Benefits

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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.

2018 Summaries:

For plans with an effective start date in 2018:

2018 Health & Wellbeing 2500

2018 Health & Wellbeing 3000

2018 Health & Wellbeing 5000

2018 Samaritan Oregon Standard Bronze

2018 Samaritan Oregon Standard Silver

2018 New Performance

2018 Everyday Choices Option 1

2018 Everyday Choices Option 2

2018 Everyday Choices Basic

2018 Everyday Choices High Deductible Health Plan 2500

2018 Everyday Choices High Deductible Health Plan 5250

2018 Alternative Care Rider - Option 1

2018 Alternative Care Rider - Option 2

2018 Vision Plan

2017 Summaries

For plans with an effective start date in 2017:

2017 Bronze Standard

2017 Silver Standard

2017 Health & Wellbeing 5000/60

2017 Health & Wellbeing 3000/20

2017 Health & Wellbeing 2500/20

2017 New Performance

2017 Small Group Benefit Exclusions

2017 Everyday Choices Option 1

2017 Everyday Choices Option 2

2017 Everyday Choices Basic

2017 Everyday Choices High Deductible Health Plan 2500

2017 Everyday Choices High Deductible Health Plan 5250

2017 Alternative Care Rider - Option 1

2017 Alternative Care Rider - Option 2

2017 Vision Plan

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 Bronze Standard

2016 Silver Standard

2016 Health & Wellbeing 5000/60

2016 Health & Wellbeing 6850/50

2016 Health & Wellbeing 3000/20

2016 Health & Wellbeing 2500/20

2016 New Performance

2016 Everyday Choices Option 1

2016 Everyday Choices Option 2

2016 Everyday Choices Basic

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

2018 Small Group Formulary for Standard, New Performance PPO and Health & Wellbeing Plans

2018 Large Group Formulary for Everyday Choices and Momentum Plans

2018 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.

2018 Authorization Lists

For plans with an effective start date in 2018:

2018 Authorization List for Standard, New Performance PPO and Health & Wellbeing Plans

2018 Authorization List for Everyday Choices Plans

2018 Authorization List for Momentum Plans