GatorGradCare Definitions

What is the GatorGradCare benefit plan year?

  • The current GatorGradCare benefit plan year began on August 16, 2019 and will run through December 31, 2020.  Beginning in 2021, GatorGradCare will move to calendar year benefits.  Services and costs for covered health and pharmacy services are tracked with accumulators during this period.

What is a deductible (DED)?

  • A deductible is the amount you must pay for covered health care services before your insurance plan starts to contribute. With a $100 deductible, for example, you pay the first $100 per benefit plan year for covered services.  For GatorCare, as each network tier progresses, the benefit year deductible increases.

What is a copayment?

  • A copayment, also known as a copay, is a fixed amount of money you pay to the provider per visit. You are required to pay a copay for all Tier 1 Physician Office Services that are not Wellness/Preventative care related. For example, if you were to visit a Tier 1 Urgent Care Center such as CareSpot for being sick, you would pay a $30 copayment. On the contrary, if you are visiting your Tier 1 Primary Care Physician for a Wellness/Preventative care visit such as an annual physical exam, there would be no copayment.

What is coinsurance?

  • Coinsurance is the percentage of costs of a covered health care service you pay after you’ve met your benefit year deductible. For example, if you choose to visit a Tier 2 Provider, your coinsurance would be 30% of the billed charges and the insurer would cover 70% of the billed charges after you meet your benefit year Tier 2 deductible.

What are the Tier 1 and Tier 2 networks?

  • GatorGradCare offers services through two provider networks.  Tier 1 is supported by the UF Student Health Care Center, UF Health hospitals and physicians, and some community providers in Gainesville and Jacksonville.  Receiving services through these providers results with low out-of-pocket and coinsurance amounts. Tier 2 is supported by the Florida Blue NetworkBlue provider network which offers additional providers, but typically results with higher out-of-pocket costs.  While you have the flexibility to receive services within each tier, the costs of services received in each network tier are very different.

What is a maximum out-of-pocket?

  • The maximum out-of-pocket is the maximum amount you will pay during a benefit plan year for covered services.  This amount includes all medical and pharmacy out-of-pocket expenses.
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