GatorGradCare
|
Graduate employees at the University of Florida—those on appointment as a graduate assistant, teaching assistant, or research assistant—may participate in the GatorGradCare health insurance plan administered by the University of Florida and UF Health.
GatorGradCare (GGC) includes two network tiers for medical providers to help reduce out-of-pocket costs for plan members. GGC also includes an annual wellness incentive and limited dental coverage (i.e., dental exam, x-rays, and cleaning). Outside of these network tiers, other services will be charged completely out-of-pocket. You may review the full text of the 2021-23 health care agreement here, and you may also view a summary layout of the new plan benefits. In addition, you can find the full benefit booklet here. To find providers, urgent care clinics, pharmacy benefits, visit gatorcare.org/gatorgradcare. Please also review this document for a complete list of psychiatric and mental health care providers that accept GatorGradCare. Below, you will find a more extensive list of commonly-asked questions about GGC and plan information. |
|
Plan Benefits, 2021-23
Insurance Information
|
Health Insurance Basics
|
GatorGradCare Benefits and Details
|
Frequently Asked Questions
Am I eligible for health insurance, and how do I enroll? Do I need to re-enroll annually?
All graduate employees (graduate, research, and teaching assistants) appointed at a 0.25 FTE or more are eligible to enroll in GatorGradCare (GGC). Enrollment is NOT automatic and must be completed by certain deadlines depending on the term of your first appointment for the year.
If you are a newly hired graduate employee, you can enroll in GGC within 60 days of your date of hire.
If you are a continuing graduate employee who was not previously a plan member—meaning you were previously employed as a graduate assistant but did not enroll in GGC--you can enroll in GGC during the next annual open enrollment period or if within 60 days of a qualifying status change event (e.g., birth, marriage, etc.).
If you are a continuing graduate employee who was previously a plan member—meaning you were employed as a graduate assistant in the previous academic year, enrolled in GGC, and your job was not terminated—you do not need to re-enroll in GGC. Continuing employees will continue to be covered under GGC for the remainder of their assistantship appointment.
If you are a newly hired graduate employee, you can enroll in GGC within 60 days of your date of hire.
If you are a continuing graduate employee who was not previously a plan member—meaning you were previously employed as a graduate assistant but did not enroll in GGC--you can enroll in GGC during the next annual open enrollment period or if within 60 days of a qualifying status change event (e.g., birth, marriage, etc.).
If you are a continuing graduate employee who was previously a plan member—meaning you were employed as a graduate assistant in the previous academic year, enrolled in GGC, and your job was not terminated—you do not need to re-enroll in GGC. Continuing employees will continue to be covered under GGC for the remainder of their assistantship appointment.
What is the difference between "Tier One," "Tier Two," and "Tier Three" coverage?
Under our insurance plan, services are divided into two tiers:
- Tier One: UF Health & Shands Hospital physicians, and other affiliated doctors and clinics (click links for directory lists)
- Tier Two: all other doctors, clinics, and hospital services covered by the Florida Blue network
- Tier Three: out-of-network providers. Only covers hospital services and emergency room visits.
Why do I have to pay a premium, and how will that payment work?
As part of the bargaining process, GAU agreed to a modest $12 per month payment in the form of an individual premium that will be automatically deducted from all graduate employee paychecks. This was in exchange for keeping the out-of-pocket maximums (i.e., the absolute most you will ever pay for the year in medical bills) at the current levels. GAU believes that this compromise will ensure those graduate employees in need of expensive care or treatments will not suffer an even greater financial burden.
What is the difference between a deductible, a copay, and coinsurance?
The application of these terms differs depending on the Tier your provider is in, as well as the specific care you are receiving:
- A deductible is the amount that you must pay out-of-pocket before the insurance company will begin coverage
- A copay is a fixed amount of money that you must pay in addition to what insurance covers
- Coinsurance is a "shared" cost between you and the insurance company, i.e. each pays a percentage of the bill
Do I have to pay the Tier One deductible before receiving coverage?
It depends. Any benefit listed in the summary with a “copay,” as distinct from “coinsurance,” will be provided at the cost of just the copay. Additionally, annual physicals are covered at no charge. However, yearly deductibles must be met for any other services that are not covered by copays, which includes hospital services regardless of tier. NOTE: coinsurance payments only count towards the deductible for the tier that the service was provided in plus any tiers below it, e.g. meeting a Tier Two deductible counts towards Tier One but not vice-versa.
Will copays count toward the Tier One deductible? Will they count toward to the Out-of-Pocket Maximum?
Copays do NOT count toward the deductible requirement. If you visit a specialist in Tier One and pay a $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 $2,700 in Tier One medical bills per benefit year.
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. 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 for Tier One. 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 for the rest of the year.
Satisfaction of the family deductible is slightly complicated. 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 for Tier One. 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 for the rest of the year.
What if I do not live or work in the Gainesville or Jacksonville areas?
Graduate employees not living or working in the Gainesville or Jacksonville, Florida areas—including those residing abroad—are eligible to enroll in the GatorGradCare Out-of-Area (OOA) plan. An OOA plan allows you to access Tier 2 providers at Tier 1 prices since there are no Tier 1 providers in-area.
In order to enroll in the OOA plan, your academic department or unit must enter your work county location as outside the Gainesville or Jacksonville, Florida areas in PeopleSoft. To change your work location, please contact your department or unit's human resources (HR) representative. For department's, this change can be done through a Job Edit ePAF and updating the County Field. If additional assistance is needed, please direct departments to UF's Employment Operations and Records Department at [email protected] or 352-273-1079.
An OOA plan benefits summary can be found above.
In order to enroll in the OOA plan, your academic department or unit must enter your work county location as outside the Gainesville or Jacksonville, Florida areas in PeopleSoft. To change your work location, please contact your department or unit's human resources (HR) representative. For department's, this change can be done through a Job Edit ePAF and updating the County Field. If additional assistance is needed, please direct departments to UF's Employment Operations and Records Department at [email protected] or 352-273-1079.
An OOA plan benefits summary can be found above.
What happens if I am outside of Florida for a conference or vacation and need care?
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., you may be covered as well through the BlueCard Worldwide program. Follow the instructions to contact a representative to ensure coverage during your travels. We also recommend you consult with the International Center to see if you need to obtain any additional coverage if you will be conducting university business such as research or attending a conference. Make sure to always carry your GatorGradCare ID with you when you travel!
Can I use the Student Health Care Center (Infirmary) free of charge?
Using the SHCC is usually the least expensive option for graduate employees. The healthcare fee you pay every semester covers most, but not all, services you will need including sick visits, chronic condition management, and an annual wellness physical. However, certain procedures, lab tests, and pharmacy may still require an additional charge.
Where should I go when the Student Health Care Center is closed or too busy?
If you need immediate attention and the SHCC cannot see you, we suggest locating an Urgent Care covered by Tier One for the least expensive care. Use this list for locations of those providers. Urgent Cares located in convenience stores (e.g. CVS) are NOT part of Tier One and may instead fall under the more expensive Tier Two coverage.
ER visits will charge a minimum of a $250 deductible. Do not visit an ER unless the emergency is life-threatening!
ER visits will charge a minimum of a $250 deductible. Do not visit an ER unless the emergency is life-threatening!
Am I covered over the summer if I am not working?
If you are on a 9-month appointment, you are still covered by GGC over the summer months if you will be returning to a graduate employee position for the next Fall semester. For graduate employees employed during the summer, you are covered by GGC for the full term even if you are appointed for just Summer A or B. If you will not be re-enrolled for the Fall term, or are no longer eligible for any other reason, your coverage will end at the end of the month that your appointment ends.
What are wellness and preventative care visits, and how do I use them?
You’ll see that wellness and preventative care visits are provided for free (i.e. no copay) under our plan. Your vitals, blood sugar, weight, and cholesterol are checked during these exams, and you have the opportunity to bring any health concerns with the Primary Care Physician or Nurse Practitioner. In other words, it's a free, annual physical. 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.
What is the wellness incentive, and how do I claim it?
The wellness incentive is a $50 Amazon gift card that all graduate employees on GGC are eligible to receive after participating in a GatorGradeCare Wellness Event as part of your free wellness and preventative care visit for the year. You do NOT have to reach your deductible in order to receive the gift card.
If you are located outside of Gainesville, or miss 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. Check the GGC website for updates on when the year's event will be held.
If you are located outside of Gainesville, or miss 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. Check the GGC website for updates on when the year's event will be held.
Will this new plan change behavioral health benefits in any way?
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 you may have to pay more to providers in this tier, but at percentage rates no higher than other specialists. If you were seeing your Tier Two mental health coverage prior to October 1, 2017, and have been negatively impacted in any way, please contact our mental health committee.
Are vision or dental covered by GatorGradCare?
GGC does not currently cover vision or dental services.
There are limited dental services provided via the University of Florida's College of Dentistry.
As Blue365 members, those with GGC do have access to discounts on eyewear, eye exams, contact lenses and more through EyeMed’s Advantage Vision discount.
There are limited dental services provided via the University of Florida's College of Dentistry.
As Blue365 members, those with GGC do have access to discounts on eyewear, eye exams, contact lenses and more through EyeMed’s Advantage Vision discount.
What is the benefit period, and what happens if I have a baby, adopt, or get married?
The benefit period the time when services are covered under your plan, for GGC begins January 1st of each year and ends December 31st of the same year. Your GGC coverage ends December 31st even if your coverage started after January 1st.
GGC participants have the opportunity to make a change to their plan coverage within 60 days of a qualifying status change event (birth, marriage, etc.) and during the annual employee benefits open enrollment period each fall. Any changes to benefits or to the health insurance plan made during open enrollment take effect at the beginning of the calendar year. If you experience a qualifying status change event, please contact the GA Benefits Office for enrollment information.
GGC participants have the opportunity to make a change to their plan coverage within 60 days of a qualifying status change event (birth, marriage, etc.) and during the annual employee benefits open enrollment period each fall. Any changes to benefits or to the health insurance plan made during open enrollment take effect at the beginning of the calendar year. If you experience a qualifying status change event, please contact the GA Benefits Office for enrollment information.
Do I have to complete an insurance waiver each year?
Yes, the Health Compliance Office requires graduate employees who are a first-time or existing GatorGradCare member to complete an insurance waiver. The purpose of the waiver is to demonstrate you have health insurance coverage satisfying the University's requirement. If you are a GatorGradCare member, you have insurance satisfying the requirement.
To complete a waiver, you will need your GatorGradCare ID card. On the eligibility questionnaire, answer “yes” to the questions. On the next screen, enter your insurance information as presented on your ID card. GatorGradCare cards do not include pharmaceutical information. For fields that your ID card does not provide, include "N/A".
You can complete your insurance waiver on the Health Compliance Office's website. If you have questions regarding the waiver process, you can contact the UF Health Compliance Office by emailing [email protected] or by calling 352-294-2925.
To complete a waiver, you will need your GatorGradCare ID card. On the eligibility questionnaire, answer “yes” to the questions. On the next screen, enter your insurance information as presented on your ID card. GatorGradCare cards do not include pharmaceutical information. For fields that your ID card does not provide, include "N/A".
You can complete your insurance waiver on the Health Compliance Office's website. If you have questions regarding the waiver process, you can contact the UF Health Compliance Office by emailing [email protected] or by calling 352-294-2925.
How do I get a GatorGradCare ID card? Is there a virtual ID card?
GatorGradCare members can order replacement or print temporary BlueCard ID cards online at www.floridablue.com. You must have your member ID number to create your online account. If you do not have your BlueCard with you, you can follow the instructions here to obtain your member ID number and set up your account.
You can also download the Florida Blue app for iOS or Android to access a virtual BlueCard or download it to your wallet.
You can also download the Florida Blue app for iOS or Android to access a virtual BlueCard or download it to your wallet.
If my insurance ends, am I eligible for COBRA?
Once your GatorGradCare plan coverage terminates, Florida Blue will send you a COBRA continuation offer by mail. COBRA allows former employees the opportunity to continue insurance plan coverage, at their expense, for up to eighteen-months following the end of employment. Once you insurance coverage ends, you have sixty days to enroll in COBRA, and insurance coverage is retroactive once enrolled.
Who should I contact if I have questions?
If you have questions about adding your significant other or dependent to your plan, updating your personal information (e.g., your address), or have a question about payroll deduction you should contact GA Human Resources at 352-392-0003 or [email protected].
For specific questions about pharmacy or medical benefit coverage, claims processing, obtaining an insurance card, or inquiries regarding a health care provider, please contact the Florida Blue representative for your area:
For specific questions about pharmacy or medical benefit coverage, claims processing, obtaining an insurance card, or inquiries regarding a health care provider, please contact the Florida Blue representative for your area:
- Lamiah Gilmore- Dedicated GatorCare Representative for Gainesville
- Email: [email protected]
- Office: 352-594-3354
- Work Cell: 904-719-2845
- Lekisha Scott- Dedicated GatorCare Representative for Jacksonville/Central Florida area
- Email: [email protected]
- Office: 904-244-9130
- Work Cell: 904-571-0416
|
SmartSaveRx Card
Your browser does not support viewing this document. Click here to download the document.
List of Psychiatric and Mental Health Care Providers that Accept GatorGradCare
Your browser does not support viewing this document. Click here to download the document.
|
Dental Benefits
Your browser does not support viewing this document. Click here to download the document.
|
