Broker Resources

Administrative Quick Guide
Oregon Standardized Group Profile Form
Member Enrollment, Termination, Change & Waiver Form
Member Enrollment, Termination, Change & Waiver Form – Spanish
Master Group Application Form
Renewal Change Form

You can also download small group plan documents.

Administrative Quick Guide
Oregon Standardized Group Profile Form
Member Enrollment, Termination, Change & Waiver Form
Master Group Application
Renewal Change Form

You can also download large group plan documents.

Enrollment Documents

Pre-enrollment Checklist
Enrollment Form Instructions
Enrollment Form
Scope of Appointment Form
Nondiscrimination Notice
Multi-Language Interpreter Services

Completed forms may be faxed directly to our Enrollment Department at 541-768-9778 or emailed to SHPOMemberEnrollment@samhealth.org.

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.

2023 Plan Documents

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 kit:

2023 Plans Overview
2023 Low Income Subsidy Premium Summary
2023 Summary of Benefits – Conventional, Premier & Premier Plus Plan (updated 2/2/2023)
2023 Prior Authorization List
2023 Over-the-Counter Drug List
2023 Star Ratings

Also see detailed information on our Benefits Mastercard and Rewards & Incentives Program.

Looking for a Dentist?

To find a dental provider, choose any dental provider who has not opted-out of participating in Medicare programs. Review CMS Opt-Out List.