Your Benefits

Close up of a Samaritan Health Plans benefits card.

Learn About Your Advantage Benefits Debit Card

You have a prepaid debit card you can use to pay for certain dental, vision, hearing and over-the-counter items.

Senior couple shopping for plants

Samaritan Rewards & Incentives Program

Earn rewards for seeing your primary care provider and staying current on preventive health services. 

New 2024 Member Benefit — Personal Emergency Response Systems

Feel safe and secure with Samaritan Advantage Health Plan’s Personal Emergency Response Systems or PERS. A PERS device is a wearable electronic device with a button used to call for help during any emergency. When pressed, a 24/7 monitoring center is alerted.

As of Jan. 1, 2024, members can ask for the Mini Guardian, MGMinilite or the MGMove PERS devices by calling our service provider, Medical Guardian at 800-914-5531.

Learn more about this exciting benefit and the Personal Emergency Response System devices you can choose:

Product Information
Frequently Asked Questions

Your Medical & Dental Coverage

If you need additional copies of your member materials, please contact Customer Service.

Your Plan Benefits

Click on the link below to download our Summary of Benefits and review details about your plan’s medical, dental and prescription drug benefits, copays, coinsurance and more.

2024 Summary of Benefits – Premier and Premier Plus Plans
2024 Summary of Benefits – Valor
2024 Summary of Benefits – Dual Advantage

For more detailed plan information including how to use the plan’s coverage to obtain medical services, your rights and responsibilities as a member, important phone numbers and other resources, see your plan’s Evidence of Coverage.

2024 Evidence of Coverage – Valor
2024 Evidence of Coverage – Premier Plan
2024 Evidence of Coverage – Premier Plan Plus
2024 Evidence of Coverage – Dual Advantage

To see how your plan benefits have changed from year to year, see your plan’s Annual Notice of Changes.

2024 Annual Notice of Changes – Valor
2024 Annual Notice of Changes – Premier Plan
2024 Annual Notice of Changes – Premier Plan Plus
2024 Annual Notice of Changes – Dual Advantage

Medical Coverage Guidelines

Find rules and policies for how we cover medical services.

Medical Coverage policies are developed to communicate Samaritan Health Plans decisions about coverage and benefits for various medical services. Determinations are made after careful consideration of evidence, insurance plan factors, Medicare rules,  community standards, service availability and other applicable factors.

For Samaritan’s Medicare Advantage Health Plans, we use applicable content from Medicare National Coverage Determinations, Local Coverage Determinations and the Medicare Benefit Policy Manual.

CMS Medicare National Coverage Determinations
CMS Medicare Local Coverage Determinations
Medicare Benefit Policy Manual

If there is not a Medicare Guideline (NCD/LCD) available, Samaritan Health Plans will use nationally recognized evidence-based guidelines from MCG Health. Care guidelines from MCG provide evidence-based medicine’s best practices and care plan tools across all areas of treatment, providing clinical decision support and documentation which enables effective transfers between different care settings.

On the rare occasion that no appropriate guideline exists from the sources above, Samaritan Health Plans uses a small number of internally developed Samaritan Health Plans medical coverage policies, listed below:

Advanced Care Planning Policy
Applied Behavioral Analysis
Computer Assisted Surgical Navigational Procedure
Cosmetic and Reconstructive Procedures Policy
Coverage of Routine Care for Members Enrolled in Qualifying Clinical Trials Policy
Drug Testing in the Outpatient Setting
Evaluation of New and Existing Technologies
Genetic Testing
Proprietary Laboratory Analyses
Psychiatric Sub-Acute Admission
Wireless Gastrointestinal Monitoring System

Smiling man in wheelchair being pushed away from a transport van by man.

Schedule a Free Ride on Cascades West Ride Line

As a Samaritan Advantage Health Plan member, you can schedule a ride to your doctor, pharmacy or any health-related location with Cascades West Ride Line. Rides can be scheduled 365 days a year, 24 hours a day. Some restrictions may apply.

How to Use Your Dental Coverage

How Do I Find a Dental Provider & Obtain Services?

  1. Contact our contracted dental provideror
  2. Many other dentists who have not opted out of Medicare will accept Samaritan Advantage. If you need assistance locating a dental provider who has not opted out of Medicare, call a Customer Service team member at 541-768-4550, toll free 800-832-4580(TTY 800-735-2900) to find one near you.

What If I Have More Questions?

Our Customer Service Team is happy to help. Call us at 541-768-4550 or toll free 800-832-4580, (TTY 800-735-2900). We are here to serve you.
Customer Service is available:

  • Oct. 1 to March 31: Daily, from 8 a.m. to 8 p.m.
  • April 1 to Sept. 30: Monday through Friday, from 8 a.m. to 8 p.m.

*Samaritan Advantage cannot pay for services rendered by providers who have opted-out of Medicare.

Stay Fit With Your Fitness Benefits

Please note: The Albany SamFit location is temporarily closed. Visit the SamFit website for other locations.

Page Updated 4-8-2024

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