Benefit Summary
Georgia Ports Authority’s Group Medical Plan is self-insured with very affordable premiums. Those participating in Georgia Ports Authority’s Waterfront Wellness option receive substantial discounts on their premiums. St. Joseph’s/Candler Health System and First Health are our two medical PPO networks depending on the area in which the employee resides.
| Medical Benefits | In-Network Provider | Out-of-Network Provider |
| Deductible | ||
| Individual | $550 | |
| Family of two | $1,100 | |
| Family of three or more | $1,650 | |
| Medical Out-of-Pocket | ||
| Individual (Max) not including deductible |
$3,850 | $8,000 |
| Family (Max) not including deductible |
$8,150 | $20,000 |
| Schedule of Medical Plan Benefits | ||
| Coinsurance (what GPA pays) | 80% of contracted rate | 60% of plan allowance |
| Physician Services | Deductible, then 80% coinsurance | Deductible, then 60% of plan allowance |
| Wellness Services | Payable at 100% | Deductible, then 60% of plan allowance |
| Disease Management Programs at St. Joseph’s/Candler | Payable at 100% | N/A |
| Emergency Room Services | $150 copay. Deductible, then 80% coinsurance; copay waived if admitted to hospital | |
| Inpatient Hospital Services: Room & Board | Deductible, then 80% coinsurance | Deductible, then 60% of plan allowance |
| Outpatient Hospital Services | Deductible, then 80% coinsurance | Deductible, then 60% of plan allowance |
| Chiropractic | Medical deductible, then 80% coinsurance based on plan allowance; limit of 25 visits per plan year | |
| Mental Health | Deductible, then 80% coinsurance | Deductible, then 60% of plan allowance |
| Excluded Facilities | East Georgia Regional (except for emergency and maternity); East Georgia Cancer Center; Optim Medical Center-Tattnall & Screven; and Optim Surgery Center-Savannah. | |
Always Use an In-Network Provider
Did you know that using an in-network provider can help you save:
- GPA pays 80% of covered medical expenses after your deductible as opposed to GPA paying 60% of plan allowance for an out-of-network provider.
- Covered medical expenses are significantly discounted before you pay your part on both your deductible and your 20% co-insurance.
In-Network vs. Out-of-Network Example:
You go to the doctor and they advise you that you’re going to need surgery. The surgery will cost a total of $25,550.
Going to St. Joseph’s/Candler, GPA’s preferred in-network provider, the total cost of the surgery is discounted to $10,550 (plan allowance). The hospital “writes off” $15,000. You’ll pay your $550 deductible and then 20% of the balance being $2,000 for a total cost to you of $2,550. GPA pays 80% which is $8,000.
Going to an out-of-network provider, the surgery is discounted to plan allowance to calculate payment responsibility. You’ll pay your $550 deductible and then 40% of the balance being $4,000 for a total cost to you of $4,550 ($2,000 more out of your pocket). GPA pays 60% which is $6,000. BUT WAIT…This hospital has the right to and may “balance bill” you for the difference between the charged amount and the plan allowance amount since they are out-of-network with no contract with GPA—the same amount that St. Joseph’s/Candler “wrote off”. This brings your total owing to the out-of-network provider to $19,550.
Finding a Provider
To find an in-network (The Care Network) physician, physical therapist, imaging center, etc., visit the St. Joseph’s/Candler website at: sjchs.org. Your lab provider is St. Joseph’s/Candler.
If you reside outside of the seven county region for St. Joseph’s/Candler’s The Care Network (Chatham, Effingham, Bryan, Liberty, Bulloch, Jasper, and Beaufort), you have a “wrap network” with the First Health Network unless services are rendered within these seven counties, then the service will be in-network under St. Joseph’s/Candler network. To locate a provider with First Health, visit their website at: providerlocator.firsthealth.com/ LocateProvider/LocateProviderSearch/. Your lab provider is LabCorp.
Know Your Options
Time-saving and cost-effective methods for getting the right kind of immediate medical care when your doctor isn’t available.
Convenience Care Clinics/Telemedicine
In situations where you may not be able to get in to see your primary care doctor and your condition is not urgent or an emergency, you may want to consider a Convenience Care Clinic or Telemedicine.
Convenience Care Clinics are conveniently located in malls or some retail stores, such as CVS, Walgreens, Walmart, and Target, and offer services without the need to schedule an appointment. Services at these types of clinics are usually available to patients 18 months of age or older.
Telemedicine is available through Teladoc at no cost for those employees & dependents covered under GPA’s medical Plans
Urgent Care Centers
In situations where you need medical care fast, but a trip to the emergency room is not necessarily required, you may want to consider an Urgent Care Center. At urgent care centers, you can be treated for many minor medical issues, usually at a lower cost and a quicker turnaround than an emergency room.
Emergency Rooms
In situations where you think you or a covered dependent may be experiencing a true medical emergency, you should go to the nearest Emergency Room or call 911. An emergency medical condition usually results in serious jeopardy to your health, impairment of bodily functions, or serious dysfunction of organs.
| Minor Health Issue | Moderate Health Issue | Life-Threatening Emergency |
| Common infections (sore or strep throat, urinary tract and bladder infections, earaches and ear infections, pink eye
Minor fevers Cough, cold, and flu Nasal congestion Allergy symptoms Skin issues (rashes, ringworm, and chicken pox) Head lice Insect bites Minor burns, cuts, and scrapes Sprains and strains |
Migraines
Severe back pain Vomiting and diarrhea Minor broken bones Fevers Asthma attacks Severe cough Eye irritations Animal bites Wounds requiring stitches |
Loss of consciousness
Chest pain Severe trouble breathing Sudden loss of vision, numbness, or difficulty speaking Severe abdominal pain Coughing or vomiting blood Severe bleeding Severe burns Major broken bones Seizures/convulsions |
| Convenience Care Clinics/Telemedicine | ||
| Urgent Care Centers | Emergency Rooms | |