- Samaritan Health Plans
- Members
- Employer Group Members
- Small Group Plans
Small Group Plans
Plans for 1 to 50 Employees
Samaritan Health Plans offers small group plans for Oregon businesses with 1 to 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).
Small Group 2023 Plan Information
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 Authorized List - Small Group Plans (Update April 25, 2023)
Summary of Benefits & Coverage
See what each plan covers and what you pay for services. 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.
Standard Plans
2023 Summary of Benefits and Coverage - Standard Silver Plan
2023 Summary of Benefits and Coverage - Standard Bronze Plan
Tier 1 - 20% Coinsurance Plans
2023 Summary of Benefits and Coverage - Platinum 500 Tier 1
2023 Summary of Benefits and Coverage - Gold 1250 Tier 1
2023 Summary of Benefits and Coverage - Gold 2000 Tier 1
2023 Summary of Benefits and Coverage - Gold 3150 Tier 1
2023 Summary of Benefits and Coverage - Gold 4000 Tier 1
Tier 2 - 30% Coinsurance Plans
2023 Summary of Benefits and Coverage - Gold 500 Tier 2
2023 Summary of Benefits and Coverage - Gold 1000 Tier 2
2023 Summary of Benefits and Coverage - Gold 1500 Tier 2
2023 Summary of Benefits and Coverage - Gold 2500 Tier 2
2023 Summary of Benefits and Coverage - Silver 5200 Tier 2
Tier 3 - 50% Coinsurance Plan
2023 Summary of Benefits and Coverage - Silver 6850 Tier 3
High Deductible Health Plans
2023 Summary of Benefits and Coverage - Silver 3000 HDHP
2023 Summary of Benefits and Coverage - Bronze 7050 HDHP
Small Group 2022 Plan Information
Certificate
For plans with an effective start date in 2022, review the 2022 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 prior authorization list:
2022 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.
Plan Summaries
See an easy to read overview of benefits for each plan.
Standard Plans
2022 Plan Summary - Standard Silver Plan
2022 Plan Summary - Standard Bronze Plan
Tier 1 - 20% Coinsurance Plans
2022 Plan Summary - Platinum 500 Tier 1
2022 Plan Summary - Gold 1250 Tier 1
2022 Plan Summary - Gold 2000 Tier 1
2022 Plan Summary - Gold 3150 Tier 1
2022 Plan Summary - Gold 4000 Tier 1
Tier 2 - 30% Coinsurance Plans
2022 Plan Summary - Gold 500 Tier 2
2022 Plan Summary - Gold 1000 Tier 2
2022 Plan Summary - Gold 1500 Tier 2
2022 Plan Summary - Gold 2500 Tier 2
2022 Plan Summary - Silver 5200 Tier 2
Tier 3 - 50% Coinsurance Plan
2022 Plan Summary - Silver 6850 Tier 3
High Deductible Health Plans
2022 Plan Summary - Silver 2800 HDHP
2022 Plan Summary - Bronze 7050 HDHP
Summary of Benefits & Coverage
See more detailed information about what each plan covers and what you pay for services.
Standard Plans
2022 Summary of Benefits and Coverage - Standard Silver Plan
2022 Summary of Benefits and Coverage - Standard Bronze Plan
Tier 1 - 20% Coinsurance Plans
2022 Summary of Benefits and Coverage - Platinum 500 Tier 1
2022 Summary of Benefits and Coverage - Gold 1250 Tier 1
2022 Summary of Benefits and Coverage - Gold 2000 Tier 1
2022 Summary of Benefits and Coverage - Gold 3150 Tier 1
2022 Summary of Benefits and Coverage - Gold 4000 Tier 1
Tier 2 - 30% Coinsurance Plans
2022 Summary of Benefits and Coverage - Gold 500 Tier 2
2022 Summary of Benefits and Coverage - Gold 1000 Tier 2
2022 Summary of Benefits and Coverage - Gold 1500 Tier 2
2022 Summary of Benefits and Coverage - Gold 2500 Tier 2
2022 Summary of Benefits and Coverage - Silver 5200 Tier 2
Tier 3 - 50% Coinsurance Plan
2022 Summary of Benefits and Coverage - Silver 6850 Tier 3
High Deductible Health Plans
2022 Summary of Benefits and Coverage - Silver 2800 HDHP
2022 Summary of Benefits and Coverage - Bronze 7050 HDHP
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 |