GatorGradCare Definitions

What is the GatorGradCare benefit plan year?

  • The GatorGradCare benefit plan year runs from January 1 through December 31 annually. 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 $200 deductible, for example, you pay the first $200 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 $35 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 BlueOptions 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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