Access and download forms and resources for your clients. Don’t hesitate to contact us if you need assistance.
Administrative Quick Guide (English)Oregon Standardized Group Profile Form (English)Member Enrollment, Termination, Change & Waiver Form (English)Master Group Application (English)Renewal Change Form (English)
You can also download large group plan documents.
Training Handout (English) (updated 10-29-2024)Broker FAQs (English) (updated 10-11-2024)Telephonic Enrollment Script Example (English)Recording of Training – Oct. 2024 (English)
Pre-enrollment Checklist (English)Enrollment Form Instructions (English)2025 Enrollment Form – Valor, Premier and Premier Plan Plus (English)2025 Enrollment Form – Dual Advantage (English)2024 Enrollment Form – Valor, Premier and Premier Plan Plus (English)2024 Enrollment Form – Dual Advantage (English)Scope of Appointment Form (English)Agent of Record Change Form (English)Nondiscrimination Notice (English)Multi-Language Interpreter Services (English)
Completed forms may be faxed directly to our Enrollment Department at 541-768-9778 or emailed to [email protected].
It is expected that the agent’s received date(s) for the completed enrollment form and completed scope of appointment form each be documented on the forms in order to be compliant.
The following plan documents are available to help you serve your clients interested in our Samaritan Advantage plans and can be used to complete an enrollment information guide.
2025 Enrollment Guide – Valor, Premier & Premier Plus Plans (English)2025 Enrollment Guide – Samaritan Dual Advantage (English)2025 Low Income Subsidy Premium Summary (English)2025 Summary of Benefits – Valor, Premier & Premier Plus Plans (English)2025 Summary of Benefits – Samaritan Dual Advantage (English)2025 Benefit Highlights – Premier Plus Plan (English)2025 Benefit Highlights – Premier Plan (English)2025 Benefit Highlights – Valor (English)2025 Prior Authorization List (English)2025 Star Ratings (English)
2024 Plans Overview (English)2024 Low Income Subsidy Premium Summary (English)2024 Summary of Benefits – Premier & Premier Plus Plans (English)2024 Summary of Benefits – Valor (English)2024 Summary of Benefits – Samaritan Dual Advantage (English)2024 Prior Authorization List (English)2024 Star Ratings (English)
Over-the-Counter Drug List (English)Medical Alert Monitoring System Information – Advantage (English)FAQs About Personal Emergency Response Services (PERS) – Advantage (English)2025 Rewards & Incentives Program (English)See detailed information on our Benefits Mastercard and Rewards & Incentives Program:
To find a dental provider, choose any dental provider who has not opted-out of participating in Medicare programs. Review CMS Opt-Out List.
Can’t find what you’re looking for? Search our document library.
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