Benefits
Your Coverage Information
The list of materials below are mailed to your home. If you need additional copies of your member materials, please contact Customer Service. For association members (Momentum Plans), please contact your employer or association for your materials.
- Medical/Pharmacy Policy
- Summary of Benefits and Coverage
- Glossary of Terms
- Vision Handbook (if applicable)
A List of Benefit Highlights
The benefits information provided is a brief summary and not a complete description of benefits. Limitations and exclusions apply. Please see your member policy (Medical and Pharmacy Handbook) for full details. The policy is are mailed to your home. If you need additional copies of your policy or other member materials, please contact Customer Service. For association members (Momentum Plans), please contact your employer or association for your materials.
2017 Summaries
For plans with an effective start date in 2017:
2017 Health & Wellbeing 5000/60
2017 Health & Wellbeing 3000/20
2017 Health & Wellbeing 2500/20
2017 Small Group Benefit Exclusions
2017 Everyday Choices Option 1
2017 Everyday Choices Option 2
2017 Everyday Choices High Deductible Health Plan 2500
2017 Everyday Choices High Deductible Health Plan 5250
2017 Everyday Choices Benefit Exclusions
Momentum Plans - Please see your Association or employer
2016 Summaries
For plans with an effective start date in 2016:
2016 Health & Wellbeing 5000/60
2016 Health & Wellbeing 6850/50
2016 Health & Wellbeing 3000/20
2016 Health & Wellbeing 2500/20
2016 Everyday Choices Option 1
2016 Everyday Choices Option 2
2016 Everyday Choices Option 4 - HSA
2016 Everyday Choices Option 5 - HSA
Momentum Plans - Please see your Association or employer
List of Covered Drugs and Network Pharmacies
2017 Formulary for Standard, New Performance PPO and Health & Wellbeing Plans
2017 Formulary for Everyday Choices and Momentum Plans
2017 Pharmacy Directory for all Employer Group Plans
SEARCH TIPS FOR PDF DOCUMENTS
After you have opened the PDF document, hold down the Ctrl + f keys on your keyboard to use the “Find” function within Adobe Reader, then type in the name of the drug, pharmacy, facility or provider that you are seeking.
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.
2017 Authorization Lists
For plans with an effective start date in 2017:
2017 Authorization List for Standard, New Performance PPO and Health & Wellbeing Plans
2017 Authorization List for Everyday Choices Plans
2017 Authorization List for Momentum Plans
2016 Authorization Lists
For plans with an effective start date in 2016:
2016 Authorization List for Standard, New Performance PPO and Health & Wellbeing Plans
2016 Authorization List for Everyday Choices Plans
2016 Authorization List for Momentum Plans
Talk with our Member Services representatives
Mon.–Fri.