Samaritan Choice Plans are the medical, pharmacy and vision plans for eligible Samaritan Health Services employees and their families. Member services and plan administration are provided by Samaritan Health Plan Operations, a division of Samaritan Health Services. We’re proud to serve our fellow employees and to contribute to the health and well being of our community.
Your member materials are important documents that describe your health insurance benefits in detail. Your member materials include: Medical and pharmacy benefits handbook Vision benefits handbook Benefit changes for 2010
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. 2010 Prior Authorization List
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
The following forms need to be turned into your local Samaritan Human Resources Department for approval: Group Health Enrollment Application: add family members or dependents to Samaritan Choice Plans and/or change your health plan options. Review the eligibility section of your Plan Document for a description of who is eligible and when to enroll. Affidavit of Domestic Partnership: add a person to the health plan as a Domestic Partner if criteria have been met. Declination of Coverage: decline coverage during open enrollment. NOTE: this form can only be used if you have proof of other coverage. The following forms should 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. 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.
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 2010 Formulary
View instructions. See the eligibility section of your Plan Document for a description of who is eligible and when to enroll.