Premium Draft [Lucas]

Designed with flexibility in mind, offering three tiers of benefit coverage

The Premium plan offers you three network tier options. Tier 1 benefits are services you receive from the GatorCare Network, which includes hospitals, physicians and providers in Gainesville and Jacksonville. Tier 1 benefits offer the best value, with lower deductibles and out-of pocket costs. Tier 2 benefits apply when you receive services from Florida Blue’s NetworkBlue providers, which typically result in higher out-of-pocket costs. When using Tiers 1 and 2 for wellness and preventive care, annual physicals and labs are offered with no out-of-pocket expense to you. Tier 3 benefits apply when you receive services from an out-of-network provider; you still have coverage, but may be billed for the difference between the provider’s charge and the allowed amount.

uf health pediatrics

OVERVIEW

Looking for an overview of the plan?

Here you can find general information about the plan and get a better idea of how our coverage works for you!

Looking for more specifics?

Check out our Health Plan Benefits Document!

Here we have answers to questions like: How much do I pay per visit? What’s my deductible? and How much is covered at the pharmacy?

Urgent Care Centers

New Tier 1 Urgent Care Centers in Florida 2023

Tier 1 UCC’s are being updated accurately reflect current locations and rates.

Coming soon!

New in 2023

Egg Freezing
Pharmacy Changes: Value Max Copay Assistance, Tier 0 Contour® and Contour Next® Test Strips, Maintenance Medication refills

Infertility Benefits

Benefit descriptions

GatorCare 2022 Infertility Benefits

Below is a document that details eligibility, diagnoses, treatment, and coverage for Premium members.

FAQ

Infertility Benefits FAQ’s for 2022

Below is a list of frequently asked questions for infertility benefits and coverage for Premium members.

Providers

UF Health Reproductive Medicine Providers

Below is a list of UF Health Reproductive Medicine Providers that provide Tier 1 coverage for Premium Members.

Additional Resources (Summary of Benefits and Coverage)

Benefit Booklet

2022 Premium Benefit Booklet

This booklet describes your coverage, benefits, limitations and exclusions for the self-funded Group Health Benefit Plan Premium Plan established and
maintained by GatorCare.

Schedule of Benefits

2022 Schedule of Benefits (CYD’s and OOP’s)

This Schedule of Benefits is part of your Benefit Booklet, where more detailed information about your
benefits can be found.

SBC Medical

2022 Summary of Benefits and Coverage (MEDICAL)

The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services.

SBC PHarmacy

2022 Schedule of Benefits and Coverage (PHARMACY)

This document details the Premium pharmacy coverage and benefits.

Contact your dedicated Florida Blue representative

The following applies to the above plan:

As a result of the Affordable Care Act, GatorCare is required to provide employees with an easy-to-understand Summary of Benefits and Coverage (SBC) statement that describes the plan’s coverage. All insurance companies must use the same format allowing members to compare plan options. Please note that the examples on page 8 for medical and page 12 for pharmacy, do not reflect actual GatorCare co-pays and deductibles, rather they are general examples required by the federal government. To get your GatorCare medical specific cost of services, call (800) 664-5295; for Magellan Pharmacy Benefits, call (800) 651-8921.

For additional questions about enrollment or premiums, view the Enrollments section of the FAQ page or contact your Human Resources office.