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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.

 

Large Group Plan Information

Certificate 

For plans with an effective start date in 2022, review the 2022 Certificate - Large 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 2022 Authorization List - Large Group Plans

Additional Benefits Available 

Our large group plans can be customized with the following optional benefits:

Schedule of Benefits

Brokers can contact their Samaritan Health Plans sales representative for detailed information. Employers can call their broker or sales representative.

Employees may contact Customer Service at 541-768-4550, toll free 800-832-4580 or TTY 800-735-2900, Monday through Friday, 8 a.m. to 8 p.m. Employees may also come to our office location at 2300 NW Walnut Blvd., Corvallis, Oregon, Monday through Friday, 8:30 a.m. to 5 p.m.
No. Products are offered on a sole carrier basis.
Employees may receive urgent and emergent services nationwide as they could in network. If you do see an out of network provider for services other than for urgent care services and emergencies, your out-of-pocket costs will be higher than they would if received in network. Samaritan Health Plans has contracted with discount provider networks to keep even your out of network costs down. You can call the health plan for specific questions regarding provider networks, benefits and service area.

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.

Many employer-based health insurance plans are fully insured by a health insurance company. This means the employer contracts with a health insurance company to provide its employees benefits, pays premiums for such coverage and the insurance company assumes all claims risk. The states regulate fully insured group plans.