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

• 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 flexibilityo Higher deductibles, co-pays and

maximum out of pocket costso 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 Optionso Employee Plus Child option changes to

Employee Plus Childreno Individualo Family

COM covering ALL premium costs for faculty GatorCare. Faculty will be responsible for deductible and copay amounts.

GatorCare Prime PlusCore 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/$2000Max Out of Pocket (OOP)                             Tier 1    $2,500/$5,000 Tier 2     $5,000/$10,000IP  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 CYDOP Services    Tier 1    5% co-ins; CYD waived (diagnostics, rehab and home health) Tier 2     40% coins after CYDEmergency – Per visit deductible Tier 1 $ 0 Tier 2 & 3  $250 waived if admittedEmergency Facility services  Tier 1 5% co-ins after CYD    Tier 2 & 3   5% co-ins after CYDUrgent 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/$2,000Max OOP                             Tier 1  & 2     $2,500/$5,000 Tier 3             $5,000/$10,000IP 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 CYDEmergency – Per visit deductible Tier 1 $0 Tier 2 & 3 $250 waived if admittedEmergency 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 – CoreTier 2 – BCBS “PPO”Tier 3 – Not in BCBS “PPO”

4

Pharmacy Benefits

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.