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Great American Health Insurance in NEW MEXICO – 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 — BlueDirect A

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	90% after deductible	70% after deductible
Office Visit	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 90% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 90% after deductible Allergy Injections, Tests, Serum: Plan pays 90% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 70% Office Surgery (including casts, splints, and dressings): Plan pays 70% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 70% Allergy Injections, Tests, Serum: Plan pays 70%
Copay	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 90% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 90% after deductible Allergy Injections, Tests, Serum: Plan pays 90% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 70% Office Surgery (including casts, splints, and dressings): Plan pays 70% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 70% Allergy Injections, Tests, Serum: Plan pays 70%
Deductible	Individual: $250, Family: $750	Individual: $500, Family: $1,500

Great American — BlueDirect A

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	90% after deductible	70% after deductible
Office Visit	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 90% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 90% after deductible Allergy Injections, Tests, Serum: Plan pays 90% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 70% Office Surgery (including casts, splints, and dressings): Plan pays 70% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 70% Allergy Injections, Tests, Serum: Plan pays 70%
Copay	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 90% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 90% after deductible Allergy Injections, Tests, Serum: Plan pays 90% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 70% Office Surgery (including casts, splints, and dressings): Plan pays 70% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 70% Allergy Injections, Tests, Serum: Plan pays 70%
Deductible	Individual: $250, Family: $750	Individual: $500, Family: $1,500

Great American — BlueDirect A

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	90% after deductible	70% after deductible
Office Visit	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 90% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 90% after deductible Allergy Injections, Tests, Serum: Plan pays 90% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 70% Office Surgery (including casts, splints, and dressings): Plan pays 70% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 70% Allergy Injections, Tests, Serum: Plan pays 70%
Copay	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 90% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 90% after deductible Allergy Injections, Tests, Serum: Plan pays 90% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 70% Office Surgery (including casts, splints, and dressings): Plan pays 70% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 70% Allergy Injections, Tests, Serum: Plan pays 70%
Deductible	Individual: $250, Family: $750	Individual: $500, Family: $1,500

Great American — BlueDirect A

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	90% after deductible	70% after deductible
Office Visit	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 90% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 90% after deductible Allergy Injections, Tests, Serum: Plan pays 90% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 70% Office Surgery (including casts, splints, and dressings): Plan pays 70% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 70% Allergy Injections, Tests, Serum: Plan pays 70%
Copay	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 90% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 90% after deductible Allergy Injections, Tests, Serum: Plan pays 90% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 70% Office Surgery (including casts, splints, and dressings): Plan pays 70% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 70% Allergy Injections, Tests, Serum: Plan pays 70%
Deductible	Individual: $250, Family: $750	Individual: $500, Family: $1,500

Great American — BlueDirect B

A comparison of the BlueDirect B 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	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 80% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 80% after deductible Allergy Injections, Tests, Serum: Plan pays 80% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 60% Office Surgery (including casts, splints, and dressings): Plan pays 60% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 60% Allergy Injections, Tests, Serum: Plan pays 60%
Copay	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 80% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 80% after deductible Allergy Injections, Tests, Serum: Plan pays 80% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 60% Office Surgery (including casts, splints, and dressings): Plan pays 60% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 60% Allergy Injections, Tests, Serum: Plan pays 60%
Deductible	Individual: $250, Family: $750	Individual: $500, Family: $1,500

Great American — BlueDirect B

A comparison of the BlueDirect B 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	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 80% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 80% after deductible Allergy Injections, Tests, Serum: Plan pays 80% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 60% Office Surgery (including casts, splints, and dressings): Plan pays 60% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 60% Allergy Injections, Tests, Serum: Plan pays 60%
Copay	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 80% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 80% after deductible Allergy Injections, Tests, Serum: Plan pays 80% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 60% Office Surgery (including casts, splints, and dressings): Plan pays 60% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 60% Allergy Injections, Tests, Serum: Plan pays 60%
Deductible	Individual: $250, Family: $750	Individual: $500, Family: $1,500

Great American — BlueDirect B

A comparison of the BlueDirect B 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	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 80% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 80% after deductible Allergy Injections, Tests, Serum: Plan pays 80% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 60% Office Surgery (including casts, splints, and dressings): Plan pays 60% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 60% Allergy Injections, Tests, Serum: Plan pays 60%
Copay	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 80% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 80% after deductible Allergy Injections, Tests, Serum: Plan pays 80% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 60% Office Surgery (including casts, splints, and dressings): Plan pays 60% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 60% Allergy Injections, Tests, Serum: Plan pays 60%
Deductible	Individual: $250, Family: $750	Individual: $500, Family: $1,500

Great American — BlueDirect B

A comparison of the BlueDirect B 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	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 80% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 80% after deductible Allergy Injections, Tests, Serum: Plan pays 80% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 60% Office Surgery (including casts, splints, and dressings): Plan pays 60% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 60% Allergy Injections, Tests, Serum: Plan pays 60%
Copay	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 80% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 80% after deductible Allergy Injections, Tests, Serum: Plan pays 80% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 60% Office Surgery (including casts, splints, and dressings): Plan pays 60% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 60% Allergy Injections, Tests, Serum: Plan pays 60%
Deductible	Individual: $250, Family: $750	Individual: $500, Family: $1,500

Great American — BlueDirect B

A comparison of the BlueDirect B 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	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 80% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 80% after deductible Allergy Injections, Tests, Serum: Plan pays 80% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 60% Office Surgery (including casts, splints, and dressings): Plan pays 60% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 60% Allergy Injections, Tests, Serum: Plan pays 60%
Copay	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): $20 copay/visit (deductible waived) Office Surgery (including casts, splints, and dressings): Plan pays 80% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 80% after deductible Allergy Injections, Tests, Serum: Plan pays 80% after deductible	Office Visits (nonroutine; All other services received during the office visit are subject to deductible and coinsurance as listed below): Plan pays 60% Office Surgery (including casts, splints, and dressings): Plan pays 60% Lab Tests, X-Rays, EKGs, Other Diagnostic Tests: Plan pays 60% Allergy Injections, Tests, Serum: Plan pays 60%
Deductible	Individual: $250, Family: $750	Individual: $500, Family: $1,500

Great American — BlueDirect C

A comparison of the BlueDirect C 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	Primary Provider Office Visits (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): $40 copay Specialty Physician Office Services (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): $55 copay	Primary Provider Office Visits (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): Plan pays 50% Specialty Physician Office Services (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): Plan pays 50%
Copay	Primary Provider Office Visits (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): $40 copay Specialty Physician Office Services (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): $55 copay	Primary Provider Office Visits (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): Plan pays 50% Specialty Physician Office Services (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): Plan pays 50%
Deductible	Individual: $5,000, Family: $15,000	Individual: $10,000, Family: $30,000

Great American — BlueDirect C

A comparison of the BlueDirect C 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	Primary Provider Office Visits (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): $40 copay Specialty Physician Office Services (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): $55 copay	Primary Provider Office Visits (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): Plan pays 50% Specialty Physician Office Services (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): Plan pays 50%
Copay	Primary Provider Office Visits (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): $40 copay Specialty Physician Office Services (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): $55 copay	Primary Provider Office Visits (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): Plan pays 50% Specialty Physician Office Services (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): Plan pays 50%
Deductible	Individual: $5,000, Family: $15,000	Individual: $10,000, Family: $30,000

Great American — BlueDirect C

A comparison of the BlueDirect C 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	Primary Provider Office Visits (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): $40 copay Specialty Physician Office Services (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): $55 copay	Primary Provider Office Visits (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): Plan pays 50% Specialty Physician Office Services (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): Plan pays 50%
Copay	Primary Provider Office Visits (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): $40 copay Specialty Physician Office Services (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): $55 copay	Primary Provider Office Visits (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): Plan pays 50% Specialty Physician Office Services (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): Plan pays 50%
Deductible	Individual: $5,000, Family: $15,000	Individual: $10,000, Family: $30,000

Great American — BlueDirect C

A comparison of the BlueDirect C 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	Primary Provider Office Visits (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): $40 copay Specialty Physician Office Services (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): $55 copay	Primary Provider Office Visits (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): Plan pays 50% Specialty Physician Office Services (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): Plan pays 50%
Copay	Primary Provider Office Visits (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): $40 copay Specialty Physician Office Services (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): $55 copay	Primary Provider Office Visits (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): Plan pays 50% Specialty Physician Office Services (includes exam, medication management, and preventive/wellness visits; office surgery, including casts, splints, and dressings): Plan pays 50%
Deductible	Individual: $5,000, Family: $15,000	Individual: $10,000, Family: $30,000

Great American — BlueEdge Individual HSA

A comparison of the BlueEdge Individual 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	80%	60%
Office Visit	Office Services (nonroutine): Office Visit: Plan pays 80% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 80% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 80% after deductible Allergy Injections, Tests, Serum: Plan pays 80% after deductible	Office Services (nonroutine): Office Visit: Plan pays 60% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 60% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 60% after deductible Allergy Injections, Tests, Serum: Plan pays 60% after deductible
Copay	Office Services (nonroutine): Office Visit: Plan pays 80% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 80% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 80% after deductible Allergy Injections, Tests, Serum: Plan pays 80% after deductible	Office Services (nonroutine): Office Visit: Plan pays 60% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 60% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 60% after deductible Allergy Injections, Tests, Serum: Plan pays 60% after deductible
Deductible	Premier - Individual: $1,200, Family: $2,400	Premier - Individual: $1,200, Family: $2,400

Great American — BlueEdge Individual HSA

A comparison of the BlueEdge Individual 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	80%	60%
Office Visit	Office Services (nonroutine): Office Visit: Plan pays 80% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 80% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 80% after deductible Allergy Injections, Tests, Serum: Plan pays 80% after deductible	Office Services (nonroutine): Office Visit: Plan pays 60% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 60% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 60% after deductible Allergy Injections, Tests, Serum: Plan pays 60% after deductible
Copay	Office Services (nonroutine): Office Visit: Plan pays 80% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 80% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 80% after deductible Allergy Injections, Tests, Serum: Plan pays 80% after deductible	Office Services (nonroutine): Office Visit: Plan pays 60% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 60% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 60% after deductible Allergy Injections, Tests, Serum: Plan pays 60% after deductible
Deductible	Enhanced - Individual: $1,700, Family: $3,450	Enhanced - Individual: $1,700, Family: $3,450

Great American — BlueEdge Individual HSA

A comparison of the BlueEdge Individual 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	80%	60%
Office Visit	Office Services (nonroutine): Office Visit: Plan pays 80% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 80% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 80% after deductible Allergy Injections, Tests, Serum: Plan pays 80% after deductible	Office Services (nonroutine): Office Visit: Plan pays 60% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 60% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 60% after deductible Allergy Injections, Tests, Serum: Plan pays 60% after deductible
Copay	Office Services (nonroutine): Office Visit: Plan pays 80% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 80% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 80% after deductible Allergy Injections, Tests, Serum: Plan pays 80% after deductible	Office Services (nonroutine): Office Visit: Plan pays 60% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 60% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 60% after deductible Allergy Injections, Tests, Serum: Plan pays 60% after deductible
Deductible	Basic - Individual: $2,600, Family: $5,150	Basic - Individual: $2,600, Family: $5,150

Great American — BlueEdge 100

A comparison of the BlueEdge 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%	80%
Office Visit	Office Services (nonroutine): Office Visit/Exam: Plan pays 100% after deductible Office Surgery (including casts, splints, and dressings), Lab Tests, X-rays, EKGs, Other Diagnostic Tests, Allergy Injections, Tests, Serum: Plan pays 100% after deductible	Office Services (nonroutine): Office Visit/Exam: Plan pays 80% Office Surgery (including casts, splints, and dressings), Lab Tests, X-rays, EKGs, Other Diagnostic Tests, Allergy Injections, Tests, Serum: Plan pays 80%
Copay	Office Services (nonroutine): Office Visit/Exam: Plan pays 100% after deductible Office Surgery (including casts, splints, and dressings), Lab Tests, X-rays, EKGs, Other Diagnostic Tests, Allergy Injections, Tests, Serum: Plan pays 100% after deductible	Office Services (nonroutine): Office Visit/Exam: Plan pays 80% Office Surgery (including casts, splints, and dressings), Lab Tests, X-rays, EKGs, Other Diagnostic Tests, Allergy Injections, Tests, Serum: Plan pays 80%
Deductible	Individual: $3,500, Family: $7,000	Individual: $5,000, Family: $10,000

Great American — BlueEdge 100

A comparison of the BlueEdge 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%	80%
Office Visit	Office Services (nonroutine): Office Visit/Exam: Plan pays 100% after deductible Office Surgery (including casts, splints, and dressings), Lab Tests, X-rays, EKGs, Other Diagnostic Tests, Allergy Injections, Tests, Serum: Plan pays 100% after deductible	Office Services (nonroutine): Office Visit/Exam: Plan pays 80% Office Surgery (including casts, splints, and dressings), Lab Tests, X-rays, EKGs, Other Diagnostic Tests, Allergy Injections, Tests, Serum: Plan pays 80%
Copay	Office Services (nonroutine): Office Visit/Exam: Plan pays 100% after deductible Office Surgery (including casts, splints, and dressings), Lab Tests, X-rays, EKGs, Other Diagnostic Tests, Allergy Injections, Tests, Serum: Plan pays 100% after deductible	Office Services (nonroutine): Office Visit/Exam: Plan pays 80% Office Surgery (including casts, splints, and dressings), Lab Tests, X-rays, EKGs, Other Diagnostic Tests, Allergy Injections, Tests, Serum: Plan pays 80%
Deductible	Individual: $5,000, Family: $10,000	Individual: $7,500, Family: $15,000

Great American — BlueTransitions

A comparison of the BlueTransitions 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	70% after deductible
Office Visit	Office Services: Office Visit (excludes routine physicals and other preventive care): Plan pays 70% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 70% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 70% after deductible	Office Services: Office Visit (excludes routine physicals and other preventive care): Plan pays 70% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 70% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 70% after deductible
Copay	Office Services: Office Visit (excludes routine physicals and other preventive care): Plan pays 70% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 70% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 70% after deductible	Office Services: Office Visit (excludes routine physicals and other preventive care): Plan pays 70% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 70% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 70% after deductible
Deductible	$500 per member/per benefit period	$500 per member/per benefit period

Great American — BlueTransitions

A comparison of the BlueTransitions 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	70% after deductible
Office Visit	Office Services: Office Visit (excludes routine physicals and other preventive care): Plan pays 70% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 70% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 70% after deductible	Office Services: Office Visit (excludes routine physicals and other preventive care): Plan pays 70% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 70% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 70% after deductible
Copay	Office Services: Office Visit (excludes routine physicals and other preventive care): Plan pays 70% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 70% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 70% after deductible	Office Services: Office Visit (excludes routine physicals and other preventive care): Plan pays 70% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 70% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 70% after deductible
Deductible	$1,000 per member/per benefit period	$1,000 per member/per benefit period

Great American — BlueTransitions

A comparison of the BlueTransitions 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	70% after deductible
Office Visit	Office Services: Office Visit (excludes routine physicals and other preventive care): Plan pays 70% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 70% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 70% after deductible	Office Services: Office Visit (excludes routine physicals and other preventive care): Plan pays 70% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 70% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 70% after deductible
Copay	Office Services: Office Visit (excludes routine physicals and other preventive care): Plan pays 70% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 70% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 70% after deductible	Office Services: Office Visit (excludes routine physicals and other preventive care): Plan pays 70% after deductible Office Surgery (including casts, splints, and dressings): Plan pays 70% after deductible Lab Tests, X-Rays, EKGs, Other Diagnostic Services: Plan pays 70% after deductible
Deductible	$2,000 per member/per benefit period	$2,000 per member/per benefit period

Great American — Short Term Medical

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$1,000	$1,000

Great American — Short Term Medical

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$1,000	$1,000

Great American — Short Term Medical

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$1,000	$1,000

Great American — Short Term Medical

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$1,000	$1,000

Great American — Short Term Medical

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$1,000	$1,000

Great American — Short Term Medical

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$1,000	$1,000

Great American — Short Term Medical

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$1,000	$1,000

Great American — Short Term Medical

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$1,000	$1,000

Great American — Short Term Medical

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$1,000	$1,000

Great American — Short Term Medical

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$1,000	$1,000

Great American — Short Term Medical

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illness and injury, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$1,000	$1,000

Great American — HealthSaver Limited-Benefit

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$2,500	$2,500

Great American — HealthSaver Limited-Benefit

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$2,500	$2,500

Great American — HealthSaver Limited-Benefit

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$2,500	$2,500

Great American — HealthSaver Limited-Benefit

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$2,500	$2,500

Great American — HealthSaver Limited-Benefit

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$2,500	$2,500

Great American — HealthSaver Limited-Benefit

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$2,500	$2,500

Great American — HealthSaver Limited-Benefit

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$2,500	$2,500

Great American — HealthSaver Limited-Benefit

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.	Covered for unexpected illnesses and accidents, subject to deductible and coinsurance. 24/7 Teladoc services are included as well. See brochure for more details.
Copay	N/A	N/A
Deductible	$2,500	$2,500

Great American — 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 — Plan 80

A comparison of the Plan 80 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Doctor Office Visit - Illness and Injury: 80%	Doctor Office Visit - Illness and Injury: 80%
Copay	N/A	N/A
Deductible	$3,500 (maximum 2 per family, per calendar year)	$3,500 (maximum 2 per family, per calendar year)

Great American — Plan 80

A comparison of the Plan 80 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Doctor Office Visit - Illness and Injury: 80%	Doctor Office Visit - Illness and Injury: 80%
Copay	N/A	N/A
Deductible	$3,500 (maximum 2 per family, per calendar year)	$3,500 (maximum 2 per family, per calendar year)

Great American — Plan 80

A comparison of the Plan 80 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Doctor Office Visit - Illness and Injury: 80%	Doctor Office Visit - Illness and Injury: 80%
Copay	N/A	N/A
Deductible	$3,500 (maximum 2 per family, per calendar year)	$3,500 (maximum 2 per family, per calendar year)

Great American — Plan 80

A comparison of the Plan 80 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Doctor Office Visit - Illness and Injury: 80%	Doctor Office Visit - Illness and Injury: 80%
Copay	N/A	N/A
Deductible	$3,500 (maximum 2 per family, per calendar year)	$3,500 (maximum 2 per family, per calendar year)

Great American — Plan 80

A comparison of the Plan 80 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	80%	80%
Office Visit	Doctor Office Visit - Illness and Injury: 80%	Doctor Office Visit - Illness and Injury: 80%
Copay	N/A	N/A
Deductible	$3,500 (maximum 2 per family, per calendar year)	$3,500 (maximum 2 per family, per calendar year)

Great American — 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 — 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: 100% after deductible	Doctor Office Visit: 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: 100% after deductible	Doctor Office Visit: 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: 100% after deductible	Doctor Office Visit: 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: 100% after deductible	Doctor Office Visit: 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: 100% after deductible	Doctor Office Visit: 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: 100% after deductible	Doctor Office Visit: 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: 100% after deductible	Doctor Office Visit: 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: 100% after deductible	Doctor Office Visit: 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: 100% after deductible	Doctor Office Visit: 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 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: 100% after deductible	Doctor Office Visit: 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 — 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	$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	$1,000 (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	$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	$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	$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 — 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 - History and Exam: $35 copay, then 100% after deductible (maximum 2 visits per person, per year)	Doctor Office Visit - History and Exam: $35 copay, then 100% after deductible (maximum 2 visits per person, per year)
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 — 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 — 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 — Plan 100

A comparison of the Plan 100 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	Office Visit - History and Exam: No charge after deductible	Office Visit - History and Exam: No charge after deductible
Copay	N/A	N/A
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Great American — Plan 100

A comparison of the Plan 100 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	Office Visit - History and Exam: No charge after deductible	Office Visit - History and Exam: No charge after deductible
Copay	N/A	N/A
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Great American — Plan 100

A comparison of the Plan 100 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	Office Visit - History and Exam: No charge after deductible	Office Visit - History and Exam: No charge after deductible
Copay	N/A	N/A
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Great American — Plan 100

A comparison of the Plan 100 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	Office Visit - History and Exam: No charge after deductible	Office Visit - History and Exam: No charge after deductible
Copay	N/A	N/A
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Great American — Plan 100

A comparison of the Plan 100 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	100%	100%
Office Visit	Office Visit - History and Exam: No charge after deductible	Office Visit - History and Exam: No charge after deductible
Copay	N/A	N/A
Deductible	$2,500 (maximum 2 per family, per calendar year)	$2,500 (maximum 2 per family, per calendar year)

Great American — Plan 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 — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Select PPO Plan

A comparison of the CeltiCare Preferred Select PPO Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred "Any Doc" PPO Plan

A comparison of the CeltiCare Preferred "Any Doc" PPO Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $1,000, Family: $2,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $500, Family: $1,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $500, Family: $1,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $500, Family: $1,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $500, Family: $1,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $500, Family: $1,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $500, Family: $1,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — CeltiCare Preferred Managed Indemnity Plan

A comparison of the CeltiCare Preferred Managed Indemnity Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Copay	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins	Select: $15 copay Any Doc: $35 copay 2 visits per person, per calendar year; 3+ visits subject to ded./coins
Deductible	Individual: $500, Family: $1,000	Out of Network Deductible is $1500 + Annual Deductible

Great American — Celtic Basic - Prescription Drug Card Option

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

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

Great American — Celtic Basic - Prescription Drug Card Option

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

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

Great American — Celtic Basic - Prescription Drug Card Option

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

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

Great American — Celtic Basic

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

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

Great American — Celtic Basic

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

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

Great American — Celtic Basic

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

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

Great American — CelticSaver HSA PPO Health Plan

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	$5,000	$5,000

Great American — CelticSaver HSA PPO Health Plan

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	$2,600	$2,600

Great American — CelticSaver HSA PPO Health Plan

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	$1,500	$1,500

Great American — CelticSaver HSA PPO Health Plan

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	$2,600	$2,600

Great American — CelticSaver HSA PPO Health Plan

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	$1,500	$1,500

Great American — CelticSaver HSA Indemnity Health Plan

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	Individual: $2,600, Family: $5,150	Out of Network Deductible is $1500 + Annual Deductible

Great American — CelticSaver HSA Indemnity Health Plan

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	Individual: $2,600, Family: $5,150	Out of Network Deductible is $1500 + Annual Deductible

Great American — CelticSaver HSA Indemnity Health Plan

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	Individual: $2,600, Family: $5,150	Out of Network Deductible is $1500 + Annual Deductible

Great American — CelticSaver HSA Indemnity Health Plan

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	Individual: $2,600, Family: $5,150	Out of Network Deductible is $1500 + Annual Deductible

Great American — CelticSaver HSA Indemnity Health Plan

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

	Network	Non-Network
Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to Deductible and Coinsurance	Subject to Deductible and Coinsurance
Copay	N/A	N/A
Deductible	Individual: $2,600, Family: $5,150	Out of Network Deductible is $1500 + Annual Deductible