Prime Plus
GatorCare Prime Plus

Designed with two network options and two tiers of benefit coverage

The highest value for the Prime Plus plan is received when using the Tier 1 benefits provided by the GatorCare Network, which includes hospitals, physicians and providers in Gainesville, Jacksonville, and Central Florida. When using the Tier 1 GatorCare Network for wellness and preventive care, annual physicals and labs are offered with no out-of-pocket expense to you. The Prime Plus plan also offers Tier 2 benefits, which apply when you receive services from Florida Blue’s NetworkBlue providers. It is important to review the schedule of benefits, as utilizing Tier 2 benefits typically results in higher out-of-pocket costs.

UF Health Shands

Overview and Benefits


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 2022 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!

Look Forward to our 2023 Health Plan Benefits Document!

Changes made to the Health Plan Benefits Document here will become live on January 1st, 2023.

Infertility Benefits

Benefit descriptions

GatorCare 2022 Infertility Benefits

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

FAQ

Infertility Benefits FAQ’s for 2022

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

Providers

UF Health Reproductive Medicine Providers

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

2023 Additional Resources (Summary of Benefits and Coverage)

Benefit Booklet

2023 Prime Plus Benefit Booklet [COMING SOON]

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

Schedule of Benefits

2023 Schedule of Benefits (CYD’s and OOP’s) [COMING SOON]

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

SBC Medical

2023 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

2023 Schedule of Benefits and Coverage (PHARMACY)

This document details the Prime Plus pharmacy coverage and benefits.

2022 Additional Resources

Benefit Booklet

2022 Prime Plus Benefit Booklet

This booklet describes your coverage, benefits, limitations and exclusions for the self-funded Group Health Benefit Plan Prime Plus 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 Prime Plus pharmacy coverage and benefits.

Coming in 2023

Egg Freezing

Elective Oocyte Cryopreservation (Egg Freezing)

Egg freezing services offered by Tier 1 UF Health Reproductive Medicine physicians at Springhill Reproductive Endocrinology Institute are covered by GatorCare.

Copay Assistance

Value Max Copay Assistance

The Value Max Copay Assistance Program is being expanded to cover diabetes medications. To view all affected medications, click the link below.

Free Diabetes Tests

Tier 0 Contour® and Contour® Next Test Strips

All members are eligible to receive free Contour® and Contour® Next Test strips at a tier 0 level of coverage.

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.