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1 GatorCare is here for many and still coming for others! Overall GatorCare goals Maintain benchmark validated high level benefits Provide local control.

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Presentation on theme: "1 GatorCare is here for many and still coming for others! Overall GatorCare goals Maintain benchmark validated high level benefits Provide local control."— Presentation transcript:

1 1 GatorCare is here for many and still coming for others! Overall GatorCare goals Maintain benchmark validated high level benefits Provide local control of benefits in a changing environment Leverage UF&Shands as a health system Open enrollment for COM April/May with go live July 1 Independent analysis – very high level medical benefits Currently approved GatorCare participants include 20,000 employees plus their dependents UF clinical faculty in Gainesville and Jacksonville (7/13) Housestaff (7/13) Postdoctoral associates (7/13) Graduate assistants on appointment (8/13) UF domestic partners (1/13) Shands Gainesville and Shands Jacksonville (1/13) UFJHI/UFJPI (1/13) IFAS Florida Seed Producers (5/13) UFICO (8/13) UF Foundation (5/13) UAA and proton therapy joining in 2013-14

2 2 GatorCare is a UF Direct Services Organization UF Governing Board Multiple working groups – network; plan design; finance; reporting; etc. BCBS is the plan administrator GatorCare makes benefit design and network decisions Opportunity to innovate How Does GatorCare Work? BASIC PLAN CONSIDERATIONS GatorCare Prime Plus o Least cost option when using GatorCare network providers, facilities (can use non-network emergency care) o Lower deductibles; lower co-pays = best value as long as you keep your care in-network GatorCare Premium o Provides greater network flexibility o Higher deductibles, co-pays and maximum out of pocket costs o May be better option if you know substantial amounts of care will be outside the core network (e.g., multiple kids out of state in school Coverage Options o Employee Plus Child option changes to Employee Plus Children o Individual o Family COM covering ALL premium costs for faculty GatorCare. Faculty will be responsible for deductible and copay amounts.

3 GatorCare Prime Plus Core Network with Wrap OV Co-Pay Tier 1 $15 PCP and $25 Spec Tier 2 40% co-ins after CYD CY Deductible (CYD) Tier 1 $150/$300 Tier 2 $1000/$2000 Max Out of Pocket (OOP) Tier 1 $2,500/$5,000 Tier 2 $5,000/$10,000 IP services Tier 1 $0 PAD (per admission deductible) + 5% co-ins after CYD Tier 2 $1,500 PAD + 40% co-ins after CYD Tier 3 $ 1,500 PAD + 40% co-ins after Tier 2 CYD OP Services Tier 1 5% co-ins; CYD waived (diagnostics, rehab and home health) Tier 2 40% coins after CYD Emergency – Per visit deductible Tier 1 $ 0 Tier 2 & 3 $250 waived if admitted Emergency Facility services Tier 1 5% co-ins after CYD Tier 2 & 3 5% co-ins after CYD Urgent Care Tier 1 $50 co-pay Tier 2 40% co-ins after CYD Family factor for deductible/OOP: 2x GatorCare Premium 3 Tier Network OV Co-Pay Tier 1 $20 PCP and $30 Spec Tier 2 20% co-ins after CYD Tier 3 40% co-ins after CYD CY Deductible (CYD) Tier 1 $250/$500 Tier 2 $500/$1,000 Tier 3 $1,000/$2,000 Max OOP Tier 1 & 2 $2,500/$5,000 Tier 3 $5,000/$10,000 IP Services Tier 1 $0 PAD + 10% co-ins after CYD Tier 2 $1,500 PAD + 20% co-ins after CYD Tier 3 $1,500 PAD + 40% co-ins after CYD OP Services Tier 1 10% co-ins; CYD waived (diagnostics, rehab & home health) Tier 2 20% co-ins after CYD Tier 3 40% co-ins after CYD DME and Ambulance 20% co-ins at Tier 1 CYD Emergency – Per visit deductible Tier 1 $0 Tier 2 & 3 $250 waived if admitted Emergency Facility services Tier 1 10% co-ins after CYD Tier 2 & 3 10% co-ins after CYD Urgent Care Tier 1 $50 co-pay Tier 2 20% co-ins after CYD Tier 3 40% co-ins after CYD Family factor for deductible/OOP: 2x Tier 1 – Core Tier 2 – BCBS “PPO” Tier 3 – Not in BCBS “PPO”

4 4 Pharmacy Benefits

5 5 Review GatorCare benefits information online Discuss options with enrollment experts during Open Enrollment (April/May) What do I need to do? KEY INFORMATION SOURCES See the GatorCare website for up to date information: http://healthplan.ufl.edu If you have questions regarding GatorCare benefits or claims, please contact Leslie Florence, the Gainesville FloridaBlue GatorCare liaison, at leslie.florence@floridablue.com, or by phone at 352-594-3354, internal extension: 4-3354. E-mail general questions about the GatorCare plan to the GatorCare office at gatorcare@ahc.ufl.edu.


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