Prime (Shands Jax)

Designed with the highest value; all services provided by the GatorCare Network

The majority of services received under the Prime plan fall into Tier 1 benefits provided by the GatorCare Network. This includes hospitals, physicians and providers in Gainesville and Jacksonville, and emergency care for you and your covered dependents. Physician office visits require co-payments; other services require paying deductibles and co-insurance. Wellness and preventive care and annual physicals are offered with no out-of-pocket expense to you.

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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!

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?

Infertility Benefits

Benefit descriptions

GatorCare 2022 Infertility Benefits

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

FAQ

Infertility Benefits FAQ’s for 2022

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

Providers

UF Health Reproductive Medicine Providers

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