Thank you for choosing Samaritan Health Plans! We are working hard to ensure you have all the information you need to get the most out of your benefits.
Check back to see our progress as we add more information to this page. We will add more questions and answers as they are received. Would like to print these questions and answers? Download a copy (updated March 21). If you do not have a printer, contact Customer Service at 541-768-7866 or 866-768-7250 (TTY 800-735-2900) and a copy can be mailed to you.
A: Yes. We cover one routine eye exam per calendar year. Medicare-covered medical eye exams (to diagnose or treat diseases and injuries of the eye) are covered as often as needed. A preventive glaucoma screening is also covered at no cost. Your provider should bill all eye exams directly to Samaritan Health Plans.
There is no cost for one pair of Medicare-covered eyeglasses (standard frame and lenses) following cataract surgery. Samaritan Health Plans should be billed directly for this service. All plans also have an annual allowance for routine vision hardware (eyeglasses, frames, lenses, contacts and upgrades). Use your Benefits Mastercard to pay for routine vision hardware, up to the annual allowance covered by your plan.
A. Only these vaccines are covered by Medicare Part B:
A. If you have been eligible for Medicare longer than 12 months, then you do not need to wait to schedule an Annual Wellness Visit. The Annual Wellness Visit, annual physical exam and Welcome to Medicare Visit are all free benefits for plan members. (The Welcome to Medicare Visit can only be scheduled during the first 12 months after becoming eligible for Medicare.) Members who complete one of these visits will receive $25 on their Rewards & Incentives Mastercard (a limit of one $25 reward per year). For more information on the incentive, please visit samhealthplans.org/Rewards-and-Incentives.
A: The plan will only cover in the event of an emergency when services are received in an emergency room. This does not include emergent drugs or transportation.
A: The dental benefit covers preventive services such as cleanings, exams and X-rays. It also covers comprehensive and restorative services such as crowns, fillings, root canals, bridges, dentures, etc. The only service not covered is orthodontia.
The annual dollar amount allowed (based on your plan) is pre-loaded onto your Benefits Mastercard. If you swipe your card as credit, you do not need a PIN. Using either the debit or credit option at the point of sale will reduce your benefit by the amount of the transaction. You will not receive a separate bill for the Benefits Mastercard.
A: Samaritan Advantage Health Plans offer a Personal Emergency Response Service or PERS. Find out more by visiting your Advantage benefits page at samhealthplans.org/AdvantageBenefits or by calling our service provider, Medical Guardian at 800-914-5531.
A: Please go to our provider directory and find a contracted provider. You can search by the specialist, which would be “acupuncture.” There are approximately 19 acupuncturists who are contracted providers.
There are two separate acupuncture benefits:
A: Some specialists may require a referral from a primary care provider or other physician of choice before they will see you. Contact your primary care provider if you feel you need the care of a specialist. They can assist you with a referral. Samaritan Advantage does not require referrals to be submitted to the plan.
A: You can access the Samaritan Advantage provider directory at samhealthplans.org/Find-a-Provider. If you have any questions, please call Customer Service at 541-768-4550 or toll free at 800-832-4580(TTY 800-735-2900). Hours are 8 a.m. to 8 p.m. daily, Oct. 1 through March 31, and 8 a.m. to 8 p.m. Monday through Friday, April 1 through Sept. 30.
A: If you were assigned a new PCP but want to stay with your current primary care provider in our network, please call Customer Service at 541-768-4550 or toll free at 800-832-4580 (TTY 800-735-2900) to get your PCP updated to the one you currently see.
A: This location is planning to reopen soon, but an exact date has not been determined. You can follow all the news about SamFit at facebook.com/BeMoreThanFit.
A: You can certainly check the formulary and see if it is a covered medication. You can also ask your provider to check and see if it is covered. If they send it to the pharmacy and it is not covered, the pharmacy will tell you at that point it is not covered. The pharmacy will reach out to your provider to initiate a prior authorization. Your provider can also look it up or you can call Samaritan Health Plans Customer Service and we can look it up for you. Also, for more urgent prescriptions, like antibiotics, those should not have prior authorization criteria. However, per the Centers for Medicare and Medicaid Services, we cannot cover any cough medications or anything over-the-counter.
A: To find a network pharmacy, review the pharmacy directory on the Samaritan Health Plans website at samhealthplans.org/Find-a-Drug or contact Customer Service at 541-768-4550 or toll free at 800-832-4580 (TTY 800-735-2900).
You will need to call the pharmacy you want to switch to, let them know where your prescriptions are currently being held and the pharmacies will handle the change internally themselves. If you want to go from one Safeway to another, that’s usually pretty easy. You call the Safeway you want to go to and they can transfer your prescriptions. If you want to switch from a Safeway to a Samaritan pharmacy, it’s also an easy process but usually takes a little bit more time because the pharmacies have to talk to each other and transfer the prescriptions.
A: Without seeing the letter, our best guess is it is a letter letting you know that a drug you are currently taking is nonformulary. Nonformulary means the drug prescribed for you is not covered by your health plan. Unfortunately, the language, is scripted by the Centers for Medicare and Medicaid Services and we are required to use it. You canalways call Customer Service at 541-768-4550 or toll free at 800-832-4580 (TTY 800-735-2900). Hours are 8 a.m. to 8 p.m. daily, Oct. 1 through March 31, and 8 a.m. to 8 p.m. Monday through Friday, April 1 through Sept. 30. Let them know the name of the drug and they can help you find the formulary status. They can also help you start the process of a prior authorization request or help you and your health care provider determine what forms need to be submitted.
A. To schedule a ride to any health-related location, call Cascade West Ride Line at 866-724-2975 (TTY 711). Hours of operation are Monday through Friday 8 a.m. to 5 p.m.
A: Yes, you can email Patient Advocacy at [email protected] or visit the Samaritan Health Services website at samhealth.org/Contact-Us and fill out the form for Patient Advocacy (comments or complaints).
A: The webinar is posted online at samhealthplans.org/NewMembers. You can also access it directly and watch the video now.
A: If you go to samhealthplans.org/Pay-Your-Bill, you can access the InstaMed portal for Advantage members. If you do not already have an account, you will have to set one up. Within the portal, there is an option to elect paperless billing.
A: We will continue to monitor our members’ questions and concerns. We will update our website if any new town hall dates are added and send out a postcard to announce any new events.
A: No. CPAP supplies should be covered under the DME benefit through the plan. You should not need to use your OTC dollars for those supplies, and they would not be covered as part of the over-the-counter benefit.
A: OTC items can be bought at most pharmacies, stores or online stores that take Mastercard. Some common stores in your area are Bi-Mart, Walmart, Fred Meyer and Rite Aid. You can visit Cardholders (sig-is.org) to find a store near you. For more information about OTC medications, review the Over-the-Counter Drug List or call Customer Service at 541-768-4550 or 800-832-4580 (TTY 800-735-2900). Hours are 8 a.m. to 8 p.m. daily, Oct. 1 through March 31, and 8 a.m. to 8 p.m. Monday through Friday, April 1 through Sept. 30.
A: Login to the MyHealthPlan portal at the top of the samhealthplans.org homepage. Once inside the portal, click on Benefits Card login to view your balance. You can also check your balance 24/7 by calling 888-831-4668.
A. Instead of paying out of pocket, Samaritan Advantage provides you with an easy way to pay for some of your qualified health care expenses, such as eligible over-the-counter items and certain dental, vision and hearing benefits. Your prepaid Benefits Mastercard is loaded with the value of these supplemental benefits, according to the plan you have.
A: We follow the guidelines from the Center for Medicare and Medicaid Services (also known as CMS) for what is and is not eligible to be covered by the OTC benefit. We have an OTC list that has categories of items that are considered eligible, dual purpose and ineligible. Each category has examples of items that are most likely to pay in the retail setting. You can also choose to use our online catalog. There you will find items available that our vendor has been able to source for you. You can order through this online option. Order online at samaritanOTC.com.
A: The items that Walgreens has tagged as OTC-eligible are more for a flexible spending account program that people would have through a commercial insurer or their employer’s insurance. Most of those items are not necessarily ones that are covered as a Medicare over-the-counter benefit. Also, some brand items work better when making retail purchases because of the technology behind the card. Generic items tend to not be as consistent because a store may not have updated its system to indicate that this generic item is eligible. We are working with our card vendor and looking for ways to improve that experience for you in the future.
A: Your Benefits Mastercard does work as a credit card. You do have an option to select a pin if you would like one to use it as debit, but you certainly don’t have to. If you do want to have a pin for your card, you must request that through the MyHealthPlan portal yourself. For security purposes, there is no way for us to request a pin for you and share it with you. Please note: Nobody should know your PIN other than you.
A: Yes. The list of examples is not meant to be all inclusive. If it is in the same kind of category of an item that is covered, then it would still be a covered item.
A: It is possible that a store may have the technology loaded on a specific register. Sometimes their pharmacy department has different systems on their register that may be different from the front end of the store, but we haven’t heard about many issues. In general, you should be able to use any register in the store to make those purchases.
A: You can access the Benefits Mastercard Reimbursement Claim Form on our website at samhealthplans.org/AdvantageMemberForms. Fill out the form and attach the receipt for the item(s) you bought. Make sure the receipt has all the information about the item you purchased. Mail this form and the required documentation to Employee Benefits Corporation, PO Box 44347, Madison, WI 53744-4347. You can choose if you would like to have that reimbursement sent to you as a check or to have it deposited directly into your bank account if you provide that information.
A: We are actively talking to them about options to make identifying the cards easier since we realize they look very similar. More to come on this.
This webinar will explain more about your benefits, our provider network, pharmacy and prescription medications and much more.
Page Updated 9-27-2024
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