Samaritan Select

FAQ’s

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How do I maximize my benefits? In order to maximize your benefits and keep your healthcare costs down, it is important to use preferred providers and to know your benefit plan.

How do I know if my providers are preferred? Preferred providers can be located on the Samaritan Select website (search now). If you cannot locate a provider call the Select Member Services team for assistance at 1-800-569-4616 or (541) 768-6900.

Do I need a referral to see a specialist? You do not need a referral to see a specialist. To maximize your benefits, however, you may want to see a preferred specialist (search now). Also, some services require preauthorization (review list).

Are diabetic supplies covered? Where do I get them? Diabetic supplies, such as test strips and lancets, are fully covered and have $0 out-of-pocket expense to you when you use a preferred Durable Medical Equipment (DME) supplier (search now). Supplies are sent to you from the DME supply company. They will contact your provider for you to obtain a copy of your prescription. Simply locate a preferred DME on the website and call. Insulin and needles should be obtained at a preferred pharmacy.

How does the outpatient mental health benefit work? Choose any provider, keeping in mind that a preferred provider will maximize your benefits (search now). There are no limits to the number of visits per year. However, after each ninth visit your provider will need to obtain an approved prior authorization to continue paying your claims. For more information on mental health benefits refer to pages 35-37 and 42 in the Samaritan Select Member Handbook, or contact Member Services.

What are my benefits for alternative care? What is covered under alternative care? There is a $1,000 annual limit for alternative care. As a member you are responsible for a $15 co-pay per visit and any cost after the plan has paid out $1,000. The alternative care benefit encompasses chiropractic, acupuncture and naturopathic care. Labs provided within the alternative care office apply toward the $1,000 annual limit.

What is a Medical Home and why do I need to choose one? To make certain you receive the best medical care and treatment, Samaritan Select encourages you to choose a medical home. This provider is a practitioner whom you trust, who will know and care about you –your health, habits, preferences, history and family. If you are currently not established with a preferred provider of your choice, please contact Member Services to assist you in finding a physician to best meet your healthcare needs as well as a provider that is currently accepting new patients.

What procedures require a prior authorization? Why do I need to be concerned with this? Procedures or equipment that require prior authorization are listed on page 14 of the Samaritan Select Member Handbook. The pre-authorization process helps you and your provider work together to determine the treatment that best meets your needs. This helps prevent any surprise costs to you.

What is the difference in coverage between full-time, part-time, and retiree? Full-time benefits include a co-pay or coinsurance each time you receive a covered service. There is no deductible applied. Active full- and part-time employees, retirees, covered family members, COBRA participants and self- pay individuals may be enrolled.

Part-time benefits include a coinsurance each time a covered service is received. Part- time benefits have a 50% coinsurance applied to each service until the member reaches an out-of-pocket expense of $500. After this deductible is met, the member is responsible for 20% of eligible charges for most services.

What if my physician wants me to have more than one scheduled annual test, like a Mammogram or pap smear? Samaritan Select will cover any preventive exam as many times a year as your health care provider requests the procedure and considers it medically necessary.

What constitutes preventative care? Preventive care benefits include periodic health screenings and appraisals, immunizations required for travel and routine and well baby/child exams. If the provider shows the purpose of your care is preventive then this benefit will apply. If however, treatment is for illness or injury, a co-pay will apply.

Are preexisting conditions covered? The Samaritan Select plan has no waiting period or exclusions for preexisting conditions.

What is the maternity benefit under Samaritan Select? For normal prenatal and postnatal office visits to a preferred provider, as well as standard ultrasounds and lab work, you will have one $10 copay under the Full Time plan. Your hospital stay for delivery at a preferred facility will be covered with a $100 copay per day with a maximum of $500. Services not included in the standard maternity package will be paid as listed in the summary of benefits.

Are all immunizations covered? Routine immunizations and immunizations for travel are considered preventive and are covered at 100% with $0 co-pay. Immunizations for the purpose of employment, insurance or licensing are not a covered benefit.

How do I know what lab locations are preferred, so I can get full benefits? Asking your provider to send your lab work to a preferred lab will help to maximize your benefits. Preferred labs are listed on the Samaritan Select website (search now). For further assistance contact the Member Services team.

How does dual coverage work? It is important for you to notify both insurance companies if you or members of your family have double coverage. This allows coordination of benefits to take place. This is a method for determining which plan has the primary responsibility of benefits and which has secondary responsibility. We request this information be updated anytime there are changes to your coverage.