Medical


Medical and Pharmacy

 

City of Savannah Medical Plan  

The City of Savannah’s Plan is a self-funded group health plan.  The claims administration is provided through UMR and Quantum Health provides the coordination of benefits. The primary Preferred Provider Organization (PPO) Network for the City of Savannah is the Care Network which utilizes the St. Joseph’s / Candler Clinics and Hospitals. 

 

 

 

 

 

 

 

Contact Information 


Medical Plan Coordinated by: 

Quantum Health  

PPO Network: 

The Care Network  

Care Coordinators: 

1 (866360-7926 

Quantum Health Member Portal: 

Medical Claims Address: 

The Care Network Repricing    
PO Box 788 Arnold, MD 21012 

 

Care Coordinators 

Healthcare can be confusing; your Care Coordinators are here to make it easier. Turn to your care coordinators for help with: 

  • Benefits 

  • Claim Questions 

  • In-Network Provider Assistance  

  • Patient Advocacy  

  • Nurse Support 

  • Anything that can make the healthcare process easier  

 

Members may contact a Quantum Health Care Coordinator Monday - Friday from 8:30 AM to 10:00 PM to help with any questions you might have about your benefits. Care Coordinators can also help you find a provider, order a new ID card, and even transfer you to a nurse for questions about your treatment plan. You can also visit the Quantum Health member portal or download the MyQHealth app to get access to your health plan benefits and personal healthcare information!  

 

 

Medical Plan Benefits at a Glance  

The City offers two medical plan options to meet your individual needs. Both plans include free preventive care services (with in-network providers only) and a four-tier prescription drug plan.  



Medical Benefits 

Basic Plan 

Plus Plan 

 

In Network 

Out of Network 

In Network 

Out of Network 

Deductible  

One Person 

Two People 

Family  

 
$1,300   
$2,600  
$3,900 

 
$2,600  
$5,200  
$7,800 

 
$500  
$1,000  
$1,500 

 
$1,000 
$2,000 
$3,000 

Maximum Out of Pocket 
One Person 
Two People 

Family 

 
$3,400  
$6,800 
$10,200 

No Maximum Amount 

 
$2,200 
$4,400 
$6,600 

 
No Maximum Amount 

Coinsurance  (employee/employer) 

20%/80% 

50%/50% 

20%/80% 

50%/50% 

Physician Copay 

Primary Care Physician 

Specialist w/ PCP referral 

Specialist w/o PCP referral 

 
$20 
$35 
$75 

50% after deductible 

 
$15 
$20 
$50 

50% after deductible 

Urgent Care  

$20 co-pay 

50% after deductible 

$15 co-pay 

50% after deductible 

Emergency Room  

20% after deductible and $200 co-pay 

20% after deductible and $200 co-pay 

20% after deductible and $200 co-pay 

20% after deductible and $200 co-pay 

 

For detailed medical plan benefits, please view the 2021 Schedule of Benefits and Medical Plan Document.  

 

 

 

Medical Plan Premiums 

Below are the 2021 medical premium rates 

 


Plus SAV4HEALTH Premium 

Basic SAV4HEALTH Premium 

Weekly 

Bi-Weekly 

Weekly 

Bi-Weekly 

Employee Only 

$18.01 

Employee Only 

$36.02 

Employee Only 

$11.22 

Employee Only 

$22.45 

Employee +1 

$62.49 

Employee +1 

$124.98 

Employee +1 

$42.57 

Employee +1 

$85.14 

Family 

$114.38 

Family 

$228.77 

Family 

$79.39 

Family 

$158.78 

Plus STANDARD Premium 

Basic STANDARD Premium 

Weekly 

Bi-Weekly 

Weekly 

Bi-Weekly 

Employee Only 

$37.24 

Employee Only 

$74.48 

Employee Only 

$30.46 

Employee Only 

$60.91 

Employee +1 

$81.72 

Employee +1 

$163.44 

Employee +1 

$61.80 

Employee +1 

$123.61 

Family 

$133.61 

Family 

$267.23 

Family 

$98.62 

Family 

$197.25 

 

Sav4Health Incentive Program – Medical Premium Rate 

The City is committed to supporting employees take the steps to achieve a healthier lifestyle. Employees who complete their four SAV4Health activities 

  • Biometrics screening 

  • Annual checkup with primary doctor 

  • Health questionnaire 

  • Tobacco affidavit 

by November 15th will receive an estimated $1,000 reduction in medical premiums annually (SAV4Health premium).  Click here to learn more about the Sav4Health incentive program and how you can save an estimated $1,000 annually! 

 

 

 

Prescription Drug Coverage  

Express Scripts is the City of Savannah pharmacy drug provider; you mail fill your prescriptions at most pharmacies (Wal-Mart, Kroger, CVS, Walgreens, etc.)  Your formulary offers a wide selection of clinically-sound, cost-effective generic and brand-name prescription drugs. The program includes a retail prescription plan and mail order for maintenance medications. At network pharmacies, your co-payment is determined by the tier on which the prescription is placed (Tier I, Tier I or Tier III). Tier IV is for Specialty drugs.  

 

 


Prescription Drug Copay 

30-day supply 

90-day supply thru 

Mail Order or CVS retail 

                 Tier I Drug 

                  $5.00 copay 

$10.00 copay 

                  Tier II Drug 

                    $25.00 copay 

$50.00 copay 

                    Tier III Drug 

                    $50.00 copay 

$125.00 copay 

Tier IV Drug 

$75.00 copay 

N/A 

 

 

Save on Prescriptions  

If you take maintenance medications, you may order a 90-day supply through Express Scripts mail order service or at any CVS Retail Pharmacy and save money. By using mail order or 90-day at retail for maintenance medications, you can receive a 90-day supply at reduced co-pay 

 

 

Manage Your Medicines Anywhere, Any Time with Express-Scripts.Com and The Express Scripts Mobile App.   

More savings: Compare prices of medicines at multiple pharmacies. Get free standard 

shipping from the Express Scripts Pharmacy. 

More convenience: Get up to 90-day supplies of your long-term medicine sent to your home. Order refills, check order status, and track shipments. Print forms and ID cards, if needed. 

More confidence: Talk with a pharmacist from the privacy of your home any time, from anywhere. Find the latest information on your medicine, including possible side effects and interactions. 

More flexibility: Download the Express Scripts mobile app to manage your medicines, find nearby pharmacies and use your virtual ID card while on the go. 

 

Registering is safe and simple. Your information is secure and confidentialGo to express-scripts.com , select Register or download the Express Scripts mobile app for free from your mobile device’s app store and select Register. 

 

 

In-Network Urgent Care Centers  

Urgent care clinics are well-prepared to handle a wide array of pressing, but not life-threatening, health issues. St. Joseph/Candler Urgent Care Centers, from Georgia Emergency Associates is your in-network urgent care provider. The centers provide numerous services which includes stitches, X-rayslab work, splinting, casts, shots, and assist with diagnosing colds, infections, allergic reactions, asthma and more. Urgent care co-pays are $15.00 (Plus Plan) or  $20.00 (Basic Plan).  

If you or your dependent are not experiencing a medical emergency, consider visiting a St. Joseph’s/Candler Urgent Care CenterFor your convenience, most centers are open on evenings and weekends and now offer virtual visits. To find a location near you or to schedule a virtual visit, go to  https://sjcurgentcare.com/  

 

 

FAQ:     

 

 

How Do I Get a Replacement ID Card?  

Call the Care Coordinators at 1-866-360-7926 or visit your member portal at www.cityofSavannahhelathplan.com 

 

 

Why Did I Receive this Bill?  

All members and dependents will receive an Explanation of Benefits (EOB) from UMR for the processing of all medical claims or you may access on www.cityofsavannahhealthplan.com.  Review all EOBs before paying a bill from a provider to ensure the claim has been processed with the insurance.  Review the bottom of the EOB as you may need to verify with a Care Coordinator that you do not have secondary insurance.  If you need assistance or have a question about a claim, contact the Care Coordinators at 1-866-360-7926.   

 

 

Can I use my Flexible Spending Account (FSA) medical spending account to pay for prescriptions?  

You can spend FSA funds on prescriptions, as well as over-the-counter medicines with a doctor's prescription or letter of medical necessity. Reimbursements for insulin are allowed without a prescription. FSAs may also be used to cover costs of medical equipment such as crutches, bandages, and diagnostic devices including blood testing devices. For the full list of eligible expenses  Click here   

 

Why does my Prescription  Require a Pre-Authorization?  

Prescriptions for certain medications require a prior authorization, also known as a coverage review, to ensure the drug is safe, clinically appropriate and cost effective for your condition. The review uses both formulary and clinical guidelines to determine if the plan will pay for certain medicines. If your prescription requires a prior authorization, your doctor must submit a request for coverage review for approval.