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. Check out your Everyday Choices program opportunities!

Your coverage information for 2015: 
Your member portal at provides you with secure, 24/7 access to your 2015 benefit information, including your Summary of Benefits and Coverage. You may also request benefit information in the mail by contacting Member Services.

List of covered drugs and pharmacies:

Network providers: 
List of Primary Care Providers 
List of Specialty Providers

Prior authorization:
Coverage of certain medical services and surgical procedures requires Samaritan Choice Plans' written authorization before the services are performed.
2015 Prior Authorization List

Need information about your 2014 plan?

Additional Resources 
Plan comparison
COBRA continuation coverage
Privacy Notice 
Glossary of Terms

Save time — go online!

Your member portal at provides you with secure, 24/7 access to:
  • Claims processed by your health plan
  • Details about your eligibility with the health plan, including the amount you have met toward your deductibles, your plan limits, and summary of benefits
  • A new treatment cost estimator for select services
  • The National Library of Medicine’s MedlinePlus Connect for consumer-friendly health information in both English and Spanish
In addition to all the benefits above, your new member portal also provides you the convenience of going paperless!

Sign up today! You can stop receiving some of your health plan documents in the mail and start viewing them online with Samaritan Health Plan’s Document Center. Just click on the “Settings” tab of and select the materials you would like to view online instead of receiving a printed version. Begin enjoying these many benefits:

  • Receive a brief email notification whenever new documents are ready to be viewed on your member portal
  • Use a computer, tablet, or mobile device to conveniently access your member documents
  • Review or find the information you need on your member portal, and if necessary print a page or a whole document

You can change your mind at any time – just change your preferences in the “Settings” tab!

For questions about your member portal and technical support if needed, please contact Customer Service. 

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 from a Samaritan Health Services pharmacy.

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: March 5, 2015

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.

Wellness Plus reimbursement form

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.

Your member portal, MyHealthPlan FAQs
Wellness Plus benefit