Special Needs Plan for 2014

Samaritan Advantage Special Needs Plan for 2014

 
This plan is designed for people who meet specific enrollment criteria. This plan is available to anyone who has both Medical Assistance from the State and Medicare. Samaritan Advantage Special Needs Plan has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until 2016 based on a review of Samaritan Advantage Special Needs Plan HMO Model of Care.

Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details at 541-768-4550, 1-800-832-4580 (TTY 1-800-735-2900) from 8 a.m. to 8 p.m., daily.

Below you will find coverage information for Samaritan Advantage Special Needs Plan HMO. These materials are important documents that describe your health insurance benefits in detail.

2014 Summary of Benefits
Special Needs Plan (PDF) CMS Approved

2014 Over-the-Counter (OTC) Benefits
Special Needs Plan (PDF) CMS Approved

2014 Evidence of Coverage
Special Needs Plan (PDF) CMS Approved

2014 Prescription Drug Benefits
Special Needs Plan Formulary information
Special Needs Plan Pharmacy Directory information

Are my drugs covered?
In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances. Quantity limitations and restrictions may apply.

What are my rights as a member?
As a member of Samaritan Advantage Health Plan HMO you have the right to make a complaint if you have concerns or problems related to your coverage or care or ask us to cover a specific medical service. Read about your member rights for additional information.

Last modified: Dec. 18, 2013
H3811_MA4001_2013D CMS Approved 1/2/2014