Health Benefit Plan

SAMBA offers two health plan options for active and retired federal employees and their families.

Select a plan option for a summary of benefits or click Plan Comparison to see an overview of the two options.

Plan Comparison and Premiums

Cigna Provider Directory

Prescription Benefits

Teladoc®

United Healthcare Medicare Advantage Plan

Coronavirus (COVID-19) Benefit Information

Official Plan Brochure
Precertification Requirements
SAMBA and Medicare
Identification Cards
Cigna Provider Directory
Find Care and Costs (Members Only)
Summary of Benefits and Coverage
Quest Diagnostics Labs
LabCorp Labs

Summary of Rx Benefits
— High Option
— Standard Option
Mail Order and Smart90 Program
Price Your Medications
Contact Express Scripts
Locate a Pharmacy
Rx Paper Claim Form
Preferred Formulary

How to File a Claim
Medical Claim Form
My Claims History
Questions, Complaints & Grievances
Disputed Claims Process
Rights and Protections Against Surprise Medical Bills
Coordination of Benefits Information
Authorized Representative Form (HIPAA)

24/7 Nurseline
Health Assessment
Your Health First – Chronic Conditions
Hearing Care Discounts
Healthy Rewards
Wellness Programs
— Weight Management
— Tobacco Cessation
— Healthy Pregnancy, Healthy Babies

FAQs
Personal Health Record
Treatment Cost Estimator
Hospital Quality Ratings Guide
Health Care Fraud Prevention
Member Rights & Responsibilities
Go Paperless (EOB)
American Hospital Directory
Member Satisfaction Survey Results
Machine-Readable Files
IRS Form 1095-B Tax Information

Eligibility, Benefits & Claim Status (270/271)
Electronic Funds Transfer Authorization Form
Electronic Remittance Advice Form (835)
No Surprises Act – Independent Dispute Resolution (IDR)

SAMBA has been accredited by the Accreditation Association for Ambulatory Health Care (AAAHC) since 2017 and achieved a full three-year reaccreditation term in March 2022.