The agreement reached between GAU and the university administration makes it possible to maintain GGC as a stable, affordable, usable program for at least the next three years at least and stabilizes the plan for in the future.
It protects the most vulnerable GAs by keeping healthcare costs affordable for GAs who need to use services often.
It protects the lowest-paid GAs of our unit by keeping out-of-pocket costs at a minimum.
It protects GAs withdependents, who have suffered the most over the past few years, by reducing dependent premiums by 20% and placing a cap on annual increases.
It protects everyone with new contract language preventing the university and GatorCare administrators from implementing changes to the plan in mid-contract without bringing proposals for changes to the bargaining table first.
The agreement also locks in status quo rates on many key plan benefits under Tier 1 services (i.e. UF Health), including out-of-pocket maximums for both individuals and families; copays for physician visits, specialist visits, and urgent care centers & coinsurance rates for hospital services.
We stood firm against the university’s insistence on introducing a $10 monthly premium, but the Bargaining Team agreed to this modest unit-wide premium to prevent steep increases in out-of-pocket costs that would make the plan unusable for low-paid or chronically-ill graduate assistants. The premium will not go into effect until August 2018.
Other changes to the plan, including the introduction of a $100.00 Tier 1 deductible and a wellness rebate gift card for use of the plan’s preventive wellness visit, will go into effect in Fall 2017.
Below, you’ll find a list of some commonly-asked questions about the new plan agreement, and our responses to those questions.
GatorGradCare Agreement FAQ
How will the new individual premium be paid? At this time, we do not know for sure how the individual premium will be paid. Because this is an employee plan, we assume payment will be in the form of a payroll deduction, but we do not know this for certain. The individual premium does not go into effect until the 2018-2019 academic year.
What is the wellness incentive, and how do I claim it? The wellness incentive is a $50 Amazon gift card that all GAs on GGC are eligible to receive after participating in a GatorGradeCare Wellness Event (see below). You do NOT have to reach your deductible in order to receive the gift card. These events are free opportunities to receive biometric screenings and to meet with healthcare professionals to discuss health concerns. They are usually held annually and various dates/locations are available to make attendance as convenient as possible.
If you are located outside of Gainesville, or missed an event on-campus, you are still eligible to participate and receive your wellness incentive/gift card by visiting a Quest Diagnostics location. GAU recommends attending GatorGradCare Wellness Events in addition to your annual wellness visit with your primary care physician.
What are wellness and preventative care visits, and how do I utilize them? You’ll see that wellness and preventative care visits are provided for free (i.e. no copay) under our plan. These visits are annual checkups that the Affordable Care Act (ACA) mandates be offered free of charge to all health insurance subscribers. A patient’s vitals, blood sugar, weight, and cholesterol are checked during these exams and patients have an opportunity to bring any health concerns they have up with their Primary Care Physician or Nurse Practitioner. In other words, it's a free, annual physical mandated by law. You can schedule the wellness visit with your Tier One Primary Care Provider, or participate in one of the mass wellness events hosted by GatorCare from time to time. GAU will be active in ensuring convenient scheduling of the mass wellness events, as well as their convenient location.
Do I have to pay the Tier One deductible before receiving any of the plan’s benefits? No. Any benefit listed in the summary with a “copay,” as distinct from “coinsurance,” will provided at the cost of the copay. Additionally, as noted above, annual physicals are covered at no charge per the ACA.
Will Tier One copays count toward the deductible? Will they count toward to the Out-of-Pocket Maximum? Copays do not count toward the deductible requirement, so if you visit a specialist in Tier One and pay the $30 copayment, the amount needed to satisfy the deductible will not decrease by $30. Copays do, however, count toward the Out-of-Pocket Maximum. No matter what, you never as an individual pay more than $2,500 in Tier One medical bills per benefit year. The 2017-2020 Out-of-Pocket Maximum is the same as the current Out-of-Pocket Maximum.
What is the “Family Deductible”? Does it apply to each of dependents separately? The family deductible is the amount that must be paid out-of-pocket before coinsurance benefits for dependents kick in. The family deductible does not apply separately for each dependent. Once this deductible is satisfied, full coverage goes into effect for all family members covered under GatorGradCare.
Satisfaction of the family deductible is slightly complicated, however. For example, let’s say you, your spouse, and one child are covered under GatorGradCare. The individual deductible is $100 and the family deductible is $200 in this coverage tier. Each individual on the plan must pay the $100 individual deductible before coverage kicks in for them, but that $100 also pays down the family deductible. Once two family members satisfy their individual deductibles, the entire family deductible is satisfied and the third family member has no deductible to pay. However, no one individual family member can pay the entire family deductible. Thus, in our one spouse, one child example, you and your spouse, or you and your child, must each pay a separate $100 deductible before the family deductible is met. But once that family deductible is met, your remaining family members have no deductible to pay. Are most of the Tier Three benefits going away? Unfortunately, yes. There will no longer be complete coverage for providers out-of-network. However, there are exceptions for hospital services and emergency room visits.
What happens if I’m outside of Florida for a conference or vacation and fall ill? If you are within the United States, you will be able to utilize Tier Two services from the National Blue Card network. If you are traveling outside of the U.S. to conduct university business such as research or attending a conference, you should first consult with the International Center and can obtain any additional health insurance coverage for your travels. Will this new plan change behavioral health benefits in any way? Under law, behavioral illnesses must be covered in the same way as all other illness. Behavioral health coverage will be affected no more than the rest of the coverage. For Tier One, we were able to secure status-quo copays for specialists, and so there will be no changes to psychiatric care costs for providers in this tier. Tier Two coinsurance rates are going up, and so subscribers will have to pay more to providers in this tier, but at percentage rates no higher than other specialists. If your Tier Two mental health coverage has been negatively impacted in any way, please contact our mental health committee.