MAY I HELP YOU?
We invite you to call or visit us today: Samaritan Health Plans, 815 NW 9th Street, Corvallis OR 97330, M-F, 8 a.m. to 4:30 p.m.
(541) 768-5216
(866) 300-4100
Or, send us an email
Benefits at a glance
Benefits added for 2008!
- 7 important medications now available with a $0 co-pay
High blood pressure - enalapril and lisinopril
High cholesterol - lovastatin and simvastatin (generic Zocor)
Diabetes - glipizide, glyburide and metformin - Preferred provider network expanded
Tier 1 and Tier 2 providers have been combined into a Preferred Provider network, offering you greater flexibility and out-of-pocket savings - Mental health services increased
Samaritan Choice Plans has lifted the limits on Outpatient and Inpatient Mental Health and Chemical Dependency services to give you additional access - Vision benefit extended
Your benefit limit on frames has been increased to $85 for extra help with your vision costs
This is only a brief summary of benefits. Please refer to your Plan Document for a further explanation of benefits, including limitations and exclusions.
| 2008 Deductibles | Preferred Providers |
Non-Preferred Providers |
| Maximum Lifetime Benefit: $1,000,000 | ||
| Annual Individual Deductible | $200 | $600 |
| Annual Family Deductible | $600 | $2000 |
| Samaritan Choice High-Deductible Maximum Lifetime Benefit: $1,000,000 | ||
| Annual Individual Deductible | $2500 | $2500 |
| Annual Family Deductible | $7500 | $7500 |
| 2008 Medical Benefits Same for all Samaritan Choice Plans |
You Pay Preferred | You Pay Non-Preferred |
| Preventive Care (deductible does not apply) | ||
| Well Baby Care | $15 | Not Covered |
| Routine Physicals | $15 | Not Covered |
| Routine Gynecological Exams | $15 | 30% |
| Immunizations, Prostate Screening | $0 | 50% |
| Colonoscopy | $30/provider $100/facility |
50% |
| Professional Services | ||
| PCP Visits | $15 | 50% |
| Specialist Visits | $30 | 50% |
| Urgent Care Center Visits | $15 | $15 |
| Surgery/Prof. (at hospital) | $30 | 50% |
| Hospital Services | ||
| Inpatient Room and Board | $100/day up to 5 days or $500 | 50% |
| Inpatient Rehabilitative | $100/day up to 5 days or $500 | 50% |
| Skilled Nursing Facility Care (limited to 60 days/year) | $0 | 50% |
| Bariatric Surgery** | $5000 | Not Covered |
| Outpatient Services | ||
| Outpatient Surgery | $100 | 50% |
| Diagnostic & Therapeutic Radiology & Lab | $0 | 50% |
| CT Scans | $0 | 50% |
| MRIs | $150 | 50% |
| Emergency Dept. Visits (unless admitted to hospital) | $100 | $100 |
| Mental Health/Chemical Dependency Services (annual benefit) | ||
| Office Visits | $30 | 50% |
| Inpatient Care | $100/day up to 5 days or $500 | 50% |
| Residential Programs - lmited to 14 days/year | 30% | 50% |
| Other Covered Services | ||
| Physical & Occupational Therapy (lmited to $2900/year); Speech Therapy (limited to $2900/year) | $20 | 50% |
| Allergy Injections | $5 | 50% |
| Ambulance, Ground | 30% after $75 | 30% after $75 |
| Ambulance, Air (limited to $6000/incident) | 30% | 30% |
| Durable Medical Equipment | 30% | 50% |
| Home Health Care | $15 | 50% |
| Hospice | $0 | 50% |
| Hearing Aids | 30% up to $700 limit | 50% up to $700 limit |
*All benefits received from the plan by or on behalf of an individual covered by the plan count against the lifetime maximum, regardless of the capacity in which the individual is covered (as a current or former employee, spouse or dependent). However, if an individual is covered at one time as a current or former employee and at another time as a current or former spouse or dependent, the maximum lifetime benefit shall be the least of $1,000,000 for benefits paid while the individual was enrolled as a current or former employee, $1,000,000 for benefits paid while the individual was enrolled as a current or former spouse or dependent or $1,275,000 for all benefits paid regardless of the capacity in which the individual was covered (as a current or former employee, spouse or dependent).
**Bariatric Surgery co-pay does not apply to Out-of-Pocket Limit. Surgery covered only at GSRMC.
