductible | 20%, after deductible | 50%, after deductible |
|
Ambulance - ground |
30%, after deductible | $200, and 20%, after deductible | 50%, after deductible |
|
Ambulance - air |
30%, after deductible | $200, and 20%, after deductible | 50%, after deductible |
|
Durable medical equipment - DME |
30%, after deductible | 20%, after deductible | 50%, after deductible |
|
Home health care |
30%, after deductible | 20%, after deductible | 50%, after deductible |
|
Hospice |
30%, after deductible | 20%, after deductible | 50%, after deductible |
|
Hearing aids and cochlear implants |
30%, after deductible | 20%, after deductible | 50%, after deductible |
|
Pediatric Vision routine exam |
0%, not subject to deductible | 0%, not subject to deductible | 0%, after deductible if services are not considered preventive |
|
Pediatric Vision hardware |
1 set of standard hardware (frames/lens) every year/contacts will have 40% coinsurance with no unit limit; not subject to deductible | 1 set of standard hardware (frames/lens) every year/contacts will have 40% coinsurance with no unit limit; not subject to deductible | 1 set of standard hardware (frames/lens) every year/ contacts will have 40% coinsurance with no unit limit; subject to deductible |
|
Transplants |
30%, after deductible | 20%, after deductible | 50%, after deductible |
|
Alternative Care |
$25, not subject to deductible | $25, not subject to deductible | $25, not subject to deductible |
|
Diabetes education |
$50, not subject to deductible | $35, not subject to deductible | $60, subject to deductible |
|
Nutritional counseling |
$100, not subject to deductible | $70, not subject to deductible | $100, subject to deductible |
|
Diabetic supplies |
$0, not subject to deductible | $0, not subject to deductible | $0, not subject to deductible |
| Benefit Type | Health & Wellbeing 2500/20 | Health & Wellbeing 3000/20 | Health & Wellbeing 5000/60 |
|---|---|---|---|
|
Deductible |
$2,500 per individual $5,000 per family (Combined medical and pharmacy) | $3,000 per individual $6,000 per family (Combined medical and pharmacy) | $5,000 per individual $10,000 per family (Combined medical and pharmacy) |
|
Tier 1 - Preventive |
$0, not subject to deductible | $0, not subject to deductible | $0, not subject to deductible |
|
Tier 2 - Generic |
$20, not subject to deductible | $15, not subject to deductible | $20, not subject to deductible |
|
Tier 3 - Preferred |
$60, not subject to deductible | $45, not subject to deductible | $80, not subject to deductible |
|
Tier 4 - Non-preferred |
50%, after deductible | 50%, after deductible | 50%, after deductible |
|
Tier 5 - High-cost specialty drugs |
50%, after deductible | 50%, after deductible | 50%, after deductible |
New Performance Plan
| Benefit Type | New Performance Plan |
|---|---|
|
Individual wellness assessment |
$0 |
|
Health risk screening |
$0 |
|
Health risk score and report |
$0 |
|
Personal health coaching |
$0 |
| Benefit Type | New Performance Plan |
|---|---|
|
Deductible |
$1,500 per individual $3,000 per family (Medical only) |
|
Out-of-pocket maximum |
$4,000 per individual $8,000 per family (Combined medical and pharmacy) |
|
Primary care |
$25, not subject to deductible |
|
Lifetime benefit maximum |
N/A |
|
Urgent care |
$25, not subject to deductible |
|
Specialist visit |
$50, not subject to deductible |
|
Emergency care |
$300, not subject to deductible |
|
Mental health and chemical dependency or substance abuse - Office visits |
$25, not subject to deductible |
|
Preventive care and services |
$0, not subject to deductible |
|
Outpatient surgery - facility |
$150, after deductible |
|
Outpatient surgery - professional |
$150, after deductible |
|
Inpatient hospital |
20%, after deductible |
|
Inpatient rehabilitative and habilitative care |
20%, after deductible |
|
Skilled nursing facility care |
20%, after deductible |
|
Radiology and labs |
$0, not subject to deductible |
|
High tech imaging |
$300, not subject to deductible |
|
Mental health and chemical dependency or substance abuse - Inpatient care and residential programs |
20%, after deductible |
|
Physical therapy - rehabilitative or habilitative |
$50, not subject to deductible |
|
Occupational therapy - rehabilitative or habilitative |
$50, not subject to deductible |
|
Speech therapy - rehabilitative or habilitative |
$50, not subject to deductible |
|
Injectable drugs |
20%, after deductible |
|
Ambulance - ground |
$200, and 20%, after deductible |
|
Ambulance - air |
$200, and 20%, after deductible |
|
Durable medical equipment - DME |
20%, after deductible |
|
Home health care |
20%, after deductible |
|
Hospice |
20%, after deductible |
|
Hearing aids and cochlear implants |
20%, after deductible |
|
Pediatric Vision routine exam |
$0, not subject to deductible |
|
Pediatric Vision hardware |
1 set of standard hardware (frames/lenses) every year/contacts will have 40% coinsurance; not subject to deductible |
|
Transplants |
20%, after deductible |
|
Alternative Care |
$25, not subject to deductible |
|
Diabetes education |
$25, not subject to deductible |
|
Nutritional counseling |
$50, not subject to deductible |
|
Diabetic supplies |
$0, not subject to deductible |
| Benefit Type | New Performance Plan |
|---|---|
|
Deductible |
$500 per individual $1,000 per family |
|
Tier 1 - Preventive |
$0, not subject to deductible |
|
Tier 2 - Generic |
$10, not subject to deductible |
|
Tier 3 - Preferred |
$30, not subject to deductible |
|
Tier 4 - Non-preferred |
20%, after deductible |
|
Tier 5 - High-cost specialty drugs |
20%, after deductible |
Small Group Plan Information
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
Friendly, Local Service. Statewide Network.
Samaritan Health Plans understands the needs of our members and groups vary. We have developed two provider networks, that complement our benefit offerings. In addition to offering the expertise of our Samaritan primary care providers and specialists, we partner with other provider groups and hospital systems throughout the state of Oregon to meet the needs of our members.
And our large and small group plans use a comprehensive formulary and an extensive pharmacy network for your clients’ prescription drug coverage.
Partner With Oregon’s Healthiest Employer
For seven out of the past eight years, Samaritan has been named Oregon’s Healthiest Employer in the 1500+ employee category by Portland Business Journal. With its own self-insured plan, Samaritan has achieved a return on investment through a commitment to workplace wellness.
As the state’s healthiest employer, Samaritan is inviting Oregon businesses to join a health plan with an award-winning formula for healthier employees and lower costs.