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.
 

Your coverage information

2016 plan benefits
2016 Summary of Material Modifications (PDF): The Summary of Material Modifications is a legal and binding document that updates your plan's member handbook below. You need to read both documents to understand your benefits.
2015 Summary of Material Modifications (PDF)
Medical and Pharmacy Member Handbook (PDF)
Vision Member Handbook (PDF)

2016 Summary of Benefits and Coverage
Basic Plan - Summary of Benefits and Coverage (PDF)
High Deductible Plan - Summary of Benefits and Coverage (PDF)
Wellness Plan - Summary of Benefits and Coverage (PDF)

List of covered drugs and pharmacies
2016 Formulary
Network pharmacies
Out of area pharmacies

Network providers 
List of Primary Care Providers 
List of Specialty Providers
Other providers are available through First Choice Health Network (AK, ID, MT, ND, OR, SD, WA, WY).

Prior authorization
Coverage of certain medical services and surgical procedures requires Samaritan Choice Plans' written authorization before the services are performed.
2016 Prior Authorization List

Additional resources 
2015 plan information
COBRA continuation coverage
Privacy Notice 
Glossary of Terms

SEARCH TIPS FOR PDF DOCUMENTS

After you have opened the PDF document, hold down the Ctrl + f keys on your keyboard to use the "Find" function within Adobe Reader, then type in the name of the drug, pharmacy, facility or provider that you are seeking.

Your member portal

MyHealthPlan.samhealth.org provides you with secure, 24/7 access to the following:
  • 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
  • The National Library of Medicine’s MedlinePlus Connect for consumer-friendly health information in both English and Spanish
For questions about your member portal and technical support if needed, please contact Customer Service.

Biometric screening and health assessment for Wellness Plan members

The 2015 biometric screening results have been uploaded to the personal My Wellness website for Samaritan Wellness Plan members. The website provides links to details about each biometric measure—you will know what each measure means and quickly see if it is within healthy ranges. The secure website also features many useful and informative health and well-being resources for members.

To access My Wellness, log on to your member portal at MyHealthPlan.samhealth.org.

Be rewarded for your healthy choices

Everyday Choices is a free healthy rewards program that exists to help you keep your wellness journey on track. Members get exclusive access to a multitude of programs and earn points that can be redeemed for a vast array of cool rewards. We have even developed new wellness opportunities along the way because employees like you have come up with some great ideas.

Check out your Everyday Choices program opportunities!

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: Jan. 20, 2016

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.


Your member portal, MyHealthPlan
FAQs
Wellness Plus benefit