If I Have Florida Blue Do I Need a Referral
- At Home COVID-19 test
- General
- Enrollments
- Coordination of Benefits
- Coverage
- Out-of-State and Emergency Care
- Network Providers
- Pharmacy Benefits
General
Where can I find which health plans are offered by GatorCare?
Information can be found at gatorcare.org.
What is the effective date of my health coverage?
The effective date of coverage is determined by your employer. Please contact your Human Resources office for information.
When do I need to make a decision regarding the selection of health plans?
Please contact your Human Resources office for information.
How do I find out what I have to pay for my health plan coverage?
Please contact your Human Resources office for information.
What is a calendar-year deductible (CYD)?
A calendar-year deductible (CYD) is the amount, when applicable, that must be satisfied by the member each calendar year before any payment will be made by the group health plan.
What is a per-admission deductible?
A per-admission deductible is an amount, in addition to the CYD, that is paid by the member upon being admitted to the hospital.
What is coinsurance?
Coinsurance is percentage share of health expenses paid by the member for covered services after the CYD is satisfied.
What is balance billing?
Balance billing is the amount billed to and due from the member for services received outside of the network.
Whom should I contact if I have questions on the health plans?
GatorCare is very fortunate to have two dedicated representatives from Florida Blue, the medical administrator, available to respond to medical coverage questions.
- Gainesville – (352) 594-3354 or GatorCareCSR@bcbsfl.com
- Jacksonville & Central Florida – (904) 244-9130 or GatorCareCSR@bcbsfl.com
Magellan Rx Management administers the pharmacy benefits and can be contacted at (800) 651-8921.
I haven't received my ID card. What should I do?
Members will normally receive their GatorCare ID cards by postal mail once the enrollment is processed by Florida Blue. If you have not received your GatorCare ID card immediately following the effective date of coverage, you may contact Florida Blue Customer Service at 1-800-664-5295 or the dedicated GatorCare representatives from Florida Blue (Jacksonville/Central Florida 904-244-9130 or Gainesville 352-594-3354). If your address has recently changed please contact your Human Resource department to update the correct mailing address. The health and prescription card are one card and members will not have a separate card for prescriptions.
The GatorCare ID cards that I received are not in my dependent's name. What do I need to do to request additional cards for my spouse and children?
GatorCare subscriber IDs include only the name of the contract holder (subscriber), but any family members enrolled are included in this membership. Providers can swipe the card to determine eligibility electronically or they will call Florida Blue for the information. Additional cards can be ordered, but each card will contain only the subscriber name. This does not present a problem for the membership. Providers verify active eligibility at point of service.
During the past Open Enrollment Period, I added dependents to my health plan. Will I receive a new GatorCare ID card?
GatorCare subscribers who change plans will receive new GatorCare ID cards; if a member remains in the same plan and adds dependents, additional cards may be requested, and will have the subscriber's name.
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Enrollments
Whom should I contact regarding the enrollment process?
Please contact your Human Resources office for information. Human Resource contact information can be found on the Contact Us page.
If I decide I want to change to another health plan offered through GatorCare, when can I make the change?
You may change to another health plan that your employer is offering during a future open enrollment period or when a qualifying event occurs. Open enrollment will be scheduled each year during the fall. Please contact your Human Resources office for more information.
What is a "qualifying" event?
A qualifying event is either a "work" or "life" event that permits a change to your benefits during the plan year. Common qualifying events include, but are not limited to: marriage, birth of a child, divorce, adoption, change of employment status or the death of a covered dependent. You must notify your Human Resources office within 30 days of an event.
Am I required to enroll into one of the health plans being offered?
Normally, employees have the option to enroll. Please contact your Human Resources office if you want to opt out; they may require proof of having alternative coverage.
My dependent child is age 26. How long can he remain covered on a health plan through GatorCare?
Please contact your Human Resources office for this information. Human Resource contact information can be found on the Contact Us page.
What do I do about health insurance upon my retirement?
Employees moving to a retiree status should contact their Human Resources office to discuss continuation of health coverage 60 days prior to retirement. If you are eligible to continue health coverage following retirement, you will be responsible for paying the premiums. Depending on your age at retirement, the coverage may be secondary to the Medicare Parts A and B. It will be necessary for you to coordinate your enrollment in Medicare Part B to coincide with your retirement date.
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Coordination of Benefits
How do I know if my or my spouse's insurance is primary?
If you are the employee, your GatorCare coverage is primary for you. Your spouse's policy is primary for him/her and secondary for you provided you also are covered by your spouse's policy. If you have children covered on both plans, except in the case of separation or divorce, the plan of the parent whose birthday excluding year of birth, falls earlier in the year, is the primary coverage. For more information on how your other coverage coordinates benefits, please contact that plan provider.
How will GatorCare coordinate with my other health insurance?
GatorCare follows a standard Coordination of Benefits (COB) process. It is the member's responsibility to inform Florida Blue of any duplication of benefits or other health plan coverage. When GatorCare is your primary health plan, covered services are reimbursed without regard to coverage under the other plan. When GatorCare is not your primary health plan, covered services are reimbursed based on what the other insurance did not pay only up to the Florida Blue allowed amount under their contracted rates with providers. In the event the primary payer's insurance exceeds the allowed amount, no payment will be made for such services.
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Coverage
Do you have Medicare and GatorCare Coverage?
GatorCare would like to remind you when you visit a healthcare provider to please present both your GatorCare member ID card and your Medicare card at the time of service. If you are on Medicare and actively employed (or covered by your spouse's actively employed plan), in most cases your GatorCare plan will be primary and Medicare is your secondary coverage. However, there are some circumstances where Medicare may be primary. If you are unclear about the order of liability, you may contact the dedicated GatorCare Florida Blue customer service representatives:
Contact your dedicated Florida Blue representative
- Gainesville—(352) 594-3354
GatorCareCSR@bcbsfl.com - Jacksonville & Central Florida—(904) 244-9130
GatorCareCSR@bcbsfl.com
Are chiropractic services covered?
Yes, chiropractic care is a covered service with GatorCare. Florida Blue has partnered with American Specialty Health Group (ASH) for management of chiropractic services for the plans offered through GatorCare. Chiropractors who are participating in the ASH network are covered with specialist copays. Chiropractors who do not participate with the ASH network are considered to be Tier 3 providers and services are covered only on the Premium Plan and are subject to a calendar-year deductible and coinsurance and may balance bill the member for charges over the allowance. Chiropractic manipulations are limited to 26 per calendar-year.
How is massage therapy covered?
Massage therapy is covered under the outpatient therapy benefits and reimbursed based on the participation of the rendering providers. Massage therapy must meet medical coverage guidelines to be covered. There is a 75-visit limit per benefit period; this includes cardiac, massage, occupation, physical and speech therapies.
How is maternity covered?
You will be charged a specialist copay during the first OB visit to confirm your pregnancy. Subsequent prenatal visits and the delivery services are billed by your physician after you deliver. Those charges as well as the charges for your hospital services are subject to the calendar-year deductible and coinsurance of your plan. Benefits are determined by the plan you are enrolled in and the participating level of the physician and hospital.
Do I need a referral to see a specialist?
No referral is needed on GatorCare plans to see a specialist, however, it is always a good practice to coordinate your care with your primary care provider.
Will I have to meet three different calendar year deductibles if I use three different benefit tiers?
It is possible that you may have to meet the calendar year deductible (CYD) if you use three different benefit tiers on the Premium plan, or two different benefit tiers on the Prime Plus plan within the same year. However, any amount applied to your CYD on a higher tier also will be applied on the lower tiers. The amount applied to your CYD on a lower tier will not be applied to the higher tiers. For example, if you are covered on the Premium plan and received services from Tier 3 providers in the beginning of the year, any amount applied to your Tier 3 CYD also will apply to the Tier 2 and Tier 1 CYD, and any amount met at Tier 2 will apply to the Tier 1 CYD. This also is true on the Prime Plus plan. If you have met any or all of your Tier 1 CYD and then go to providers in Tier 2 or 3, nothing from the Tier 1 CYD will apply towards those tiers.
What will it cost me to take my child to routine wellness visits?
Please refer to the Summary of Health Plan Benefit documents.
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Out-of-State and Emergency Care
What happens if I am out of the state and need medical care?
As a GatorCare member, if you need emergency care for a life-threatening problem and you are traveling outside of Florida or internationally, you have access to an extensive network of Tier 2 providers through Florida Blue's BlueCard program. Please visit BCBS for help finding options when you travel.
Within the United States, you can take advantage of savings the local Blue Plan has negotiated with doctors and hospitals in the area. For covered emergency care services received from a BlueCard PPO provider, you should not have to pay any amount above these negotiated rates. Just follow these simple steps:
- Always carry your current GatorCare ID card.
- In a life-threatening emergency, go directly to any hospital.
- To find doctors and hospitals outside of Florida, call the BlueCard Customer Service Center at 1-800-810-BLUE(2583) or visit BCBS to access the Blue National doctor and Hospital Finder.
- If you are hospitalized, the hospital should call Florida Blue for prior authorization at 1-800-955-5692, the number on the back of your GatorCare ID card – it is different from the number above.
Outside of the United States, you have access to covered emergency care services from doctors and hospitals in more than 200 countries and territories around the world through the BlueCard Worldwide Program. Just follow these simple steps:
- Verify your international benefits by calling Florida Blue Customer Service at 1-800-664-5295 before leaving the United States. Coverage may be different outside the country.
- Always carry your current GatorCare ID card.
- In a life-threatening emergency, go directly to any hospital.
- To find doctors and hospitals around the world, call the BlueCard Customer Service Center at 1-800-810-BLUE(2583) or call collect to 1-804-673-1177 24-hours a day, seven days a week. An assistance coordinator, in conjunction with a medical professional, will help arrange a doctor's appointment or hospitalization, if necessary.
- If you are hospitalized, you should call Florida Blue for prior authorization at 1-800-955-5692, the number on the back of your GatorCare ID card – it is different from the number above.
- Call the Blue Card Customer Service Center if you need inpatient care. In most cases, you should not need to pay up front for inpatient care at participating hospitals, except for the usual out-of-pocket expenses. The hospital should submit the claims on your behalf.
- You will need to pay up front for care received from a doctor and/or non-participating hospital. Then, complete an international claim form and send it with the bill(s) to the BlueCard Worldwide Service Center address on the form – look online at BCBS Global Core.
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Network Providers
How do I know if my doctor is a Tier 1 GatorCare provider or a Network Blue provider?
The list of GatorCare Tier 1 providers is located on the GatorCare website, www.GatorCare.org as well as UF Health's Bridge under Human Resources. The Tier 2 Blue Options provider directory can be accessed from the link located at www.gatorcare.org under the Network Provider tab. The list also can be accessed on www.FloridaBlue.com
Which urgent care centers are considered Tier 1?
There are several GatorCare Tier 1 participating urgent care centers in Gainesville and Jacksonville and they are listed below. Additional Tier 1 urgent care centers throughout the state of Florida can be found in this listing.
What if I need an urgent care center and I am outside of Florida?
A list of Network Blue – Tier 2 participating Urgent Care centers is available on the Florida Blue website. When searching in the Florida Blue online provider directory, please use "BlueOptions" to find providers that qualify for Tier 2 coverage under the GatorCare health plan.
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Positive Airway Pressure
- What will it cost me for a Positive Airway Pressure (PAP) Devices (CPAP, Bi-Level PAP)?
- See attached PAP Rent to own click here
Pharmacy FAQ
Source: https://gatorcare.org/contact-us/faq/
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