1 / 5

GatorCare is here for many and s till coming for others!

GatorCare is here for many and s till coming for others!. 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)

frye
Download Presentation

GatorCare is here for many and s till coming for others!

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. GatorCare is here for many and • still coming for others! • 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 • 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

  2. How Does GatorCare Work? • BASIC PLAN CONSIDERATIONS • GatorCare Prime Plus • Least cost option when using GatorCare network providers, facilities • (can use non-network emergency care) • Lower deductibles; lower co-pays = best value as long as you keep your care in-network • GatorCare Premium • Provides greater network flexibility • Higher deductibles, co-pays and maximum out of pocket costs • 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 • Employee Plus Child option changes to Employee Plus Children • Individual • Family • 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 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 GatorCare Premium 3 Tier Network • 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 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. Pharmacy Benefits

  5. What do I need to do? • Review GatorCarebenefits information online • Discuss options with enrollment experts during Open Enrollment (April/May) • 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, atleslie.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.

More Related