- Employers Home
- Plan Administrators
- Small Group Resources
Small Group Resources
Helping You Manage Your Account
Small group plan administrators may access the administrative forms, member forms and plan documents you need below. Get answers to your frequently asked questions.
Forms and 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 Summary of benefit changes
2021 Underwriting guidelines
2021 Member enrollment, termination, change & waiver form
2021 Member enrollment, termination, change & waiver form - Spanish
2021 Group application
2021 Policy application addendum
2021 Renewal change form
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 Benefit Changes - Standard Bronze Plan
2021 Plan Summary - Standard Bronze Plan
2021 Summary of Benefit Changes - Standard Silver Plan
2021 Plan Summary - Standard Silver Plan
Tier 1 - 20% Coinsurance Plans
2021 Summary of Benefit Changes - Platinum 500 Tier 1
2021 Plan Summary - Platinum 500 Tier 1
2021 Summary of Benefit Changes - Gold 1250 Tier 1
2021 Plan Summary - Gold 1250 Tier 1
2021 Summary of Benefit Changes - Gold 2000 Tier 1
2021 Plan Summary - Gold 2000 Tier 1
2021 Summary of Benefit Changes - Gold 3150 Tier 1
2021 Plan Summary - Gold 3150 Tier 1
2021 Summary of Benefit Changes - Gold 4000 Tier 1
2021 Plan Summary - Gold 4000 Tier 1
Tier 2 - 30% Coinsurance Plans
2021 Summary of Benefit Changes - Gold 500 Tier 2
2021 Plan Summary - Gold 500 Tier 2
2021 Summary of Benefit Changes - Gold 1000 Tier 2
2021 Plan Summary - Gold 1000 Tier 2
2021 Summary of Benefit Changes - Gold 1500 Tier 2
2021 Plan Summary - Gold 1500 Tier 2
2021 Summary of Benefit Changes - Gold 2500 Tier 2
2021 Plan Summary - Gold 2500 Tier 2
2021 Summary of Benefit Changes - Silver 5200 Tier 2
2021 Plan Summary - Silver 5200 Tier 2
Tier 3 - 50% Coinsurance Plan
2021 Summary of Benefit Changes - Silver 6850 Tier 3
2021 Plan Summary - Silver 6850 Tier 3
HDHP Plan
2021 Summary of Benefit Changes - Silver 2800 HDHP
2021 Plan Summary - Silver 2800 HDHP
2021 Summary of Benefit Changes - Bronze 7000 HDHP
2021 Plan Summary - Bronze 7000 HDHP
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.
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: