- Samaritan Health Plans
- Members
- Employer Group Members
- Large Group Plans
Large Group Plans
Plans for 51+ 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 your employees and their families in maintaining and improving their health.
For more information on our various plan offerings, contact your broker or a Samaritan Health Plans sales agent.
Large Group Plan Information
Certificate
For plans with an effective start date in:
2023, review the 2023 Certificate - Large Group Plans
2022, review the 2022 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 prior authorization list:
2023 Authorization List - Large Group Plans (Updated April 17, 2023)
2022 Authorization List - Large Group Plans.
Additional Benefits Available
Our large group plans can be customized with the following optional benefits:
- Massage Therapy:
Massage Therapy - Vision Coverage:
Vision Benefits - Employee Assistance Program (EAP): EAP Enhanced EAP Enhanced WholeLife Directions, EAP Platform or EAP Platform WholeLife Directions
Schedule of Benefits
Brokers can contact their Samaritan Health Plans sales representative for detailed information. Employers can call their broker or sales representative.
Looking for Additional Forms & Documents?
High Deductible Health Plans
| Benefit Type | Everyday Choices High Deductible Health Plan 5250 |
|---|---|
|
Individual wellness assessment |
$0 cost share |
|
Health risk screening |
$0 cost share |
|
Health risk score and report |
$0 cost share |
|
Personal health coaching |
$0 cost share |
| Benefit Type | Everyday Choices High Deductible Health Plan 5250 |
|---|---|
|
Deductible |
$5,250 per individual $10,500 per family |
|
Out-of-pocket maximum |
$6,550 per individual $13,100 per family |
|
Lifetime benefit maximum |
Unlimited |
|
Primary care |
20%, after deductible |
|
Urgent care |
20%, after deductible |
|
Specialty care |
20%, after deductible |
|
Emergency care |
20%, after deductible |
|
Mental health and chemical dependency - Office Visits |
20%, after deductible |
|
Preventive care and services |
$0, not subject to deductible |
|
Outpatient surgery |
20%, after deductible |
|
Inpatient hospital |
20%, after deductible |
|
Inpatient rehabilitative care |
20%, after deductible |
|
Skilled nursing facility care |
20%, after deductible |
|
Radiology and Labs |
20%, after deductible |
|
Bariatric surgery and Gastric banding |
Not available with this plan |
|
Specialized surgical procedures |
20%, after deductible |
|
High tech imaging services |
20%, after deductible |
|
Mental health and chemical dependency - Inpatient care |
20%, after deductible |
|
Mental health and chemical dependency - Residential programs |
20%, after deductible |
|
Physical therapy |
20%, after deductible |
|
Occupational therapy |
20%, after deductible |
|
Speech therapy |
20%, after deductible |
|
Allergy injections |
20%, after deductible |
|
Injectables |
20%, after deductible |
|
Ambulance and ground |
20%, after deductible |
|
Ambulance and air |
20%, after deductible |
|
Durable medical equipment |
20%, after deductible |
|
Home health care |
20%, after deductible |
|
Hospice |
20%, after deductible |
|
Hearing aids and cochlear implants |
20%, after deductible |
|
Transplants |
50%, after deductible |
| Benefit Type | Everyday Choices High Deductible Health Plan 5250 |
|---|---|
|
Tier 1 - Preventive |
$0, not subject to deductible, for:
|
|
Tier 2 - Generic |
20%, after deductible |
|
Tier 3 - Preferred |
20%, after deductible |
|
Tier 4 - Non-preferred |
20%, after deductible |
|
Tier 5 - High-cost specialty drugs |
50%, after deductible |
Traditional Plans
| Benefit Type | Everyday Choices Basic | Everyday Choices Option 1 | Everyday Choices Option 2 |
|---|---|---|---|
|
Individual wellness assessment |
$0 cost share | $0 cost share | $0 cost share |
|
Health risk screening |
$0 cost share | $0 cost share | $0 cost share |
|
Health risk score and report |
$0 cost share | $0 cost share | $0 cost share |
|
Personal health coaching |
$0 cost share | $0 cost share | $0 cost share |
| Benefit Type | Everyday Choices Basic | Everyday Choices Option 1 | Everyday Choices Option 2 |
|---|---|---|---|
|
Deductible |
Individual: [$0 -$7,350] Family: [$0 - $14,700] |
Individual: [$0 - $7,350] Family: [$0 - $14,700] |
Individual: [$0 -$7,350] Family: [$0 - $14,700] |
|
Out-of-pocket maximum |
Individual: [$0 -$7,350] Family: [$0 - $14,700] |
Individual: [$0 - $7,350] Family: [$0 - $14,700] |
Individual: [$0 -$7,350] Family: [$0 - $14,700] |
|
Lifetime benefit maximum |
Unlimited | Unlimited | Unlimited |
|
Primary care |
$35, not subject deductible | $20, not subject to deductible | $30, not subject to deductible |
|
Urgent care |
$60, not subject deductible | $20, not subject to deductible | $30, not subject to deductible |
|
Specialty care |
$50, not subject deductible | $35, not subject to deductible | $45, not subject to deductible |
|
Emergency care |
[$100 - $350], after deductible | [$100 - $350], after deductible | [$100 - $350], after deductible |
|
Mental health and chemical dependency - Office Visits |
$30, not subject deductible | $15, not subject to deductible | $25, not subject to deductible |
|
Preventive care and services |
$0, not subject deductible | $0, not subject to deductible | $0, not subject to deductible |
|
Outpatient surgery |
30%, after deductible | 20%, after deductible | 25%, after deductible |
|
Inpatient hospital |
30%, after deductible | 20%, after deductible | 25%, after deductible |
|
Inpatient rehabilitative care |
30%, after deductible | 20%, after deductible | 25%, after deductible |
|
Skilled nursing facility care |
$0, after deductible | $0, after deductible | $0, after deductible |
|
Radiology and Labs |
$0, not subject deductible | $0, not subject to deductible | $0, not subject to deductible |
|
Bariatric surgery and Gastric banding |
$5,000 - does not accrue to member out-of-pocket or deductible limits; listed copay does not include other applicable cost shares | $5,000 - does not accrue to member out-of-pocket or deductible limits; listed copay does not include other applicable cost shares | $5,000 - does not accrue to member out-of-pocket or deductible limits; listed copay does not include other applicable cost shares |
|
Specialized surgical procedures |
$600, not subject to deductible | $400, not subject to deductible | $500, not subject to deductible |
|
High tech imaging services |
$400, after deductible | $200, after deductible | $300, after deductible |
|
Mental health and chemical dependency - Inpatient care |
30%, after deductible | 20%, after deductible | 25%, after deductible |
|
Mental health and chemical dependency - Residential programs |
30%, after deductible | 30%, after deductible | 30%, after deductible |
|
Physical therapy |
$40, after deductible | $25, after deductible | $35, after deductible |
|
Occupational therapy |
$40, after deductible | $25, after deductible | $35, after deductible |
|
Speech therapy |
$40, after deductible | $25, after deductible | $35, after deductible |
|
Allergy injections |
$15, after deductible | $5, after deductible | $5, after deductible |
|
Injectables |
20%, after deductible | 10%, after deductible | 10%, after deductible |
|
Ambulance and ground |
$100 and 30%, after deductible | $100 and 30%, after deductible | $100 and 30%, after deductible |
|
Ambulance and air |
30%, after deductible | 30%, after deductible | 30%, after deductible |
|
Durable medical equipment |
40%, after deductible | 30%, after deductible | 30%, after deductible |
|
Home health care |
$30, after deductible | $15, after deductible | $25, after deductible |
|
Hospice |
$0, after deductible | $0, after deductible | $0, after deductible |
|
Hearing aids and cochlear implants |
One pair per four years, after deductible per impaired ear | One pair per four years, after deductible per impaired ear | One pair per four years, after deductible per impaired ear |
|
Transplants |
50%, after deductible | 50%, after deductible | 50%, after deductible |
| Benefit Type | Everyday Choices Basic | Everyday Choices Option 1 | Everyday Choices Option 2 |
|---|---|---|---|
|
Tier 1 - Preventive |
$0, not subject to deductible, for:
|
$0, not subject to deductible, for:
|
$0, not subject to deductible, for:
|
|
Tier 2 - Generic |
$10, not subject to deductible | $0, not subject to deductible | $7, not subject to deductible |
|
Tier 3 - Preferred |
$75, not subject to deductible | $25, not subject to deductible | $50, not subject to deductible |
|
Tier 4 - Non-preferred |
$100, not subject to deductible | $75, not subject to deductible | $100, not subject to deductible |
|
Tier 5 - High-cost specialty drugs |
30%, not subject to deductible | 10%, not subject to deductible | 20%, not subject to deductible |