Samaritan Advantage » Benefits at a Glance

Benefits at a glance

Samaritan Advantage offers four plans:

Conventional Plan – generous medical benefits with an affordable premium and low co-pays; does not include Medicare Part D prescription drug coverage
Premier Plan – all the medical benefits of the Conventional Plan, plus Medicare Part D prescription drug coverage
Premier Plan Plus – all the medical benefits and pharmacy benefits of the Premier Plan, plus dental benefits, coverage for generic drugs through the Coverage Gap, hearing aid benefit and out-of-pocket maximum for durable medical equipment.
Special Needs Plan – this plan provides the same benefit coverage as the Premier Plan for those needing extra help. Please contact Samaritan Advantage for qualifications.

While you are a member of any of our plans, you must use our Plan providers to get your covered services. We list the providers that participate with Samaritan Advantage Health Plan in our provider directory. Coverage is available when you travel out of the area. See Getting care when you travel for additional information.

Benefits at a Glance
2009 Benefits	Conventional Plan $37 month	Premier Plan $70.10 month	Premier Plan Plus $83.20 month
Hospitalization	Out-of-pocket limit: $400/year $50/day for days 1-4 $0/day for days 5-90	Out-of-pocket limit: $500/year $100/day for days 1-4 $0/day for days 5-90	Out-of-pocket limit: $500/year $100/day for days 1-4 $0/day for days 5-90
Doctor office visits Primary care visit: $10 co-pay Specialist visit: $15 co-pay
Emergency care Worldwide coverage: $50 co-pay $0 co-pay if you are admitted to the hospital within 12 hours $50 co-pay for ambulance
Urgent Care Anywhere in the U.S.: $10 co-pay
Routine physical exams: $15 co-pay
Skilled nursing facility care Days 1-10 in a facility: $0 co-pay Days 1-20: $50 co-pay each day Days 21-100: $80 co-pay each day
Chiropractic services/ Acupuncture: $15 co-pay for manual manipulation of the spine to correct subluxation $25 co-pay for up to 5 routine chiropractic visits per year $15 co-pay per acupuncture visit; up to 15 visits per year
Vision services Treatment of eye conditions & diseases: $15 co-pay Routine eye exam: $15 co-pay for each; limited to 1 exam every 2 years Eyewear: up to $125 for every 2 years
Preventive and diagnostic services: $0 co-pay For Medicare-covered bone mass measurements, colorectal screening, flu and pneumonia vaccines Mammograms Pap smears Pelvic exams Prostrate cancer screening Diagnostic tests X-rays Lab services
Outpatient Prescription Drugs $0 deductible $0 co-pay for Enalapril, Lisinopril (high blood pressure); Lovastatin, Simvastatin (high cholesterol); Glipizide, Glyburide, Metformin (diabetes); OTC (over-the-counter) Prilosec and OTC Claritin Up to $9 co-pay for generic formulary drugs Up to $36 co-pay for preferred brand drugs 30% coinsurance for specialty drugs Up to $75 co-pay for non-preferred drugs
You pay 100% for your prescription drugs once your total drug spend reaches: $2,700			Coverage for generics drugs through the Medicare prescription drug coverage gap
After you've spent $4,350 out-of-pocket: you will pay the greater of: $2.40 and $6 co-pays or 5% coinsurance
Dental Benefit per year one exam one set of x-rays one cleaning
Hearing Aids Up to $500 every year
Durable Medical Equipment Annual out-of-pocket max: $2,000

Need 2008 benefits information?

MA213.pdf (363k) 2008 Benefit Highlights.