GAU has agreed to an extension of the GatorGradCare health insurance plan as part of our collective bargaining agreement for the three-year period from July 1st, 2017 through July 1st, 2020.
The agreement reached between GAU and the university administration makes it possible to maintain GatorGradCare as a stable, affordable, usable program for the next three years at least, and puts the program on solid footing for years to come.
It protects the most vulnerable members of our unit by keeping healthcare costs affordable for GAs who need to use services often. It protects the lowest-paid members of our unit by keeping out-of-pocket costs at a minimum. It protects dependents, who have suffered the most over the past few years, by reducing current dependent premiums by 20% and placing a cap on annual increases. It protects everyone in the unit with new contract language preventing the university and GatorCare administrators from implementing arbitrary, unilateral changes to the plan in mid-contract. Instead, they must bring proposals for changes to the bargaining table.
The agreement also locks in status quo rates on many key plan benefits under Tier 1 services (which includes all of UF Health), including out-of-pocket maximums for both individuals and families; copays for physician visits, specialist visits, and urgent care centers; and coinsurance rates for hospital services.
For months, we stood firm against the university’s insistence on introducing a $10.00 monthly premium, but in the end, 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 later this year.
These changes were approved by a vote of the GAU Bargaining Team and are subject to ratification by all graduate assistants, along with the rest of the contract, when negotiations are complete later this summer.
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 deductible rebate, and how do I claim it? The deductible rebate is a $50 dollar gift card that GAs on GatorGradCare can claim after utilizing the annual wellness exam benefit and paying their full $100 Tier One deductible. This gift card rebate applies only to the Tier One deductible. Please note: GAs are only eligible for the gift card rebate after they both pay their full $100 Tier One deductible and utilize the annual wellness exam benefit.
The claims process and gift card offerings still need to be worked out, but the GAU Healthcare Committee will be hard at work with GatorCare to ensure the process is easy and efficient, and that the offerings include liquid gift cards, such as a Visa/MasterCard/Amex card. Ensuring liquid card offerings should not present much of a problem, as this is the standard in the industry. As soon the claims process is worked out, GAU will post the procedure and necessary forms or links on its webpage.
What is the wellness exam benefit, and how do I utilize it? The wellness benefit is an annual checkup that the Affordable Care Act 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 fancy term for an annual physical that law mandates be free. 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 spouse or your child has no deductible to pay. Are most of the Tier Three benefits going away, as indicated by the N/A entries in the new benefits summary? Unfortunately, yes. There will no longer be coverage for out-of-network providers. There are exceptions for hospital services and emergency room visits, however.
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. 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.