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SAMBA Health Benefit Plan (SAMBA HBP) Brochures:
The SAMBA HBP member’s obligations concerning liability insurance and third party actions (subrogation) are described in the annual plan brochures. Below you will find links to recent editions of the SAMBA HBP brochures, with the relevant on-line page referenced for convenience:

  Year 2008 SAMBA HBP brochure (see pages 68 and 69)
  Year 2007 SAMBA HBP brochure (see page 71)
  Year 2006 SAMBA HBP brochure (see page 67)
  Year 2005 SAMBA HBP brochure (see page 72)
  Year 2004 SAMBA HBP brochure (see page 63)
  Year 2003 SAMBA HBP brochure (see page 64)
  Year 2002 SAMBA HBP brochure (see page 62)
  Year 2001 SAMBA HBP brochure (see page 62)
  Year 2000 SAMBA HBP brochure (see page 32)

Below is a link to the SAMBA HBP Individual’s Authorization for Release of Information Form used to confirm the direction of an individual that we use or disclose Protected Health Information (PHI) for a particular purpose, as well as the Lien Against Proceeds of Recovery/ Reimbursement Agreements required under the terms of the Plans’ brochures to be executed and returned to us on behalf of the Plan.

  Individual’s Authorization for Release of Information (SAMBA HBP)
  Lien Against Proceeds of Recovery/Reimbursement Agreement (Attorney)
  Lien Against Proceeds of Recovery/Reimbursement Agreement (Enrollee)

 


Visit FEHBlog, an Ermer & Brownell, PLLC service providing Federal Employees Health Benefits Program and general health benefits law, policy commentary, and news filter -- written and maintained by David M. Ermer, managing partner of Ermer & Brownell, PLLC, a Washington, DC law firm.

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