Small Group Resources and Forms

Medical reimbursement claim form
Prescription reimbursement claim form
Coordination of benefits form
Disabled dependent certification form
Medication exception form
Authorized representative form
Appeal request form
Member request for health plan records form

Where can my employees get their questions answered?

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.

Can we split coverage between two providers?

No. Products are offered on a sole carrier basis.

Some of my employees work out of state. What happens if they need medical attention?

Employees may receive urgent and emergent services nationwide as they could in network. If your employees do see an out-of-network provider for services other than for urgent care services and emergencies, 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 both in- and out-of-network costs down. You can call the plan for specific questions regarding provider networks, benefits and service area.

I have some employees that live out of the service area, are they still eligible for coverage?

A minimum of 51% of the enrolled population must reside in the Samaritan Small Group service area. An eligible employer is one that:

employs an average of at least one but not more than 50 employees on business days during the preceding calendar year, the majority of whom are employed within the Samaritan Health Plans Small Group Service area (currently the entire state of Oregon).
employs at least one eligible employee on the effective date of coverage.

Will I get any tax credits by enrolling my employees onto your plan?

Samaritan Health Plans is not on the Exchange. Enrolling onto a health plan on the Exchange opens up the employers’ opportunity to get these tax credits. You will not be eligible for the IRS Small Business Health Care Tax Credit. This tax credit is available to those employers who meet specific criteria and who enroll through the SHOP Marketplace.

For more information, reference the following websites:

Small Group Resources

Helping You Manage Your Account

Forms & Resources

Forms and Resources

Member Forms

2021 Member Materials

Small Group Plan Information

Certificate

Some Services Require Authorization

Benefit Summaries

Standards Plans

Tier 1 - 20% Coinsurance Plans

Tier 2 - 30% Coinsurance Plans

Tier 3 - 50% Coinsurance Plan

HDHP Plan

Frequently Asked Questions