2021 Benefits
Coverage Information
Below you can find your plan documents. If you need additional copies of your member materials, please contact your employer for your materials.
- Medical/Pharmacy Certificate.
- Summary of Benefits and Coverage.
- Riders.
- Vision Certificate (if applicable).
Plans for 1-50 Employees
Samaritan Health Plans offers small group plans for Oregon businesses with 1–50 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).
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
Employers 50+ Employees
Samaritan Health Plans offers large group plans for Oregon businesses with more than 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. All of our plans include:
- A nationwide provider network
- Free preventive services
- Wellness services (includes a health assessment, biometric screening and online health courses)
Certificate
For plans with an effective start date in 2021 review the 2021 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 2021 Authorization List - Large Group Plans.
Additional Benefits Available
Our large group plans can be customized with the following optional benefits:
- Alternative Care (including chiropractic, acupuncture and massage services):
Alternative Care Option 1 or Alternative Care Option 2 - Vision Coverage:
Vision Benefits - Employee Assistance Program (EAP):
EAP Enhanced, EAP Enhanced WholeLife Directions, EAP Platform or EAP Platform WholeLife Directions