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Great American Health Insurance in IDAHO – Health Plan Options

Great American — Patriot Class 1

A comparison of the Patriot Class 1 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Great American — Patriot Class 3

A comparison of the Patriot Class 3 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	see brochure
Copay	see brochure	see brochure
Deductible	see brochure	see brochure

Great American — Patriot Class 4

A comparison of the Patriot Class 4 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	N/A	N/A
Office Visit	Doctor visit: $60/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)	Doctor visit: $60/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)
Copay	Doctor visit: $60/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)	Doctor visit: $60/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)
Deductible	N/A	N/A

Great American — Patriot Class 5

A comparison of the Patriot Class 5 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	N/A	N/A
Office Visit	Doctor visit: $70/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)	Doctor visit: $70/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)
Copay	Doctor visit: $70/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)	Doctor visit: $70/visit (Up to 5 visits on the individual plan and up to 8 vists per calendar year per family)
Deductible	N/A	N/A

Great American — Essential Blue Basic PPO

A comparison of the Essential Blue Basic PPO offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible	50% after deductible
Office Visit	Inpatient Physician Services- 80% after deductible Outpatient Physician Services- Not covered	Inpatient Physician Services- 50% after deductible Outpatient Physician Services- Not covered
Copay	N/A	N/A
Deductible	$1,000 Individual, $2,000 Family	$1,000 Individual, $2,000 Family

Great American — Essential Blue Basic PPO

A comparison of the Essential Blue Basic PPO offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible	50% after deductible
Office Visit	Inpatient Physician Services- 80% after deductible Outpatient Physician Services- Not covered	Inpatient Physician Services- 50% after deductible Outpatient Physician Services- Not covered
Copay	N/A	N/A
Deductible	$2,000 Individual, $4,000 Family	$2,000 Individual, $4,000 Family

Great American — Essential Blue Basic PPO

A comparison of the Essential Blue Basic PPO offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible	50% after deductible
Office Visit	Inpatient Physician Services- 80% after deductible Outpatient Physician Services- Not covered	Inpatient Physician Services- 50% after deductible Outpatient Physician Services- Not covered
Copay	N/A	N/A
Deductible	$3,000 Individual, $6,000 Family	$3,000 Individual, $6,000 Family

Great American — Essential Blue Basic PPO

A comparison of the Essential Blue Basic PPO offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible	50% after deductible
Office Visit	Inpatient Physician Services- 80% after deductible Outpatient Physician Services- Not covered	Inpatient Physician Services- 50% after deductible Outpatient Physician Services- Not covered
Copay	N/A	N/A
Deductible	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 Family

Great American — Essential Blue Plus

A comparison of the Essential Blue Plus offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible	50% after deductible
Office Visit	Physician Office Visit- $30 copayment (deductible and/or coinsurance for other services during physician office visit)	Physician Office Visit- 50% after deductible (deductible and/or coinsurance for other services during physician office visit)
Copay	$30 copayment (deductible and/or coinsurance for other services during physician office visit)	50% after deductible (deductible and/or coinsurance for other services during physician office visit)
Deductible	$1,000 Individual, $2,000 Family	$1,000 Individual, $2,000 Family

Great American — Essential Blue Plus

A comparison of the Essential Blue Plus offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible	50% after deductible
Office Visit	Physician Office Visit- $30 copayment (deductible and/or coinsurance for other services during physician office visit)	Physician Office Visit- 50% after deductible (deductible and/or coinsurance for other services during physician office visit)
Copay	$30 copayment (deductible and/or coinsurance for other services during physician office visit)	50% after deductible (deductible and/or coinsurance for other services during physician office visit)
Deductible	$2,000 Individual, $4,000 Family	$2,000 Individual, $4,000 Family

Great American — Essential Blue Plus

A comparison of the Essential Blue Plus offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible	50% after deductible
Office Visit	Physician Office Visit- $30 copayment (deductible and/or coinsurance for other services during physician office visit)	Physician Office Visit- 50% after deductible (deductible and/or coinsurance for other services during physician office visit)
Copay	$30 copayment (deductible and/or coinsurance for other services during physician office visit)	50% after deductible (deductible and/or coinsurance for other services during physician office visit)
Deductible	$3,000 Individual, $6,000 Family	$3,000 Individual, $6,000 Family

Great American — Essential Blue Plus

A comparison of the Essential Blue Plus offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible	50% after deductible
Office Visit	Physician Office Visit- $30 copayment (deductible and/or coinsurance for other services during physician office visit)	Physician Office Visit- 50% after deductible (deductible and/or coinsurance for other services during physician office visit)
Copay	$30 copayment (deductible and/or coinsurance for other services during physician office visit)	50% after deductible (deductible and/or coinsurance for other services during physician office visit)
Deductible	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 Family

Great American — Blue Care PPO

A comparison of the Blue Care PPO offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible	50% after deductible
Office Visit	Other Services- Subject to deductible and coinsurance	Other Services- Subject to deductible and coinsurance
Copay	Physician Office Visits- $25 copayment Physician Office Visits- $30 copayment Physician Office Visits- $35 copayment	Physician Office Visits- 50% after deductible
Deductible	$1,000 Individual, $2,000 Family	$1,000 Individual, $2,000 Family

Great American — Blue Care PPO

A comparison of the Blue Care PPO offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible	50% after deductible
Office Visit	Other Services- Subject to deductible and coinsurance	Other Services- Subject to deductible and coinsurance
Copay	see brochure	Physician Office Visits- 50% after deductible
Deductible	$2,000 Individual, $4,000 Family	$2,000 Individual, $4,000 Family

Great American — Blue Care PPO

A comparison of the Blue Care PPO offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80% after deductible	50% after deductible
Office Visit	Other Services- Subject to deductible and coinsurance	Other Services- Subject to deductible and coinsurance
Copay	see brochure	Physician Office Visits- 50% after deductible
Deductible	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 Family

Great American — Simply Blue

A comparison of the Simply Blue offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70% after deductible	50% after deductible
Office Visit	70% after deductible	50% after deductible
Copay	N/A	N/A
Deductible	$2,500 Individual, $5,000 Family	Applies to all options unless otherwise indicated.

Great American — Simply Blue

A comparison of the Simply Blue offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70% after deductible	50% after deductible
Office Visit	70% after deductible	50% after deductible
Copay	N/A	N/A
Deductible	$5,000 Individual, $10,000 Family	Applies to all options unless otherwise indicated.

Great American — Simply Blue

A comparison of the Simply Blue offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	70% after deductible	50% after deductible
Office Visit	70% after deductible	50% after deductible
Copay	N/A	N/A
Deductible	$7,500 Individual, $15,000 Family	Applies to all options unless otherwise indicated.

Great American — Simply Blue

A comparison of the Simply Blue offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100% after deductible	50% after deductible
Office Visit	100% after deductible	50% after deductible
Copay	N/A	N/A
Deductible	$10,000 Individaul, $20,000 Family	Applies to all options unless otherwise indicated.

Great American — HSA Blue

A comparison of the HSA Blue offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	80% after deductible	60% after deductible
Copay	N/A	N/A
Deductible	$2,000 Individual, $4,000 Family	$2,000 Individual, $4,000 Family

Great American — HSA Blue

A comparison of the HSA Blue offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	80% after deductible	60% after deductible
Copay	N/A	N/A
Deductible	$3,000 Individual, $6,000 Family	$3,000 Individual, $6,000 Family

Great American — HSA Blue

A comparison of the HSA Blue offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	90%	70%
Office Visit	90% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$2,000 Individual, $4,000 Family	$2,000 Individual, $4,000 Family

Great American — HSA Blue

A comparison of the HSA Blue offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	90%	70%
Office Visit	90% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$3,000 Individual, $6,000 Family	$3,000 Individual, $6,000 Family

Great American — HSA Blue

A comparison of the HSA Blue offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	100% after deductible	100% after deductible
Copay	N/A	N/A
Deductible	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 Family

Great American — Short Term Medical

A comparison of the Short Term Medical offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$250	$250

Great American — Short Term Medical

A comparison of the Short Term Medical offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$250	$250

Great American — Short Term Medical

A comparison of the Short Term Medical offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$250	$250

Great American — Short Term Medical

A comparison of the Short Term Medical offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$250	$250

Great American — Short Term Medical

A comparison of the Short Term Medical offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$250	$250

Great American — Short Term Medical

A comparison of the Short Term Medical offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$250	$250

Great American — Short Term Medical

A comparison of the Short Term Medical offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$250	$250

Great American — Short Term Medical

A comparison of the Short Term Medical offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$250	$250

Great American — Short Term Medical

A comparison of the Short Term Medical offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$250	$250

Great American — Short Term Medical

A comparison of the Short Term Medical offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$250	$250

Great American — Short Term Medical

A comparison of the Short Term Medical offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$250	$250

Great American — Short Term Medical

A comparison of the Short Term Medical offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$250	$250