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Large Group Resources
Helping You Manage Your Account
Large group plan administrators may access the administrative forms, member forms and plan documents you need below. Get answers to your frequently asked questions.
Oregon standardized group profile form
2019 Member enrollment, termination, change & waiver form
2019 Group application
2019 Policy application addendum
2020 Summary of changes
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
Benefit Information
2019 Everyday Choices Option 1
2019 Everyday Choices Option 2
2019 Everyday Choices Basic
2019 Everyday Choices HSA 2500
2019 Everyday Choices HSA 2700
2019 Everyday Choices HSA 5250
2019 Alternative Care Rider - Option 1
2019 Alternative Care Rider - Option 2
2019 Vision Plan
2019 Creditable Coverage Summary
2019 Everyday Choices Prior Authorization List
Prescription Drugs
2019 Large Group Formulary
2019 Large Group Formulary Changes
Pharmacy Directory
Benefit Information
2018 Large Group Certificate for Everyday Choices Plans
2018 Everyday Choices Option 1
2018 Everyday Choices Option 2
2018 Everyday Choices Basic
2018 Everyday Choices High Deductible Health Plan 2500
2018 Everyday Choices High Deductible Health Plan 5250
2018 Vision Plan
2018 Alternative Care Rider - Option 1
2018 Alternative Care Rider - Option 2
2018 Everyday Choices Prior Authorization List
2018 Creditable Coverage Summary
Prescription Drugs
A minimum of 51% of the enrolled population must reside in the Samaritan Large Group service area. An eligible employer is one that:
- employs an average of at least 51 employees on business days during the preceding calendar year, the majority of whom are employed within the Samaritan Health Plans Large Group service area (currently the entire state of Oregon)
- meets the Oregon Insurance Division’s definition of a large group employer on the effective date of coverage
All employers will want to assess whether they will be considered to have at least 50 full-time equivalent employees once the federal calculation for determining an employer’s number of full-time equivalent employees is finalized.
For more information, refer to the final IRS regulation, Shared Responsibility for Employers Regarding Health Coverage.