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Great American Health Insurance in KENTUCKY – 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 — PPO Value 7500

A comparison of the PPO Value 7500 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 Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Visit 1-2 $30 copay, deductible waived; Visit 3+ 70% after deductible (Unlimited visits); Specialist Visit: Visit 1-2 $30 copay, deductible waived; Visit 3+ 70% after deductible (Unlimited visits, Specialist and Non-Specialist share visit max.)	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): Visit 1-2 $30 copay, deductible waived; Visit 3+ 70% after deductible (Unlimited visits); Specialist Visit: Visit 1-2 $30 copay, deductible waived; Visit 3+ 70% after deductible (Unlimited visits, Specialist and Non-Specialist share visit max.)	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: $7,500, Family $15,000	Individual: $10,000, Family: $20,000

Great American — PPO 2500

A comparison of the PPO 2500 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: $30 copay deductible waived (unlimited visits), Specialist Visit: $40 copay deductible waived (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 deductible waived (unlimited visits), Specialist Visit: $40 copay deductible waived (unlimited visits).	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits).
Deductible	Individual: $2,500, Family: $5,000	Individual: $5,000, Family: $10,000

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 — PPO High Deductible 3000 (HSA Compatible)

A comparison of the PPO High Deductible 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	100% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.	70% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	see brochure	see brochure
Copay	Not Covered	Not Covered
Deductible	Individual: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

Great American — PPO High Deductible 5000 (HSA Compatible)

A comparison of the PPO High Deductible 5000 (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	100% 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): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (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): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (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 — 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 — PPO Value 7500 with Dental

A comparison of the PPO Value 7500 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 Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Visit 1-2 $30 copay, deductible waived; Visit 3+ 70% after deductible (Unlimited visits); Specialist Visit: Visit 1-2 $30 copay, deductible waived; Visit 3+ 70% after deductible (Unlimited visits, Specialist and Non-Specialist share visit max.)	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): Visit 1-2 $30 copay, deductible waived; Visit 3+ 70% after deductible (Unlimited visits); Specialist Visit: Visit 1-2 $30 copay, deductible waived; Visit 3+ 70% after deductible (Unlimited visits, Specialist and Non-Specialist share visit max.)	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: $7,500, Family $15,000	Individual: $10,000, Family: $20,000

Great American — PPO 2500 with Dental

A comparison of the PPO 2500 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: $30 copay deductible waived (unlimited visits), Specialist Visit: $40 copay deductible waived (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 deductible waived (unlimited visits), Specialist Visit: $40 copay deductible waived (unlimited visits).	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits).
Deductible	Individual: $2,500, Family: $5,000	Individual: $5,000, Family: $10,000

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 — PPO High Deductible 3000 (HSA Compatible) with Dental

A comparison of the PPO High Deductible 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	100% 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): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (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): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (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: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

Great American — PPO High Deductible 5000 (HSA Compatible) with Dental

A comparison of the PPO High Deductible 5000 (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	100% 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): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 70% after deductible (Unlimited visits); Specialist Visit: 70% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 70% after deductible (Unlimited visits); Specialist Visit: 70% after deductible (Unlimited visits)
Deductible	Individual: $5,000, Family: $10,000	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 — 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 — 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 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 — 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	Not covered	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	Not covered	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	Not covered	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	Not covered	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	Not covered	Not covered
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	Not covered	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 — 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	80%	80%
Office Visit	Doctor Office Visit - Illness & Injury: History and Exam: $35 copay, then 100% (not subject to deductible, maximum 2 visits per person, per year - with an option to buy 2 more)	Doctor Office Visit - Illness & Injury: History and Exam: $35 copay, then 100% (not subject to deductible, maximum 2 visits per person, per year - with an option to buy 2 more)
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	80%	80%
Office Visit	Doctor Office Visit - Illness & Injury: History and Exam: $35 copay, then 100% (not subject to deductible, maximum 2 visits per person, per year - with an option to buy 2 more)	Doctor Office Visit - Illness & Injury: History and Exam: $35 copay, then 100% (not subject to deductible, maximum 2 visits per person, per year - with an option to buy 2 more)
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 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 — 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% after deductible	100% after deductible
Office Visit	Doctor Office Visit - Illness & Injury: 100% after deductible	Doctor Office Visit - Illness & Injury: 100% after deductible
Copay	see brochure	see brochure
Deductible	$1,150 (one per family, per calendar year)	$1,150 (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% after deductible	100% after deductible
Office Visit	Doctor Office Visit - Illness & Injury: 100% after deductible	Doctor Office Visit - Illness & Injury: 100% after deductible
Copay	see brochure	see brochure
Deductible	$1,900 (one per family, per calendar year)	$1,900 (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% after deductible	100% after deductible
Office Visit	Doctor Office Visit - Illness & Injury: 100% after deductible	Doctor Office Visit - Illness & Injury: 100% after deductible
Copay	see brochure	see brochure
Deductible	$2,900 (one per family, per calendar year)	$2,900 (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% after deductible	100% after deductible
Office Visit	Doctor Office Visit - Illness & Injury: 100% after deductible	Doctor Office Visit - Illness & Injury: 100% 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% after deductible	100% after deductible
Office Visit	Doctor Office Visit - Illness & Injury: 100% after deductible	Doctor Office Visit - Illness & Injury: 100% 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 Saver

A comparison of the Single HSA 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	100% after deductible	100% after deductible
Office Visit	Doctor Office Visit: Not covered	Doctor Office Visit: Not covered
Copay	N/A	N/A
Deductible	$5,000 (one per family, per calendar year)	$5,000 (one per family, per calendar year)

Great American — Single HSA Saver

A comparison of the Single HSA 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	100% after deductible	100% after deductible
Office Visit	Doctor Office Visit: Not covered	Doctor Office Visit: Not covered
Copay	N/A	N/A
Deductible	$5,000 (one per family, per calendar year)	$5,000 (one per family, per calendar year)

Great American — Single HSA Saver

A comparison of the Single HSA 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	100% after deductible	100% after deductible
Office Visit	Doctor Office Visit: Not covered	Doctor Office Visit: Not covered
Copay	N/A	N/A
Deductible	$5,000 (one per family, per calendar year)	$5,000 (one per family, per calendar year)

Great American — Single HSA Saver

A comparison of the Single HSA 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	100% after deductible	100% after deductible
Office Visit	Doctor Office Visit: Not covered	Doctor Office Visit: Not covered
Copay	N/A	N/A
Deductible	$5,000 (one per family, per calendar year)	$5,000 (one per family, per calendar year)

Great American — Single HSA Saver

A comparison of the Single HSA 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	100% after deductible	100% after deductible
Office Visit	Doctor Office Visit: Not covered	Doctor Office Visit: Not covered
Copay	N/A	N/A
Deductible	$5,000 (one per family, per calendar year)	$5,000 (one per family, per calendar year)

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	$2,000 Individual, $4,000 Family	$4,000 Individual, $8,000 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	$3,000 Individual, $6,000 Family	$6,000 Individual, $12,000 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	$5,000 Individual, $10,000 Family	$10,000 Individual, $20,000 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%	70%
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 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%	60%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
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%	70%
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 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%	60%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
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%	70%
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 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%	60%
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 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%	70%
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 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%	70%
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 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%	70%
Office Visit	Subject to deductible and coinsurance.	Subject to deductible and coinsurance.
Copay	N/A	N/A
Deductible	see brochure	see brochure

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)$250 Individual, $500 Family	(Includes deductible)$250 Individual, $500 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 copay for the first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visit visits once deductible is met	see brochure
Copay	$35 copay for first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visits once deductible is met	50% after deductible
Deductible	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 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 copay for the first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visit visits once deductible is met	see brochure
Copay	$35 copay for first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visits once deductible is met	50% after deductible
Deductible	$500 Individual, $1,000 Family	$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)$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 — 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 copay for the first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visit visits once deductible is met	see brochure
Copay	$35 copay for first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visits once deductible is met	50% after deductible
Deductible	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 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 copay for the first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visit visits once deductible is met	see brochure
Copay	$35 copay for first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visits once deductible is met	50% after deductible
Deductible	$1,000 Individual, $2,000 Family	$1,000 Individual, $2,000 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)$1,000 Individual, $2,000 Family	(Includes deductible)$1,000 Individual, $2,000 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 copay for the first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visit visits once deductible is met	see brochure
Copay	$35 copay for first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visits once deductible is met	50% after deductible
Deductible	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 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 copay for the first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visit visits once deductible is met	see brochure
Copay	$35 copay for first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visits once deductible is met	50% after deductible
Deductible	$1,500 Individual, $3,000 Family	$1,500 Individual, $3,000 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)$1,500 Individual, $3,000 Family	(Includes deductible)$1,500 Individual, $3,000 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 copay for the first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visit visits once deductible is met	see brochure
Copay	$35 copay for first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visits once deductible is met	50% after deductible
Deductible	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 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 copay for the first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visit visits once deductible is met	see brochure
Copay	$35 copay for first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visits once deductible is met	50% after deductible
Deductible	$2,500 Individual, $5,000 Family	$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	$2,500 Individual, $5,000 Family	$2,500 Individual, $5,000 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	$2,500 Individual, $5,000 Family	$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)$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)$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	$3,500 Individual, $7,000 Family	$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	$3,500 Individual, $7,000 Family	$3,500 Individual, $7,000 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 copay for the first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visit visits once deductible is met	see brochure
Copay	$35 copay for first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visits once deductible is met	50% after deductible
Deductible	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 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 copay for the first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visit visits once deductible is met	see brochure
Copay	$35 copay for first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visits once deductible is met	50% after deductible
Deductible	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 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	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 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	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 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 copay for the first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visit visits once deductible is met	see brochure
Copay	$35 copay for first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visits once deductible is met	50% after deductible
Deductible	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 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 copay for the first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visit visits once deductible is met	see brochure
Copay	$35 copay for first 3 visits per person per calendar year for primary care physician/specialist (deductible waived); then 70% for 4+ office visits once deductible is met	50% after deductible
Deductible	$10,000 Individual, $20,000 Family	$10,000 Individual, $20,000 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	$10,000 Individual, $20,000 Family	$10,000 Individual, $20,000 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	$10,000 Individual, $20,000 Family	$10,000 Individual, $20,000 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	$3,000 Individual, $6,000 Family	$3,000 Individual, $6,000 Family

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	$5,000 Individual, $10,000 Family	$5,000 Individual, $10,000 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	$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	$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	$250 Individual, $500 Family	$250 Individual, $500 Family

Great American — Autograph Total Plus Rx/HSA

A comparison of the Autograph Total Plus Rx/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	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$5,000	$10,000

Great American — Autograph Total Plus Rx/HSA and Dental

A comparison of the Autograph Total Plus Rx/HSA and 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	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$3,500	$7,000

Great American — Autograph Total Plus Rx/HSA

A comparison of the Autograph Total Plus Rx/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	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$5,000	$10,000

Great American — Autograph Total Plus Rx/HSA and Dental

A comparison of the Autograph Total Plus Rx/HSA and 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	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$3,500	$7,000

Great American — Autograph Total Plus Rx/HSA

A comparison of the Autograph Total Plus Rx/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	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$5,000	$10,000

Great American — Autograph Total Plus Rx/HSA and Dental

A comparison of the Autograph Total Plus Rx/HSA and 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	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$3,500	$7,000

Great American — Autograph Total Plus Rx/HSA

A comparison of the Autograph Total Plus Rx/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	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$5,000	$10,000

Great American — Autograph Total Plus Rx/HSA and Dental

A comparison of the Autograph Total Plus Rx/HSA and 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	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$3,500	$7,000

Great American — Autograph Total/HSA

A comparison of the Autograph Total/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	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$4,000(one per family)	$8,000(one per family)

Great American — Autograph Total/HSA with Dental

A comparison of the Autograph Total/HSA 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	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$5,200	$10,400

Great American — Autograph Total/HSA

A comparison of the Autograph Total/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	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$4,000(one per family)	$8,000(one per family)

Great American — Autograph Total/HSA with Dental

A comparison of the Autograph Total/HSA 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	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$5,200	$10,400

Great American — Autograph Total/HSA

A comparison of the Autograph Total/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	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$4,000(one per family)	$8,000(one per family)

Great American — Autograph Total/HSA with Dental

A comparison of the Autograph Total/HSA 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	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$5,200	$10,400

Great American — Autograph Total/HSA

A comparison of the Autograph Total/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	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$4,000(one per family)	$8,000(one per family)

Great American — Autograph Total/HSA with Dental

A comparison of the Autograph Total/HSA 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	100%	70%
Office Visit	100% after deductible	70% after deductible
Copay	N/A	N/A
Deductible	$5,200	$10,400

Great American — Monogram

A comparison of the Monogram 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%	75%
Office Visit	100% after deductible	75% after deductible
Copay	N/A	N/A
Deductible	$7,500 (Two family members must meet their individual deductibles)	$15,000 (Two family members must meet their individual deductibles)

Great American — Monogram with Dental

A comparison of the Monogram 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	100%	75%
Office Visit	100% after deductible	75% after deductible
Copay	N/A	N/A
Deductible	$7,500 (Two family members must meet their individual deductibles)	$15,000 (Two family members must meet their individual deductibles)

Great American — Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible)

A comparison of the Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	60% after deductible
Copay	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	N/A
Deductible	$1,000 (Two members must meet their deductible).	$2,000 (Two members must meet their deductible).

Great American — Portrait Share 80 Plus Rx Unlimited

A comparison of the Portrait Share 80 Plus Rx Unlimited offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	60% after deductible
Copay	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	N/A
Deductible	$2,500 (Two members must meet their deductible).	$5,000 (Two members must meet their deductible).

Great American — Portrait Share 80 Plus Rx Unlimited and Dental

A comparison of the Portrait Share 80 Plus Rx Unlimited and 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%	60%
Office Visit	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	60% after deductible
Copay	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	N/A
Deductible	$2,500 (Two members must meet their deductible).	$5,000 (Two members must meet their deductible).

Great American — Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) with Dental

A comparison of the Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) 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%	60%
Office Visit	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	60% after deductible
Copay	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	N/A
Deductible	$2,500 (Two members must meet their deductible).	$5,000 (Two members must meet their deductible).

Great American — Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible)

A comparison of the Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	60% after deductible
Copay	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	N/A
Deductible	$1,000 (Two members must meet their deductible).	$2,000 (Two members must meet their deductible).

Great American — Portrait Share 80 Plus Rx Unlimited

A comparison of the Portrait Share 80 Plus Rx Unlimited offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	60%
Office Visit	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	60% after deductible
Copay	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	N/A
Deductible	$2,500 (Two members must meet their deductible).	$5,000 (Two members must meet their deductible).

Great American — Portrait Share 80 Plus Rx Unlimited and Dental

A comparison of the Portrait Share 80 Plus Rx Unlimited and 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%	60%
Office Visit	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	60% after deductible
Copay	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	N/A
Deductible	$2,500 (Two members must meet their deductible).	$5,000 (Two members must meet their deductible).

Great American — Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) with Dental

A comparison of the Portrait Share 80 Plus Rx Unlimited (with $0 Rx Deductible) 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%	60%
Office Visit	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	60% after deductible
Copay	Primary Care (unlimited visits): $35 copayment. Specialty Care (unlimited visits): $50 copayment.	N/A
Deductible	$2,500 (Two members must meet their deductible).	$5,000 (Two members must meet their deductible).

Great American — Autograph Share 80 Plus Rx

A comparison of the Autograph Share 80 Plus 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%	60%
Office Visit	Office visits (including allergy injections): 100% after office visit copayment up to 6 combined primary care and specialty care visits, then 80% after deductible Diagnostic lab and X-ray, Allergy testing: First $200 per calendar year 100%, then 80% after deductible Allergy serum, Inpatient and outpatient services, Surgery: 80% after deductible	Office visits (including allergy injections): 60% after deductible Diagnostic lab and X-ray, Allergy testing: 60% after deductible Allergy serum, Inpatient and outpatient services, Surgery: 60% after deductible
Copay	Primary Care: $35 copay (limited to 6 combined primary and specialty care visits) Specialty Care: $50 copay (limited to 6 combined primary and specialty care visits)	N/A
Deductible	Individual: $6,000, Family: $12,000	Individual: $12,000, Family: $24,000

Great American — Autograph Share 80 Plus Rx (with $500 Deductible Rx)

A comparison of the Autograph Share 80 Plus Rx (with $500 Deductible 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%	60%
Office Visit	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	60% after deductible
Copay	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	N/A
Deductible	$6,000 (Two family members must meet their individual deductibles)	$12,000 (Two family members must meet their individual deductibles)

Great American — Autograph Share 80 Plus Rx with Dental

A comparison of the Autograph Share 80 Plus Rx 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%	60%
Office Visit	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	60% after deductible
Copay	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	N/A
Deductible	$5,000	$10,000

Great American — Autograph Share 80 Plus Rx

A comparison of the Autograph Share 80 Plus 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%	60%
Office Visit	Office visits (including allergy injections): 100% after office visit copayment up to 6 combined primary care and specialty care visits, then 80% after deductible Diagnostic lab and X-ray, Allergy testing: First $200 per calendar year 100%, then 80% after deductible Allergy serum, Inpatient and outpatient services, Surgery: 80% after deductible	Office visits (including allergy injections): 60% after deductible Diagnostic lab and X-ray, Allergy testing: 60% after deductible Allergy serum, Inpatient and outpatient services, Surgery: 60% after deductible
Copay	Primary Care: $35 copay (limited to 6 combined primary and specialty care visits) Specialty Care: $50 copay (limited to 6 combined primary and specialty care visits)	N/A
Deductible	Individual: $6,000, Family: $12,000	Individual: $12,000, Family: $24,000

Great American — Autograph Share 80 Plus Rx (with $500 Deductible Rx)

A comparison of the Autograph Share 80 Plus Rx (with $500 Deductible 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%	60%
Office Visit	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	60% after deductible
Copay	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	N/A
Deductible	$6,000 (Two family members must meet their individual deductibles)	$12,000 (Two family members must meet their individual deductibles)

Great American — Autograph Share 80 Plus Rx with Dental

A comparison of the Autograph Share 80 Plus Rx 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%	60%
Office Visit	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	60% after deductible
Copay	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	N/A
Deductible	$5,000	$10,000

Great American — Autograph Share 80 Plus Rx

A comparison of the Autograph Share 80 Plus 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%	60%
Office Visit	Office visits (including allergy injections): 100% after office visit copayment up to 6 combined primary care and specialty care visits, then 80% after deductible Diagnostic lab and X-ray, Allergy testing: First $200 per calendar year 100%, then 80% after deductible Allergy serum, Inpatient and outpatient services, Surgery: 80% after deductible	Office visits (including allergy injections): 60% after deductible Diagnostic lab and X-ray, Allergy testing: 60% after deductible Allergy serum, Inpatient and outpatient services, Surgery: 60% after deductible
Copay	Primary Care: $35 copay (limited to 6 combined primary and specialty care visits) Specialty Care: $50 copay (limited to 6 combined primary and specialty care visits)	N/A
Deductible	Individual: $6,000, Family: $12,000	Individual: $12,000, Family: $24,000

Great American — Autograph Share 80 Plus Rx (with $500 Deductible Rx)

A comparison of the Autograph Share 80 Plus Rx (with $500 Deductible 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%	60%
Office Visit	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	60% after deductible
Copay	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	N/A
Deductible	$6,000 (Two family members must meet their individual deductibles)	$12,000 (Two family members must meet their individual deductibles)

Great American — Autograph Share 80 Plus Rx with Dental

A comparison of the Autograph Share 80 Plus Rx 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%	60%
Office Visit	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	60% after deductible
Copay	Primary Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $35 copayment for 6 visits, then 80% after deductible. Specialty Care (limited to 6 combined (Primary and Specialty Care) visits/calendar year)(includes allergy injections)- $50 copayment for 6 visits, then 80% after deductible.	N/A
Deductible	$5,000	$10,000

Great American — *HumanaOne PPO Short Term 80/60 (Single Pay)

A comparison of the *HumanaOne PPO Short Term 80/60 (Single Pay) 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	80% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $2,500, Family: $5,000	Individual: $2,500, Family: $5,000

Great American — *HumanaOne PPO Short Term 80/60 (Single Pay)

A comparison of the *HumanaOne PPO Short Term 80/60 (Single Pay) 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	80% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $2,500, Family: $5,000	Individual: $2,500, Family: $5,000

Great American — *HumanaOne PPO Short Term 80/60 (Single Pay)

A comparison of the *HumanaOne PPO Short Term 80/60 (Single Pay) 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	80% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $2,500, Family: $5,000	Individual: $2,500, Family: $5,000

Great American — *HumanaOne PPO Short Term 80/60 (Single Pay)

A comparison of the *HumanaOne PPO Short Term 80/60 (Single Pay) 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	80% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $2,500, Family: $5,000	Individual: $2,500, Family: $5,000

Great American — *HumanaOne PPO Short Term 80/60 (Single Pay)

A comparison of the *HumanaOne PPO Short Term 80/60 (Single Pay) 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	80% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $2,500, Family: $5,000	Individual: $2,500, Family: $5,000

Great American — *HumanaOne PPO Short Term 80/60 (Single Pay)

A comparison of the *HumanaOne PPO Short Term 80/60 (Single Pay) 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	80% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $2,500, Family: $5,000	Individual: $2,500, Family: $5,000

Great American — *HumanaOne PPO Short Term 80/60 (Single Pay)

A comparison of the *HumanaOne PPO Short Term 80/60 (Single Pay) 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	80% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $2,500, Family: $5,000	Individual: $2,500, Family: $5,000

Great American — *HumanaOne PPO Short Term 100/75 (Single Pay)

A comparison of the *HumanaOne PPO Short Term 100/75 (Single Pay) 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	100% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $1,000, Family: $2,000	Individual: $1,000, Family: $2,000

Great American — *HumanaOne PPO Short Term 100/75 (Single Pay)

A comparison of the *HumanaOne PPO Short Term 100/75 (Single Pay) 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	100% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $1,000, Family: $2,000	Individual: $1,000, Family: $2,000

Great American — *HumanaOne PPO Short Term 100/75 (Single Pay)

A comparison of the *HumanaOne PPO Short Term 100/75 (Single Pay) 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	100% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $1,000, Family: $2,000	Individual: $1,000, Family: $2,000

Great American — *HumanaOne PPO Short Term 100/75 (Single Pay)

A comparison of the *HumanaOne PPO Short Term 100/75 (Single Pay) 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	100% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $1,000, Family: $2,000	Individual: $1,000, Family: $2,000

Great American — *HumanaOne PPO Short Term 100/75 (Single Pay)

A comparison of the *HumanaOne PPO Short Term 100/75 (Single Pay) 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	100% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $1,000, Family: $2,000	Individual: $1,000, Family: $2,000

Great American — *HumanaOne PPO Short Term 100/75 (Single Pay)

A comparison of the *HumanaOne PPO Short Term 100/75 (Single Pay) 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	100% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $1,000, Family: $2,000	Individual: $1,000, Family: $2,000

Great American — HumanaOne PPO Short Term 80/60 (up to 6 Months)

A comparison of the HumanaOne PPO Short Term 80/60 (up to 6 Months) 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	80% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $500, Family: $1,000	Individual: $500, Family: $1,000

Great American — HumanaOne PPO Short Term 80/60 (up to 6 Months)

A comparison of the HumanaOne PPO Short Term 80/60 (up to 6 Months) 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	80% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $500, Family: $1,000	Individual: $500, Family: $1,000

Great American — HumanaOne PPO Short Term 80/60 (up to 6 Months)

A comparison of the HumanaOne PPO Short Term 80/60 (up to 6 Months) 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	80% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $500, Family: $1,000	Individual: $500, Family: $1,000

Great American — HumanaOne PPO Short Term 80/60 (up to 6 Months)

A comparison of the HumanaOne PPO Short Term 80/60 (up to 6 Months) 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	80% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $500, Family: $1,000	Individual: $500, Family: $1,000

Great American — HumanaOne PPO Short Term 80/60 (up to 12 Months)

A comparison of the HumanaOne PPO Short Term 80/60 (up to 12 Months) 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	80% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $5,000, Family: $10,000	Individual: $5,000, Family: $10,000

Great American — HumanaOne PPO Short Term 80/60 (up to 12 Months)

A comparison of the HumanaOne PPO Short Term 80/60 (up to 12 Months) 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	80% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $5,000, Family: $10,000	Individual: $5,000, Family: $10,000

Great American — HumanaOne PPO Short Term 80/60 (up to 12 Months)

A comparison of the HumanaOne PPO Short Term 80/60 (up to 12 Months) 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	80% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 80% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $5,000, Family: $10,000	Individual: $5,000, Family: $10,000

Great American — HumanaOne PPO Short Term 100/75 (up to 6 Months)

A comparison of the HumanaOne PPO Short Term 100/75 (up to 6 Months) 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	100% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $2,500, Family: $5,000	Individual: $2,500, Family: $5,000

Great American — HumanaOne PPO Short Term 100/75 (up to 6 Months)

A comparison of the HumanaOne PPO Short Term 100/75 (up to 6 Months) 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	100% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $2,500, Family: $5,000	Individual: $2,500, Family: $5,000

Great American — HumanaOne PPO Short Term 100/75 (up to 6 Months)

A comparison of the HumanaOne PPO Short Term 100/75 (up to 6 Months) 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	100% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $2,500, Family: $5,000	Individual: $2,500, Family: $5,000

Great American — HumanaOne PPO Short Term 100/75 (up to 12 Months)

A comparison of the HumanaOne PPO Short Term 100/75 (up to 12 Months) 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	100% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $2,500, Family: $5,000	Individual: $2,500, Family: $5,000

Great American — HumanaOne PPO Short Term 100/75 (up to 12 Months)

A comparison of the HumanaOne PPO Short Term 100/75 (up to 12 Months) 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	100% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $2,500, Family: $5,000	Individual: $2,500, Family: $5,000

Great American — HumanaOne PPO Short Term 100/75 (up to 12 Months)

A comparison of the HumanaOne PPO Short Term 100/75 (up to 12 Months) 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	100% after deductible
Office Visit	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible	Primary Doctor (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible Specialist (Excludes coverage for visits related to behavioral health medication checks): 100% Coinsurance after deductible
Copay	N/A	N/A
Deductible	Individual: $2,500, Family: $5,000	Individual: $2,500, Family: $5,000