Notification of Disclosures

Certificate of Coverage 

These documents explain the health benefits enrolled members and their dependents have under the plan(s). It details the services that will and will not be covered. Services that are not covered are called exclusions. The actions members must take to receive the health benefits such as paying a copay, meeting a deductible, or using particular health care providers are called conditions.

• Basic Life/AD&D Certificate of Coverage
• Dental Low Plan Certificate of Coverage
• Dental High Plan Certificate of Coverage
• Dental Platinum Plan Certificate of Coverage 
• Long-Term Disability Certificate of Coverage 
• Vision Plan Certificate of Coverage

COBRA Continuation of Health Coverage

This notice has important information about a member's right to Consolidated Omnibus Budget Reconciliation Act (COBRA) continuation coverage, which is a temporary extension of coverage under the plan. This notice explains COBRA continuation coverage, when it may become available to a member and their family, and what is needed to protect rights to receive COBRA.

• Consolidated Omnibus Budget Reconciliation Act (COBRA)

Legal Notices Affecting Health Plan Coverage

The Woman's Health Cancer Rights Act of 1998, Notice of Special Enrollment Rights, Statement of ERISA Rights, Medicare Creditable Coverage Notice, Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP), Health Insurance Marketplace; Notice of Coverage Options.

• Important Legal Notices Affecting your Health Plan Coverage

Medical Plan Document

The plan document(s) tells plan participants about the benefits they are entitled to under the medical plan and provides guidelines to be used by the plan administrator in decision-making when it comes to plan operations.

• The City of Savannah Employee Group Medical Plan - TCN Network
  • Medical Plan Amendment - TCN Network
• The City of Savannah Employee Group Medical Plan - PHCS Network 
  • Medical Plan Amendment - PHCS Network

Notice of Privacy Practices

• City of Savannah Group Health Plan Notice of Privacy Practices
  
• HPI Notice of Privacy Practices
• HPI Sample Letter to Employees Privacy Practices Notice

Summary of Benefits & Coverage (SBC)

Summary of each medical plan that provides comparisons of costs and coverage between health plans. Compare the options based on price, benefits, and other features that may be important to a member and their family. 

SBC Year 2026 

• Basic Plan Option 1
• Plus Plan Option 1
• SBC Glossary - Health Coverage & Medical Terms

SBC Year 2025

• Basic Plan Option 1
• Basic Plan Option 2
• Plus Plan Option 1
• Plus Plan Option 2
• SBC Glossary - Health Coverage & Medical Terms

Section 125 Plan

A section 125 plan is the only means by which an employer can offer employees a choice between taxable and nontaxable benefits without the choice causing the benefits to become taxable. 

• Flexible Benefit Plan 

Wellness Program Information & Disclosures

This document explains how the City's wellness program works and what is required to be compliant and receive an incentive.

• Wellness Program Disclosures