Getting started with Samaritan Choice Plans

Welcome, Samaritan Choice members!

Every day we make choices about our health, and those choices can make a positive difference in our own health and the overall health of our organization. When we are as healthy as we can be, we can strengthen the wellbeing of those who depend on us: Our families, our patients, our communities. By taking steps to achieve and maintain good health, we help to create a better future—one that positively impacts the cost, quality and availability of health care here at home.

What's new for 2012?

Our new health plan approach for 2012 reflects the ideals of health stewardship: to take greater responsibility for our own health and to use wisely the resources we have at hand. By making use of our own facilities and taking advantage of the talent and passion of our employees, we can shift how our health plan benefit dollars are spent. We can move more dollars toward creating and protecting good health and fewer toward treating preventable illness as we fulfill our goal to be healthier.

You have a NEW plan: Samaritan Choice Wellness
See plan comparison

Premium rates for 2012 health plans are available from your local HR department. You can stop by or send an email to your HR department to request your premium information.

Your 2012 benefits

Your member materials are important documents that describe your health insurance benefits in detail. Your plan documents for 2012 are now available below.

NEW 2012 Summary of Materials Modifications: This document provides a list of changes to your Medical, Pharmacy and Vision Benefits, effective Jan. 1, 2012. Keep this official document with your 2010 Samaritan Choice Plans Member Handbook and your 2011 Summary of Materials Modification. This is a legal part of your plan documents.
2011 Summary of Material Modifications: This document provides a list of changes to your Medical, Pharmacy and Vision Benefits, effective Jan. 1, 2011. Keep this notice with your 2010 Samaritan Choice Plans’ Medical & Pharmacy and Vision plan documents. This is a legal part of your plan documents.
2011 SCP Disclosures: This document provides changes to required disclosures for your Medical & Pharmacy Benefits. Keep this notice with your 2010 Samaritan Choice Plans’ Medical & Pharmacy plan documents. This is a legal part of your plan documents.
2010 Medical & Pharmacy Benefits Handbook
2010 Vision Benefits Handbook
Information on double coverage
Privacy Notice

P R I O R A U T H O R I Z A T I O N
Coverage of certain medical services and surgical procedures requires Samaritan Choice Plans' (SCP) written authorization before the services are performed.
2012 Prior Authorization List

H E A L T H A S S E S S M E N T
For employees who would like to take advantage of your Personalized Health Portal benefit or if you need to update your health information, go to www.Vivacity4me.com for your online health assessment questionnaire.

Taking the Health Assessment is quick and easy — it only takes about 15 minutes to answer questions on your health and health habits using the secure, online tool provided by Vivacity.

Click on the "Vivacity" button to activate and log in to your account.

Click the "Activate Benefits" button under "First Time User" and follow the instructions. To complete your registration, you will need:

Your first name and last name as reported by you to HR
Date of birth (M/D/YYYY)
Gender
User ID which is SHS-xxxxx-00 (replace the x's with your employee ID number; be sure to insert the dashes)
If you are unable to login to the Vivacity website, please contact us for assistance.

You will be asked to provide information about yourself to set-up account access. This includes creating a login name and password that will allow you secure access to your health risk assessment and a personalized portal to valuable health programs and tools that you and your family can use at home. Be sure to save your Vivacity login and password information in a safe place for your future use.

Click on "Personal Health Assessment" link.
Follow the instructions provided and answer all questions within the health assessment questionnaire. You will recieve your personalized report back soon after completing your questionnaire.

Need information about your 2011 plan?

Your network providers

Samaritan Choice Plans has an extensive provider network for your needs. Please note that provider information may change at any time. We recommend that you confirm your provider's network status and level of coverage PRIOR TO SEEKING SERVICE.

Primary Care Provider Directory
Specialties Directory

Your member forms

The following forms should be sent to Samaritan Choice Plans:

Medical reimbursement claim:
Request reimbursement for services that you have received and paid for that are a covered benefit.

Prescription reimbursement claim:
Request reimbursement for prescriptions obtained at a non-participating pharmacy.

Coordination of Benefits:
To properly process your claims, Samaritan Choice Plans needs periodic updates regarding your other health insurance coverage. More information on double coverage.

Disabled Dependent Certification:
Request continuance of coverage for a dependent that is reaching the limiting age of coverage.

Medication Exception:
Request medication exception to Samaritan Choice Plans’ coverage rules, e.g., covering your drug even if it is not on the formulary, waiving coverage restrictions or limits on your drug, or providing a higher level of coverage for your drug.

Prescription Mail Order Form:
Use this form when you have a written prescription that you are mailing to Samaritan Health Services.

Authorized Representative Form:
Use this form to confirm permission for Samaritan Choice Plans to discuss or disclose your protected health information to a particular person who acts as your Authorized Representative.

SCP Appeal Request:
Use this form if you intend to appeal a benefit coverage decision made by Samaritan Choice Plans.

Member Request for Health Plan Records Form:
You are required to complete and send this form to the Health Plan at the address indicated when requesting any documentation from Samaritan Choice Plans.

Last modified: Feb. 7, 2012

Your pharmacies and
covered drugs

Your Samaritan Choice Formulary contains a listing of covered drugs, their co-pays, and any prior authorization requirements or quantity limits. This formulary does not contain the names of all medications available in the market. If your medication is not listed, please contact Samaritan Choice Customer Care for assistance.
Network Pharmacies
2012 Formulary

Forms for your local Samaritan Human Resources Department

The following forms need to be turned into your local Samaritan Human Resources Department for approval:

Affidavit of Domestic Partnership:
Add a person to the health plan as a Domestic Partner if criteria have been met.

Declination of Coverage:
Samaritan offers an additional amount in each paycheck to employees who decline health plan coverage even though they are eligible. The amount of the additional income is determined by Samaritan each year. To decline coverage, you must complete and submit this form within 30 days of the close of open enrollment each year. You must be able to provide proof of other coverage.

Other forms

Use this form to request annual reimbursement for the Wellness Plus benefit. Follow instructions that indicate where to send this form. DO NOT fax or mail to Samaritan Choice Plans. Go here for details on this benefit.

Samaritan Health Plan Operations

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