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Great American Health Insurance in INDIANA – 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 — MedOne Plus- PPO Benefit Plan

A comparison of the MedOne Plus- PPO Benefit Plan 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	$2,500(2 per family maximum)	$5,000(2 per family maximum)

Great American — MedOne Plus- PPO Benefit Plan w/Rx Opt $0/$15/50%

A comparison of the MedOne Plus- PPO Benefit Plan w/Rx Opt $0/$15/50% 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	$30 Copay then 100%	Subject to deductible, then coinsurance.
Copay	$30	N/A
Deductible	$1,000(2 per family maximum)	$2,000(2 per family maximum)

Great American — MedOne- HSAvings Individual

A comparison of the MedOne- HSAvings Individual 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	Subject to deductible, then coinsurance.	Subject to deductible, then coinsurance.
Copay	N/A	N/A
Deductible	$2,800	$5,600

Great American — MedOne Plus- PPO Benefit Plan

A comparison of the MedOne Plus- PPO Benefit Plan 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	$2,500(2 per family maximum)	$5,000(2 per family maximum)

Great American — MedOne- HSAvings Individual with Wellness

A comparison of the MedOne- HSAvings Individual with Wellness 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	Subject to deductible, then coinsurance.	Subject to deductible, then coinsurance.
Copay	N/A	N/A
Deductible	$2,600	$5,200

Great American — MedOne Security- PPO Facility Copay Plan

A comparison of the MedOne Security- PPO Facility Copay Plan 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	$40 Copay then 100%	Subject to deductible, then coinsurance.
Copay	$40	N/A
Deductible	$2,000(2 per family maximum)	$4,000(2 per family maximum)

Great American — MedOne Plus- PPO Benefit Plan w/Rx Opt $0/$15/50%

A comparison of the MedOne Plus- PPO Benefit Plan w/Rx Opt $0/$15/50% 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	$30 Copay then 100%	Subject to deductible, then coinsurance.
Copay	$30	N/A
Deductible	$1,000(2 per family maximum)	$2,000(2 per family maximum)

Great American — MedOne Security- PPO Facility Copay Plan w/Rx Opt $0/$15/50%

A comparison of the MedOne Security- PPO Facility Copay Plan w/Rx Opt $0/$15/50% 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	Subject to deductible, then coinsurance.
Copay	see brochure	see brochure
Deductible	$2,000(2 per family maximum)	$4,000(2 per family maximum)

Great American — MedOne Security- PPO Facility Copay Plan

A comparison of the MedOne Security- PPO Facility Copay Plan 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	$40 Copay then 100%	Subject to deductible, then coinsurance.
Copay	$40	N/A
Deductible	$2,000(2 per family maximum)	$4,000(2 per family maximum)

Great American — MedOne Plus- PPO Benefit Plan

A comparison of the MedOne Plus- PPO Benefit Plan 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	$2,500(2 per family maximum)	$5,000(2 per family maximum)

Great American — MedOne Security- PPO Facility Copay Plan w/Rx Opt $0/$15/50%

A comparison of the MedOne Security- PPO Facility Copay Plan w/Rx Opt $0/$15/50% 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	Subject to deductible, then coinsurance.
Copay	see brochure	see brochure
Deductible	$2,000(2 per family maximum)	$4,000(2 per family maximum)

Great American — MedOne Plus- PPO Benefit Plan w/Rx Opt $0/$15/50%

A comparison of the MedOne Plus- PPO Benefit Plan w/Rx Opt $0/$15/50% 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	$30 Copay then 100%	Subject to deductible, then coinsurance.
Copay	$30	N/A
Deductible	$1,000(2 per family maximum)	$2,000(2 per family maximum)

Great American — First Dollar PPO 30

A comparison of the First Dollar PPO 30 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% up to out of pocket max. $0 once out of pocket max is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max is satisfied.
Office Visit	Non-Specialist Office Visit: $30 copay (unlimited visits), Specialist Visit: $40 copay (unlimited visits)	Non-Specialist Office Visit: 70% after deductible (unlimited visits), Specialist Visit: 70% after deductible (unlimited visits)
Copay	Non-Specialist Office Visit: $30 copay (unlimited visits), Specialist Visit: $40 copay (unlimited visits)	Non-Specialist Office Visit: 70% after deductible (unlimited visits), Specialist Visit: 70% after deductible (unlimited visits)
Deductible	Individual: $0, Family: $0	Individual: $5,000, Family: $10,000

Great American — First Dollar PPO 40

A comparison of the First Dollar PPO 40 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	60% up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $40 copay (Unlimited visits); Specialist Visit: $50 copay (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $40 copay (Unlimited visits); Specialist Visit: $50 copay (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Deductible	Individual: $0, Family: $0	Individual: $7,000, Family: $14,000

Great American — PPO 5000

A comparison of the PPO 5000 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 up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $40 copay, deductible waived (Unlimited visits); Specialist Visit: $50 copay, deductible waived (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $40 copay, deductible waived (Unlimited visits); Specialist Visit: $50 copay, deductible waived (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Deductible	Individual: $5,000, Family: $10,000	Individual: $10,000, Family: $20,000

Great American — PPO Value 10000

A comparison of the PPO Value 10000 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 up to out of pocket max. $0 once out of pocket max. is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	Non-Specialist and Specialist Office Visit: Visits 1-2 $30 copay, deductible waived; Visits 3+ 70% after deductible. Specialist and Non-Specialist share visit max (unlimited visits).	Non-Specialist and Specialist Office Visit: 50% after deductible (unlimited visits).
Copay	Non-Specialist and Specialist Office Visit: Visits 1-2 $30 copay, deductible waived; Visits 3+ 70% after deductible. Specialist and Non-Specialist share visit max (unlimited visits).	Non-Specialist and Specialist Office Visit: 50% after deductible (unlimited visits).
Deductible	Individual: $10,000, Family: $20,000	Individual: $10,000, Family: $20,000

Great American — Preventive and Hospital Care 1250

A comparison of the Preventive and Hospital Care 1250 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 up to out of pocket max. $0 once out of pocket max. is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	Not covered	Not covered
Copay	Not covered	Not covered
Deductible	Individual: $1,250, Family: $2,500	Individual: $2,500, Family: $5,000

Great American — Preventive and Hospital Care 3000 (HSA Compatible)

A comparison of the Preventive and Hospital Care 3000 (HSA Compatible) 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 up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered (Unlimited visits); Specialist Visit: Not covered (Includes Chiropractic Care Visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered (Unlimited visits); Specialist Visit: Not covered (Includes Chiropractic Care Visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered (Unlimited visits); Specialist Visit: Not covered (Includes Chiropractic Care Visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered (Unlimited visits); Specialist Visit: Not covered (Includes Chiropractic Care Visits)
Deductible	Individual: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

Great American — First Dollar PPO 30 with Dental

A comparison of the First Dollar PPO 30 with Dental 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% up to out of pocket max. $0 once out of pocket max is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max is satisfied.
Office Visit	Non-Specialist Office Visit: $30 copay (unlimited visits), Specialist Visit: $40 copay (unlimited visits)	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits).
Copay	Non-Specialist Office Visit: $30 copay (unlimited visits), Specialist Visit: $40 copay (unlimited visits)	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits).
Deductible	Individual: $0, Family: $0	Individual: $5,000, Family: $10,000

Great American — First Dollar PPO 40 with Dental

A comparison of the First Dollar PPO 40 with Dental offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	60% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $40 copay (Unlimited visits); Specialist Visit: $50 copay (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $40 copay (Unlimited visits); Specialist Visit: $50 copay (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Deductible	Individual: $0, Family: $0	Individual: $7,000, Family: $14,000

Great American — PPO 5000 with Dental

A comparison of the PPO 5000 with Dental 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 up to out of pocket max. $0 once out of pocket max. is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	Non-Specialist Office Visit: $40 copay deductible waived (unlimited visits), Specialist Visit: $50 copay deductible waived (unlimited visits).	50% after deductible (unlimited visits)
Copay	Non-Specialist Office Visit: $40 copay deductible waived (unlimited visits), Specialist Visit: $50 copay deductible waived (unlimited visits).	50% after deductible (unlimited visits)
Deductible	Individual: $5,000, Family: $10,000	Individual: $10,000, Family: $20,000

Great American — PPO Value 10000 with Dental

A comparison of the PPO Value 10000 with Dental 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 up to out of pocket max. $0 once out of pocket max. is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	Non-Specialist and Specialist Office Visit: Visits 1-2 $30 copay, deductible waived; Visits 3+ 70% after deductible. Specialist and Non-Specialist share visit max (unlimited visits).	Non-Specialist and Specialist Office Visit: 50% after deductible (unlimited visits).
Copay	Non-Specialist and Specialist Office Visit: Visits 1-2 $30 copay, deductible waived; Visits 3+ 70% after deductible. Specialist and Non-Specialist share visit max (unlimited visits).	Non-Specialist and Specialist Office Visit: 50% after deductible (unlimited visits).
Deductible	Individual: $10,000, Family: $20,000	Individual: $10,000, Family: $20,000

Great American — Preventive and Hospital Care 1250 with Dental

A comparison of the Preventive and Hospital Care 1250 with Dental 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 up to out of pocket max. $0 once out of pocket max. is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	Not covered	Not covered
Copay	Not covered	Not covered
Deductible	Individual: $1,250, Family: $2,500	Individual: $2,500, Family: $5,000

Great American — Preventive and Hospital Care 3000 (HSA Compatible) with Dental

A comparison of the Preventive and Hospital Care 3000 (HSA Compatible) with Dental 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 up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered; Specialist Visit: Not covered	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered; Specialist Visit: Not covered
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered; Specialist Visit: Not covered	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered; Specialist Visit: Not covered
Deductible	Individual: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

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	$1,000	$1,000

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	$1,000	$1,000

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	$1,000	$1,000

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	$1,000	$1,000

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	$1,000	$1,000

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	$1,000	$1,000

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	$1,000	$1,000

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	$1,000	$1,000

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	$1,000	$1,000

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	$1,000	$1,000

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	$1,000	$1,000

Great American — HealthSaver Limited-Benefit

A comparison of the HealthSaver Limited-Benefit 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 illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$2,500	$2,500

Great American — HealthSaver Limited-Benefit

A comparison of the HealthSaver Limited-Benefit 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 illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$2,500	$2,500

Great American — HealthSaver Limited-Benefit

A comparison of the HealthSaver Limited-Benefit 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 illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$2,500	$2,500

Great American — HealthSaver Limited-Benefit

A comparison of the HealthSaver Limited-Benefit 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 illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$2,500	$2,500

Great American — HealthSaver Limited-Benefit

A comparison of the HealthSaver Limited-Benefit 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 illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$2,500	$2,500

Great American — HealthSaver Limited-Benefit

A comparison of the HealthSaver Limited-Benefit 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 illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$2,500	$2,500

Great American — HealthSaver Limited-Benefit

A comparison of the HealthSaver Limited-Benefit 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 illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$2,500	$2,500

Great American — HealthSaver Limited-Benefit

A comparison of the HealthSaver Limited-Benefit 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 illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$2,500	$2,500

Great American — Blue Access Value

A comparison of the Blue Access Value 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%	60%
Office Visit	Visits 1 and 2- member pays $30 copayment. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.	Visits 1 and 2- member pays coinsurance. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.
Copay	$30 for first 2 Office Visits.	N/A
Deductible	$10,000 Individual, $20,000 Family	$20,000 Individual, $40,000 Family

Great American — Blue Access Value

A comparison of the Blue Access Value 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%	60%
Office Visit	Visits 1 and 2- member pays $30 copayment. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.	Visits 1 and 2- member pays coinsurance. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.
Copay	$30 for first 2 Office Visits.	N/A
Deductible	$10,000 Individual, $20,000 Family	$20,000 Individual, $40,000 Family

Great American — Blue Access Value

A comparison of the Blue Access Value 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%	60%
Office Visit	Visits 1 and 2- member pays $30 copayment. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.	Visits 1 and 2- member pays coinsurance. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.
Copay	$30 for first 2 Office Visits.	N/A
Deductible	$10,000 Individual, $20,000 Family	$20,000 Individual, $40,000 Family

Great American — Blue Access Value

A comparison of the Blue Access Value 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%	60%
Office Visit	Visits 1 and 2- member pays $30 copayment. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.	Visits 1 and 2- member pays coinsurance. The deductible does not apply. Other covered office services subject to deductible and coinsurance. Visits 3+ are not covered.
Copay	$30 for first 2 Office Visits.	N/A
Deductible	$10,000 Individual, $20,000 Family	$20,000 Individual, $40,000 Family

Great American — Lumenos Health Incentive Account Plan 1

A comparison of the Lumenos Health Incentive Account Plan 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	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	100% after deductible	60% after deductible
Deductible	see brochure	see brochure

Great American — Lumenos Health Incentive Account Plan 2

A comparison of the Lumenos Health Incentive Account Plan 2 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	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	80% after deductible	60% after deductible
Deductible	$1,000 Individual, $2,000 Family	$2,000 Individual, $4,000 Family

Great American — Lumenos Health Incentive Account Plan 1

A comparison of the Lumenos Health Incentive Account Plan 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	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	100% after deductible	60% after deductible
Deductible	see brochure	see brochure

Great American — Lumenos Health Incentive Account Plan 2

A comparison of the Lumenos Health Incentive Account Plan 2 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	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	80% after deductible	60% after deductible
Deductible	$2,500 Individual, $5,000 Family	$5,000 Individual, $10,000 Family

Great American — Lumenos Health Incentive Account Plus Plan 1

A comparison of the Lumenos Health Incentive Account Plus Plan 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	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	100% after deductible	60% after deductible
Deductible	$2,500 Individual, $5,000 Family	$5,000 Individual, $10,000 Family

Great American — Lumenos Health Incentive Account Plus Plan 2

A comparison of the Lumenos Health Incentive Account Plus Plan 2 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	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	80% after deductible	60% after deducible
Deductible	$2,500 Individual, $5,000 Family	$5,000 Individual, $10,000 Family

Great American — Lumenos Health Incentive Account Plan 1

A comparison of the Lumenos Health Incentive Account Plan 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	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	100% after deductible	60% after deductible
Deductible	see brochure	see brochure

Great American — Lumenos Health Incentive Account Plus Plan 1

A comparison of the Lumenos Health Incentive Account Plus Plan 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	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	100% after deductible	60% after deductible
Deductible	$5,000 Individual, $10,000 Family	$10,000 Individual, $20,000 Family

Great American — Lumenos Health Incentive Account Plus Plan 1

A comparison of the Lumenos Health Incentive Account Plus Plan 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	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	100% after deductible	60% after deductible
Deductible	$10,000 Individual, $20,000 Family	$20,000 Individual, $40,000 Family

Great American — Premier 80% Std Rx

A comparison of the Premier 80% Std Rx 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	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 80% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$500 Individual, $1,000 Family	(Includes deductible)$500 Individual, $1,000 Family

Great American — Premier 80% BuyUp Rx

A comparison of the Premier 80% BuyUp Rx 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	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 80% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$500 Individual, $1,000 Family	(Includes deductible)$500 Individual, $1,000 Family

Great American — Premier 80% Std Rx

A comparison of the Premier 80% Std Rx 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	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 80% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$1,000 Individual, $2,000 Family	(Includes deductible)$1,000 Individual, $2,000 Family

Great American — Premier 80% BuyUp Rx

A comparison of the Premier 80% BuyUp Rx 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	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 80% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$500 Individual, $1,000 Family	(Includes deductible)$500 Individual, $1,000 Family

Great American — Premier 80% Std Rx

A comparison of the Premier 80% Std Rx 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	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 80% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$1,500 Individual, $3,000 Family	(Includes deductible)$1,500 Individual, $3,000 Family

Great American — Premier 80% BuyUp Rx

A comparison of the Premier 80% BuyUp Rx 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	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 80% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$500 Individual, $1,000 Family	(Includes deductible)$500 Individual, $1,000 Family

Great American — Premier 100% Std Rx

A comparison of the Premier 100% Std Rx 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	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$3,500 Individual, $7,000 Family	(Includes deductible)$3,500 Individual, $7,000 Family

Great American — Premier 100% BuyUp Rx

A comparison of the Premier 100% BuyUp Rx 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	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$2,500 Individual, $5,000 Family	(Includes deductible)$2,500 Individual, $5,000 Family

Great American — Premier 80% Std Rx

A comparison of the Premier 80% Std Rx 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	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 80% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$2,500 Individual, $5,000 Family	(Includes deductible)$2,500 Individual, $5,000 Family

Great American — Premier 80% BuyUp Rx

A comparison of the Premier 80% BuyUp Rx 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	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 80% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$500 Individual, $1,000 Family	(Includes deductible)$500 Individual, $1,000 Family

Great American — Premier 100% Std Rx

A comparison of the Premier 100% Std Rx 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	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$3,500 Individual, $7,000 Family	(Includes deductible)$3,500 Individual, $7,000 Family

Great American — Premier 100% BuyUp Rx

A comparison of the Premier 100% BuyUp Rx 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	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$2,500 Individual, $5,000 Family	(Includes deductible)$2,500 Individual, $5,000 Family

Great American — Premier 100% Std Rx

A comparison of the Premier 100% Std Rx 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	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$3,500 Individual, $7,000 Family	(Includes deductible)$3,500 Individual, $7,000 Family

Great American — Premier 100% BuyUp Rx

A comparison of the Premier 100% BuyUp Rx 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	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$2,500 Individual, $5,000 Family	(Includes deductible)$2,500 Individual, $5,000 Family

Great American — Premier 100% Std Rx

A comparison of the Premier 100% Std Rx 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	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$3,500 Individual, $7,000 Family	(Includes deductible)$3,500 Individual, $7,000 Family

Great American — Premier 100% BuyUp Rx

A comparison of the Premier 100% BuyUp Rx 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	60% after deductible
Office Visit	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist Other Services- 100% after deductible	60% after deductible
Copay	Primary Care Physician/Specialist, Deductible waived- $30 PCP/$40 Specialist	60% after deductible
Deductible	(Includes deductible)$2,500 Individual, $5,000 Family	(Includes deductible)$2,500 Individual, $5,000 Family

Great American — Lumenos Health Savings Account Plan 3

A comparison of the Lumenos Health Savings Account Plan 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	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	N/A	N/A
Deductible	see brochure	see brochure

Great American — Lumenos Health Savings Account Plan 3

A comparison of the Lumenos Health Savings Account Plan 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	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	N/A	N/A
Deductible	see brochure	see brochure

Great American — Lumenos Health Savings Account Plan 5

A comparison of the Lumenos Health Savings Account Plan 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	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	N/A	N/A
Deductible	$3,500 Individual, $7,000 Family	$3,500 Individual, $7,000 Family

Great American — Lumenos Health Savings Account Plan 3

A comparison of the Lumenos Health Savings Account Plan 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	100% after deductible	60% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	N/A	N/A
Deductible	see brochure	see brochure

Great American — SmartSense Premier Rx

A comparison of the SmartSense Premier Rx 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	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Copay	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Deductible	$1,500 Individual, $3,000 Family	$1,500 Individual, $3,000 Family

Great American — SmartSense Generic Rx

A comparison of the SmartSense Generic Rx 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	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Copay	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Deductible	$2,500 Individual, $5,000 Family	$2,500 Individual, $5,000 Family

Great American — SmartSense Premier Rx

A comparison of the SmartSense Premier Rx 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	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Copay	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Deductible	$1,500 Individual, $3,000 Family	$1,500 Individual, $3,000 Family

Great American — SmartSense Generic Rx

A comparison of the SmartSense Generic Rx 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	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Copay	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Deductible	$2,500 Individual, $5,000 Family	$2,500 Individual, $5,000 Family

Great American — SmartSense Premier Rx

A comparison of the SmartSense Premier Rx 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	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Copay	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Deductible	$1,500 Individual, $3,000 Family	$1,500 Individual, $3,000 Family

Great American — SmartSense Generic Rx

A comparison of the SmartSense Generic Rx 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	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Copay	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Deductible	$2,500 Individual, $5,000 Family	$2,500 Individual, $5,000 Family

Great American — SmartSense Premier Rx

A comparison of the SmartSense Premier Rx 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	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Copay	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Deductible	$1,500 Individual, $3,000 Family	$1,500 Individual, $3,000 Family

Great American — SmartSense Generic Rx

A comparison of the SmartSense Generic Rx 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	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Copay	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Deductible	$2,500 Individual, $5,000 Family	$2,500 Individual, $5,000 Family

Great American — SmartSense Premier Rx

A comparison of the SmartSense Premier Rx 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	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Copay	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Deductible	$1,500 Individual, $3,000 Family	$1,500 Individual, $3,000 Family

Great American — SmartSense Generic Rx

A comparison of the SmartSense Generic Rx 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	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Copay	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Deductible	$2,500 Individual, $5,000 Family	$2,500 Individual, $5,000 Family

Great American — SmartSense Premier Rx

A comparison of the SmartSense Premier Rx 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	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Copay	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Deductible	$1,500 Individual, $3,000 Family	$1,500 Individual, $3,000 Family

Great American — SmartSense Generic Rx

A comparison of the SmartSense Generic Rx 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	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Copay	$35 for the first 3 visits per person per calendar year for Primary Care physician/Specialist (deductible waived); then 70% after deductible for 4+ office visit	50% after deductible
Deductible	$2,500 Individual, $5,000 Family	$2,500 Individual, $5,000 Family

Great American — Blue Short Term

A comparison of the Blue Short Term 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%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$250 Individual, $500 Family	$250 Individual, $500 Family

Great American — Blue Short Term

A comparison of the Blue Short Term 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%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$500 Individual, $1,000 Family	$500 Individual, $1,000 Family

Great American — Blue Short Term

A comparison of the Blue Short Term 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%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$1,000 Individual, $2,000 Family	$1,000 Individual, $2,000 Family

Great American — Blue Short Term

A comparison of the Blue Short Term 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%	80%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	$2,500 Individual, $5,000 Family	$2,500 Individual, $5,000 Family

Great American — Copay Saver

A comparison of the Copay Saver 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%	70%
Office Visit	Office Visit - History and Exam: $35 copay - no deductible, 2 visits per person per calendar year, including wellness office visits (2 Additional Visits plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible, 2 visits per person per calendar year, including wellness office visits (2 Additional Visits plan enhancement available)
Copay	see brochure	see brochure
Deductible	$1,500 (maximum 2 per family, per calendar year)	$1,500 (maximum 2 per family, per calendar year)

Great American — Copay Saver

A comparison of the Copay Saver 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%	70%
Office Visit	Office Visit - History and Exam: $35 copay - no deductible, 2 visits per person per calendar year, including wellness office visits (2 Additional Visits plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible, 2 visits per person per calendar year, including wellness office visits (2 Additional Visits plan enhancement available)
Copay	see brochure	see brochure
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Great American — Copay Saver

A comparison of the Copay Saver 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%	70%
Office Visit	Office Visit - History and Exam: $35 copay - no deductible, 2 visits per person per calendar year, including wellness office visits (2 Additional Visits plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible, 2 visits per person per calendar year, including wellness office visits (2 Additional Visits plan enhancement available)
Copay	see brochure	see brochure
Deductible	$5,000 (maximum 2 per family, per calendar year)	$5,000 (maximum 2 per family, per calendar year)

Great American — Copay Saver

A comparison of the Copay Saver 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%	70%
Office Visit	Office Visit - History and Exam: $35 copay - no deductible, 2 visits per person per calendar year, including wellness office visits (2 Additional Visits plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible, 2 visits per person per calendar year, including wellness office visits (2 Additional Visits plan enhancement available)
Copay	see brochure	see brochure
Deductible	$7,500 (maximum 2 per family, per calendar year)	$7,500 (maximum 2 per family, per calendar year)

Great American — Copay Saver

A comparison of the Copay Saver 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%	70%
Office Visit	Office Visit - History and Exam: $35 copay - no deductible, 2 visits per person per calendar year, including wellness office visits (2 Additional Visits plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible, 2 visits per person per calendar year, including wellness office visits (2 Additional Visits plan enhancement available)
Copay	see brochure	see brochure
Deductible	$10,000 (maximum 2 per family, per calendar year)	$10,000 (maximum 2 per family, per calendar year)

Great American — Single HSA 100

A comparison of the Single HSA 100 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	Office Visit - History and Exam: No charge after deductible	Office Visit - History and Exam: No charge after deductible
Copay	see brochure	see brochure
Deductible	$1,250 (one per family, per calendar year)	$1,250 (one per family, per calendar year)

Great American — Single HSA 100

A comparison of the Single HSA 100 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	Office Visit - History and Exam: No charge after deductible	Office Visit - History and Exam: No charge after deductible
Copay	see brochure	see brochure
Deductible	$2,500 (one per family, per calendar year)	$2,500 (one per family, per calendar year)

Great American — Single HSA 100

A comparison of the Single HSA 100 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	Office Visit - History and Exam: No charge after deductible	Office Visit - History and Exam: No charge after deductible
Copay	see brochure	see brochure
Deductible	$3,000 (one per family, per calendar year)	$3,000 (one per family, per calendar year)

Great American — Single HSA 100

A comparison of the Single HSA 100 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	Office Visit - History and Exam: No charge after deductible	Office Visit - History and Exam: No charge after deductible
Copay	see brochure	see brochure
Deductible	$3,500 (one per family, per calendar year)	$3,500 (one per family, per calendar year)

Great American — Single HSA 100

A comparison of the Single HSA 100 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	Office Visit - History and Exam: No charge after deductible	Office Visit - History and Exam: No charge after deductible
Copay	see brochure	see brochure
Deductible	$5,000 (one per family, per calendar year)	$5,000 (one per family, per calendar year)

Great American — Single HSA 70

A comparison of the Single HSA 70 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%	70%
Office Visit	Office Visit - History and Exam: You pay: 30% after deductible	Office Visit - History and Exam: You pay: 30% after deductible
Copay	see brochure	see brochure
Deductible	$1,250 (one per family, per calendar year)	$1,250 (one per family, per calendar year)

Great American — Single HSA 70

A comparison of the Single HSA 70 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%	70%
Office Visit	Office Visit - History and Exam: You pay: 30% after deductible	Office Visit - History and Exam: You pay: 30% after deductible
Copay	see brochure	see brochure
Deductible	$2,500 (one per family, per calendar year)	$2,500 (one per family, per calendar year)

Great American — Single HSA 70

A comparison of the Single HSA 70 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%	70%
Office Visit	Office Visit - History and Exam: You pay: 30% after deductible	Office Visit - History and Exam: You pay: 30% after deductible
Copay	see brochure	see brochure
Deductible	$3,000 (one per family, per calendar year)	$3,000 (one per family, per calendar year)

Great American — Single HSA 70

A comparison of the Single HSA 70 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%	70%
Office Visit	Office Visit - History and Exam: You pay: 30% after deductible	Office Visit - History and Exam: You pay: 30% after deductible
Copay	see brochure	see brochure
Deductible	$3,500 (one per family, per calendar year)	$3,500 (one per family, per calendar year)

Great American — Single HSA 70

A comparison of the Single HSA 70 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%	70%
Office Visit	Office Visit - History and Exam: You pay: 30% after deductible	Office Visit - History and Exam: You pay: 30% after deductible
Copay	see brochure	see brochure
Deductible	$5,000 (one per family, per calendar year)	$5,000 (one per family, per calendar year)

Great American — Plan 100

A comparison of the Plan 100 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	Office Visit - History and Exam: No charge after deductible	Office Visit - History and Exam: No charge after deductible
Copay	N/A	N/A
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Great American — Plan 100

A comparison of the Plan 100 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	Office Visit - History and Exam: No charge after deductible	Office Visit - History and Exam: No charge after deductible
Copay	N/A	N/A
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Great American — Plan 100

A comparison of the Plan 100 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	Office Visit - History and Exam: No charge after deductible	Office Visit - History and Exam: No charge after deductible
Copay	N/A	N/A
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Great American — Plan 100

A comparison of the Plan 100 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	Office Visit - History and Exam: No charge after deductible	Office Visit - History and Exam: No charge after deductible
Copay	N/A	N/A
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Great American — Plan 100

A comparison of the Plan 100 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	Office Visit - History and Exam: No charge after deductible	Office Visit - History and Exam: No charge after deductible
Copay	N/A	N/A
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Great American — Plan 80

A comparison of the Plan 80 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%	80%
Office Visit	Doctor Office Visit - Illness and Injury: 80%	Doctor Office Visit - Illness and Injury: 80%
Copay	N/A	N/A
Deductible	$3,500 (maximum 2 per family, per calendar year)	$3,500 (maximum 2 per family, per calendar year)

Great American — Plan 80

A comparison of the Plan 80 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%	80%
Office Visit	Doctor Office Visit - Illness and Injury: 80%	Doctor Office Visit - Illness and Injury: 80%
Copay	N/A	N/A
Deductible	$3,500 (maximum 2 per family, per calendar year)	$3,500 (maximum 2 per family, per calendar year)

Great American — Plan 80

A comparison of the Plan 80 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%	80%
Office Visit	Doctor Office Visit - Illness and Injury: 80%	Doctor Office Visit - Illness and Injury: 80%
Copay	N/A	N/A
Deductible	$3,500 (maximum 2 per family, per calendar year)	$3,500 (maximum 2 per family, per calendar year)

Great American — Plan 80

A comparison of the Plan 80 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%	80%
Office Visit	Doctor Office Visit - Illness and Injury: 80%	Doctor Office Visit - Illness and Injury: 80%
Copay	N/A	N/A
Deductible	$3,500 (maximum 2 per family, per calendar year)	$3,500 (maximum 2 per family, per calendar year)

Great American — Plan 80

A comparison of the Plan 80 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%	80%
Office Visit	Doctor Office Visit - Illness and Injury: 80%	Doctor Office Visit - Illness and Injury: 80%
Copay	N/A	N/A
Deductible	$3,500 (maximum 2 per family, per calendar year)	$3,500 (maximum 2 per family, per calendar year)

Great American — Saver 80

A comparison of the Saver 80 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%	80%
Office Visit	Office Visit - History and Exam: Not covered	Office Visit - History and Exam: Not covered
Copay	N/A	N/A
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Saver 80

A comparison of the Saver 80 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%	80%
Office Visit	Office Visit - History and Exam: Not covered	Office Visit - History and Exam: Not covered
Copay	N/A	N/A
Deductible	$1,000 (maximum 2 per family, per calendar year)	$1,000 (maximum 2 per family, per calendar year)

Great American — Saver 80

A comparison of the Saver 80 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%	80%
Office Visit	Office Visit - History and Exam: Not covered	Office Visit - History and Exam: Not covered
Copay	N/A	N/A
Deductible	$1,500 (maximum 2 per family, per calendar year)	$1,500 (maximum 2 per family, per calendar year)

Great American — Saver 80

A comparison of the Saver 80 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%	80%
Office Visit	Office Visit - History and Exam: Not covered	Office Visit - History and Exam: Not covered
Copay	N/A	N/A
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Great American — Saver 80

A comparison of the Saver 80 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%	80%
Office Visit	Office Visit - History and Exam: Not covered	Office Visit - History and Exam: Not covered
Copay	N/A	N/A
Deductible	$5,000 (maximum 2 per family, per calendar year)	$5,000 (maximum 2 per family, per calendar year)

Great American — Saver 80

A comparison of the Saver 80 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%	80%
Office Visit	Office Visit - History and Exam: Not covered	Office Visit - History and Exam: Not covered
Copay	N/A	N/A
Deductible	$7,500 (maximum 2 per family, per calendar year)	$7,500 (maximum 2 per family, per calendar year)

Great American — Saver 80

A comparison of the Saver 80 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%	80%
Office Visit	Office Visit - History and Exam: Not covered	Office Visit - History and Exam: Not covered
Copay	N/A	N/A
Deductible	$10,000 (maximum 2 per family, per calendar year)	$10,000 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — Copay Select

A comparison of the Copay Select 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	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)	Office Visit - History and Exam: $35 copay - no deductible ($25 Copay plan enhancement available)
Copay	see brochure	see brochure
Deductible	$500 (maximum 2 per family, per calendar year)	$500 (maximum 2 per family, per calendar year)

Great American — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $500, Family: $1,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $500, Family: $1,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $500, Family: $1,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $500, Family: $1,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $500, Family: $1,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $500, Family: $1,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan 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	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $500, Family: $1,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — Celtic Basic - Prescription Drug Card Option

A comparison of the Celtic Basic - Prescription Drug Card Option offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80/20 Coverage after deductible of the next $10,000	60/40 Coverage after deductible of the next $10,000
Office Visit	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	Subject to annual deductible and coinsurance.
Copay	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	N/A
Deductible	Individual: $5,000, Family: $10,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — Celtic Basic - Prescription Drug Card Option

A comparison of the Celtic Basic - Prescription Drug Card Option offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80/20 Coverage after deductible of the next $10,000	60/40 Coverage after deductible of the next $10,000
Office Visit	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	Subject to annual deductible and coinsurance.
Copay	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	N/A
Deductible	Individual: $5,000, Family: $10,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — Celtic Basic - Prescription Drug Card Option

A comparison of the Celtic Basic - Prescription Drug Card Option offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80/20 Coverage after deductible of the next $10,000	60/40 Coverage after deductible of the next $10,000
Office Visit	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	Subject to annual deductible and coinsurance.
Copay	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	N/A
Deductible	Individual: $5,000, Family: $10,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — Celtic Basic

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80/20 Coverage after deductible of the next $10,000	60/40 Coverage after deductible of the next $10,000
Office Visit	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	Subject to annual deductible and coinsurance.
Copay	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	N/A
Deductible	Individual: $2,500, Family: Up to 3 times the individual deductible	Out of Network Deductible is $1500 + Annual Deductible

Great American — Celtic Basic

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80/20 Coverage after deductible of the next $10,000	60/40 Coverage after deductible of the next $10,000
Office Visit	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	Subject to annual deductible and coinsurance.
Copay	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	N/A
Deductible	Individual: $2,500, Family: Up to 3 times the individual deductible	Out of Network Deductible is $1500 + Annual Deductible

Great American — Celtic Basic

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80/20 Coverage after deductible of the next $10,000	60/40 Coverage after deductible of the next $10,000
Office Visit	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	Subject to annual deductible and coinsurance.
Copay	$30 copay for the first 2 visits per person, per year. After 2 visits, subject to annual deductible and coinsurance.	N/A
Deductible	Individual: $2,500, Family: Up to 3 times the individual deductible	Out of Network Deductible is $1500 + Annual Deductible

Great American — CelticSaver HSA PPO Health Plan

A comparison of the CelticSaver HSA PPO Health Plan 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	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	$5,000	$5,000

Great American — CelticSaver HSA PPO Health Plan

A comparison of the CelticSaver HSA PPO Health Plan 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	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	$2,600	$2,600

Great American — CelticSaver HSA PPO Health Plan

A comparison of the CelticSaver HSA PPO Health Plan 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	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	$1,500	$1,500

Great American — CelticSaver HSA PPO Health Plan

A comparison of the CelticSaver HSA PPO Health Plan 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	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	$2,600	$2,600

Great American — CelticSaver HSA PPO Health Plan

A comparison of the CelticSaver HSA PPO Health Plan 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	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	$1,500	$1,500

Great American — CelticSaver HSA Indemnity Health Plan

A comparison of the CelticSaver HSA Indemnity Health Plan 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	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	Individual: $2,600, Family: $5,150	Out of Network Deductible is $1500 + Annual Deductible

Great American — CelticSaver HSA Indemnity Health Plan

A comparison of the CelticSaver HSA Indemnity Health Plan 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	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	Individual: $2,600, Family: $5,150	Out of Network Deductible is $1500 + Annual Deductible

Great American — CelticSaver HSA Indemnity Health Plan

A comparison of the CelticSaver HSA Indemnity Health Plan 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	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	Individual: $2,600, Family: $5,150	Out of Network Deductible is $1500 + Annual Deductible

Great American — CelticSaver HSA Indemnity Health Plan

A comparison of the CelticSaver HSA Indemnity Health Plan 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	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	Individual: $2,600, Family: $5,150	Out of Network Deductible is $1500 + Annual Deductible

Great American — CelticSaver HSA Indemnity Health Plan

A comparison of the CelticSaver HSA Indemnity Health Plan 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	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	Individual: $2,600, Family: $5,150	Out of Network Deductible is $1500 + Annual Deductible

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $1,500	Individual:$1,500, Family: $3,000 $1,500

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $1,500	Individual:$1,500, Family: $3,000 $1,500

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $2,000	Individual:$1,500, Family: $3,000 $2,000

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $2,000	Individual:$1,500, Family: $3,000 $2,000

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $2,500	Individual:$1,500, Family: $3,000 $2,500

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $2,500	Individual:$1,500, Family: $3,000 $2,500

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $5,000	Individual:$1,500, Family: $3,000 $5,000

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $5,000	Individual:$1,500, Family: $3,000 $5,000

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $1,500	Individual:$1,500, Family: $3,000 $1,500

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $1,500	Individual:$1,500, Family: $3,000 $1,500

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $2,000	Individual:$1,500, Family: $3,000 $2,000

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $2,000	Individual:$1,500, Family: $3,000 $2,000

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $2,500	Individual:$1,500, Family: $3,000 $2,500

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $2,500	Individual:$1,500, Family: $3,000 $2,500

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $1,500	Individual:$1,500, Family: $3,000 $1,500

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $1,500	Individual:$1,500, Family: $3,000 $1,500

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $2,000	Individual:$1,500, Family: $3,000 $2,000

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $2,000	Individual:$1,500, Family: $3,000 $2,000

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $2,500	Individual:$1,500, Family: $3,000 $2,500

Great American — Generations HSA

A comparison of the Generations HSA 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual:$1,500, Family: $3,000 $2,500	Individual:$1,500, Family: $3,000 $2,500

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $750	Individual: $25,000, Family: $75,000 $750

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $750	Individual: $25,000, Family: $75,000 $750

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $1,500	Individual: $25,000, Family: $75,000 $1,500

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $1,500	Individual: $25,000, Family: $75,000 $1,500

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $2,000	Individual: $25,000, Family: $75,000 $2,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $2,000	Individual: $25,000, Family: $75,000 $2,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $2,500	Individual: $25,000, Family: $75,000 $2,500

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $2,500	Individual: $25,000, Family: $75,000 $2,500

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $5,000	Individual: $25,000, Family: $75,000 $5,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $5,000	Individual: $25,000, Family: $75,000 $5,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $10,000	Individual: $25,000, Family: $75,000 $10,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $10,000	Individual: $25,000, Family: $75,000 $10,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $15,000	Individual: $25,000, Family: $75,000 $15,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $15,000	Individual: $25,000, Family: $75,000 $15,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $20,000	Individual: $25,000, Family: $75,000 $20,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $20,000	Individual: $25,000, Family: $75,000 $20,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $25,000	Individual: $25,000, Family: $75,000 $25,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $25,000	Individual: $25,000, Family: $75,000 $25,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $750	Individual: $25,000, Family: $75,000 $750

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $750	Individual: $25,000, Family: $75,000 $750

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $1,500	Individual: $25,000, Family: $75,000 $1,500

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $1,500	Individual: $25,000, Family: $75,000 $1,500

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $2,000	Individual: $25,000, Family: $75,000 $2,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $2,000	Individual: $25,000, Family: $75,000 $2,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $2,500	Individual: $25,000, Family: $75,000 $2,500

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $2,500	Individual: $25,000, Family: $75,000 $2,500

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $5,000	Individual: $25,000, Family: $75,000 $5,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $5,000	Individual: $25,000, Family: $75,000 $5,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $10,000	Individual: $25,000, Family: $75,000 $10,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $10,000	Individual: $25,000, Family: $75,000 $10,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $15,000	Individual: $25,000, Family: $75,000 $15,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $15,000	Individual: $25,000, Family: $75,000 $15,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $20,000	Individual: $25,000, Family: $75,000 $20,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $20,000	Individual: $25,000, Family: $75,000 $20,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $25,000	Individual: $25,000, Family: $75,000 $25,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $25,000	Individual: $25,000, Family: $75,000 $25,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $750	Individual: $25,000, Family: $75,000 $750

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $750	Individual: $25,000, Family: $75,000 $750

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $1,500	Individual: $25,000, Family: $75,000 $1,500

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $1,500	Individual: $25,000, Family: $75,000 $1,500

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $2,000	Individual: $25,000, Family: $75,000 $2,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $2,000	Individual: $25,000, Family: $75,000 $2,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $2,500	Individual: $25,000, Family: $75,000 $2,500

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $2,500	Individual: $25,000, Family: $75,000 $2,500

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $5,000	Individual: $25,000, Family: $75,000 $5,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $5,000	Individual: $25,000, Family: $75,000 $5,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $10,000	Individual: $25,000, Family: $75,000 $10,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $10,000	Individual: $25,000, Family: $75,000 $10,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $15,000	Individual: $25,000, Family: $75,000 $15,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $15,000	Individual: $25,000, Family: $75,000 $15,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $20,000	Individual: $25,000, Family: $75,000 $20,000

Great American — Generations One

A comparison of the Generations One 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	Deductible then coinsurance	Deductible then coinsurance
Copay	N/A	N/A
Deductible	Individual: $25,000, Family: $75,000 $20,000	Individual: $25,000, Family: $75,000 $20,000