Special Needs Plan for 2013

Samaritan Advantage Special Needs Plan for 2013

 
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), a non-profit organization dedicated to improving health care quality through 2014.

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.

2013 Summary of Benefits
Special Needs Plan (PDF) CMS Approved

2013 Evidence of Coverage
Special Needs Plan (PDF) CMS Approved

2013 Prescription Drug Benefits
Special Needs Plan Formulary
Special Needs Plan Pharmacy Directory

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 What are my rights as a member? for additional information.

Last modified: October 1, 2012
H3811_MA4001_2012A CMS Approved 10/24/12