Medical

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.


quantum


Contact Information

Medical Plan Coordinated by:

Quantum Health 

PPO Network:

The Care Network 

Care Coordinators:

1-866-360-7926

Quantum Health Member Portal:

www.cityofsavannahhealthplan.com

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
  • Nurse Support
  • Claim Questions
  • Patient Advocacy 
  • In-Network Provider Assistance
  • 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 

express scripts

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 confidential. Go 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-rays, lab 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 Center. For 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/ 


FAQs:

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.