SAMBA Health Benefit Plan (SAMBA HBP)

Click here for frequently asked questions about our recovery services.

Click here for the online Reimbursement Questionnaire. You must have your Username and Password to access.

Click here for the online Settlement Survey. You must have your Username and Password to access.

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 2012 SAMBA HBP brochure (see pages 80-81)
			Year 2011 SAMBA HBP brochure (see pages 78-79)
			Year 2010 SAMBA HBP brochure (see pages 71-72)
			Year 2009 SAMBA HBP brochure (see pages 69 and 70)
			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)

SAMBA HBP Individual’s Authorization for Release of Information Form
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.

Individual’s Authorization for Release of Information (SAMBA HBP)

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