Great American Health Insurance in OHIO – 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 — First Dollar PPO 30

A comparison of the First Dollar PPO 30 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	70% up to out of pocket max. $0 once out of pocket max is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max is satisfied.
Office Visit	Non-Specialist Office Visit: $30 copay (unlimited visits), Specialist Visit: $40 copay (unlimited visits)	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits).
Copay	Non-Specialist Office Visit: $30 copay (unlimited visits), Specialist Visit: $40 copay (unlimited visits)	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits).
Deductible	Individual: $0, Family: $0	Individual: $5,000, Family: $10,000

Great American — First Dollar PPO 40

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

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	60% up to out of pocket max. $0 once out of pocket max. is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	Non-Specialist Office Visit: $40 Copay (unlimited visits), Specialist Visit: $50 Copay (unlimited visits)	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits)
Copay	Non-Specialist Office Visit: $40 Copay (unlimited visits), Specialist Visit: $50 Copay (unlimited visits)	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits)
Deductible	Individual: $0, Family: $0	Individual: $7,000, Family: $14,000

Great American — PPO 1500

A comparison of the PPO 1500 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $25 copay, deductible waived (Unlimited visits); Specialist Visit: $35 copay, deductible waived (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $25 copay, deductible waived (Unlimited visits); Specialist Visit: $35 copay, deductible waived (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Deductible	Individual: $1,500, Family: $3,000	Individual: $3,000, Family: $6,000

Great American — PPO 2500

A comparison of the PPO 2500 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $30 copay, deductible waived (Unlimited visits); Specialist Visit: $40 copay, deductible waived (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $30 copay, deductible waived (Unlimited visits); Specialist Visit: $40 copay, deductible waived (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Deductible	Individual: $2,500, Family: $5,000	Individual: $5,000, Family: $10,000

Great American — PPO 5000

A comparison of the PPO 5000 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	Non-Specialist Office Visit: $40 copay deductible waived (unlimited visits), Specialist Visit: $50 copay deductible waived (unlimited visits).	50% after deductible (unlimited visits)
Copay	Non-Specialist Office Visit: $40 copay deductible waived (unlimited visits), Specialist Visit: $50 copay deductible waived (unlimited visits).	50% after deductible (unlimited visits)
Deductible	Individual: $5,000, Family: $10,000	Individual: $10,000, Family: $20,000

Great American — PPO Value 5000

A comparison of the PPO Value 5000 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	65% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Visits 1-5 $50 copay, deductible waived; Visit 5+ member is responsible for 100% but Aetna discount applies; Aetna will pay 100% after out-of-pocket maximum is satisfied (Unlimited visits); Specialist Visit: Visits 1-5 $50 copay, deductible waived; Visit 5+ member is responsible for 100% but Aetna discount applies; Aetna will pay 100% after out-of-pocket maximum is satisfied (Unlimited visits, Specialist and Non-Specialist will share visit max.)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Visits 1-5 $50 copay plus 80% coinsurance, deductible applies; Visit 5+ member is responsible for 100% but Aetna discount applies; Aetna will pay 100% after out-of-pocket maximum is satisfied (Unlimited visits); Specialist Visit: Visits 1-5 $50 copay plus 80% coinsurance, deductible applies; Visit 5+ member is responsible for 100% but Aetna discount applies; Aetna will pay 100% after out-of-pocket maximum is satisfied (Unlimited visits, Specialist and Non-Specialist will share visit max.)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Visits 1-5 $50 copay, deductible waived; Visit 5+ member is responsible for 100% but Aetna discount applies; Aetna will pay 100% after out-of-pocket maximum is satisfied (Unlimited visits); Specialist Visit: Visits 1-5 $50 copay, deductible waived; Visit 5+ member is responsible for 100% but Aetna discount applies; Aetna will pay 100% after out-of-pocket maximum is satisfied (Unlimited visits, Specialist and Non-Specialist will share visit max.)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Visits 1-5 $50 copay plus 80% coinsurance, deductible applies; Visit 5+ member is responsible for 100% but Aetna discount applies; Aetna will pay 100% after out-of-pocket maximum is satisfied (Unlimited visits); Specialist Visit: Visits 1-5 $50 copay plus 80% coinsurance, deductible applies; Visit 5+ member is responsible for 100% but Aetna discount applies; Aetna will pay 100% after out-of-pocket maximum is satisfied (Unlimited visits, Specialist and Non-Specialist will share visit max.)
Deductible	Individual: $5,000, Family: $10,000	Individual: $10,000, Family: $20,000

Great American — PPO High Deductible 3000 (HSA Compatible)

A comparison of the PPO High Deductible 3000 (HSA Compatible) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (Includes Chiropractic Care Visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 70% after deductible (Unlimited visits); Specialist Visit: 70% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (Includes Chiropractic Care Visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 70% after deductible (Unlimited visits); Specialist Visit: 70% after deductible (Unlimited visits)
Deductible	Individual: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

Great American — PPO High Deductible 5000 (HSA Compatible)

A comparison of the PPO High Deductible 5000 (HSA Compatible) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Deductible	Individual: $5,000, Family: $10,000	Individual: $10,000, Family: $20,000

Great American — Preventive and Hospital Care 1250

A comparison of the Preventive and Hospital Care 1250 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered; Specialist Visit: Not covered	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered; Specialist Visit: Not covered
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered; Specialist Visit: Not covered	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered; Specialist Visit: Not covered
Deductible	Individual: $1,250, Family: $2,500	Individual: $2,500, Family: $5,000

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

A comparison of the Preventive and Hospital Care 3000 (HSA Compatible) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	Not covered	Not covered
Copay	Not covered	Not covered
Deductible	Individual: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

Great American — PPO Value 2500

A comparison of the PPO Value 2500 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible up to out-of-pocket max. $0 once out-of-pocket max. is satisfied	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	Non-Specialist Office Visits 1-5 $30 copay, deductible waived; Specialist Visits 1-5 $50 copay, deductible waived.	Non-Specialist and Specialist Office Visit: 50% after deductible (unlimited visits).
Copay	Non-Specialist Office Visits 1-5 $30 copay, deductible waived; Specialist Visits 1-5 $50 copay, deductible waived.	Non-Specialist and Specialist Office Visit: 50% after deductible (unlimited visits).
Deductible	Individual: $2,500, Family: $5,000	Individual: $5,000, Family: $10,000

Great American — PPO Value 10000

A comparison of the PPO Value 10000 offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

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

Great American — PPO 1500 with Medical $50K CYM

A comparison of the PPO 1500 with Medical $50K CYM 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. $0 once out of pocket max. is satisfied	50% after deductible. $0 once out of pocket max. is satisfied
Office Visit	Non-Specialist Office Visit: $25 Copay (Unlimited visits), Specialist Visit: $50 Copay (Unlimited visits)	Non-Specialist Office Visit: 50% after deductible (Unlimited visits), Specialist Visit: 50% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit: $25 Copay (Unlimited visits), Specialist Visit: $50 Copay (Unlimited visits)	Non-Specialist Office Visit: 50% after deductible (Unlimited visits), Specialist Visit: 50% after deductible (Unlimited visits)
Deductible	Individual: $1,500, Family: $3,000	Individual: $3,000, Family: $6,000

Great American — PPO 2500 with Medical $50K CYM

A comparison of the PPO 2500 with Medical $50K CYM 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 ($0 once out-of-pocket max. is satisfied)	50% after deductible ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $25 copay (Unlimited visits); Specialist Visit: $50 copay (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $25 copay (Unlimited visits); Specialist Visit: $50 copay (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Deductible	Individual: $2,500, Family: $5,000	Individual: $5,000, Family: $10,000

Great American — First Dollar PPO 30 with Dental

A comparison of the First Dollar PPO 30 with Dental offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	70% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $30 copay (Unlimited visits); Specialist Visit: $40 copay (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $30 copay (Unlimited visits); Specialist Visit: $40 copay (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Deductible	Individual: $0, Family: $0	Individual: $5,000, Family: $10,000

Great American — First Dollar PPO 40 with Dental

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

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	60% up to out of pocket max. $0 once out of pocket max. is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	Non-Specialist Office Visit: $40 Copay (unlimited visits), Specialist Visit: $50 Copay (unlimited visits)	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits)
Copay	Non-Specialist Office Visit: $40 Copay (unlimited visits), Specialist Visit: $50 Copay (unlimited visits)	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits)
Deductible	Individual: $0, Family: $0	Individual: $7,000, Family: $14,000

Great American — PPO 1500 with Dental

A comparison of the PPO 1500 with Dental offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out of pocket max. $0 once out of pocket max is satisfied.50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or internist): $25 copay; Specialist Visit: $35 copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or internist): 50% after deductible; Specialist Visit: 50% after deductible
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or internist): $25 copay; Specialist Visit: $35 copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or internist): 50% after deductible; Specialist Visit: 50% after deductible
Deductible	Individual: $1,500, Family: $3,000	Individual: $3,000, Family: $6,000

Great American — PPO 2500 with Dental

A comparison of the PPO 2500 with Dental offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible up to out of pocket max. $0 once out of pocket max is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max is satisfied.
Office Visit	Non-specialist Office Visit: $30 copay deductible waived (unlimited visits), Specialist Visit: $40 copay deductible waived (unlimited visits).	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits).
Copay	Non-specialist Office Visit: $30 copay deductible waived (unlimited visits), Specialist Visit: $40 copay deductible waived (unlimited visits).	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits).
Deductible	Individual: $2,500, Family: $5,000	Individual: $5,000, Family: $10,000

Great American — PPO 5000 with Dental

A comparison of the PPO 5000 with Dental offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $40 copay, deductible waived (Unlimited visits); Specialist Visit: $50 copay, deductible waived (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $40 copay, deductible waived (Unlimited visits); Specialist Visit: $50 copay, deductible waived (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Deductible	Individual: $5,000, Family: $10,000	Individual: $10,000, Family: $20,000

Great American — PPO Value 5000 with Dental

A comparison of the PPO Value 5000 with Dental offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	70% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	Non-Specialist and Specialist Office Visit: Visits 1-2 $30 copay, deductible waived; Visits 3+ 70% after deductible. Specialist and Non-Specialist share visit max (unlimited visits).	Non-Specialist and Specialist Office Visit: 50% after deductible (unlimited visits).
Copay	Non-Specialist and Specialist Office Visit: Visits 1-2 $30 copay, deductible waived; Visits 3+ 70% after deductible. Specialist and Non-Specialist share visit max (unlimited visits).	Non-Specialist and Specialist Office Visit: 50% after deductible (unlimited visits).
Deductible	Individual: $5,000, Family: $10,000	Individual: $10,000, Family: $20,000

Great American — PPO High Deductible 3000 (HSA Compatible) with Dental

A comparison of the PPO High Deductible 3000 (HSA Compatible) with Dental offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	70% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $0 copay after deductible (Unlimited visits); Specialist Visit: $0 copay after deductible (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 70% after deductible (Unlimited visits); Specialist Visit: 70% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $0 copay after deductible (Unlimited visits); Specialist Visit: $0 copay after deductible (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 70% after deductible (Unlimited visits); Specialist Visit: 70% after deductible (Unlimited visits)
Deductible	Individual: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

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

A comparison of the PPO High Deductible 5000 (HSA Compatible) with Dental offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 100% after deductible (Unlimited visits); Specialist Visit: 100% after deductible (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits)
Deductible	Individual: $5,000, Family: $10,000	Individual: $10,000, Family: $20,000

Great American — Preventive and Hospital Care 1250 with Dental

A comparison of the Preventive and Hospital Care 1250 with Dental offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.	50% after deductible up to out of pocket max. $0 once out of pocket max. is satisfied.
Office Visit	Not covered	Not covered
Copay	Not covered	Not covered
Deductible	Individual: $1,250, Family: $2,500	Individual: $2,500, Family: $5,000

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

A comparison of the Preventive and Hospital Care 3000 (HSA Compatible) with Dental offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible up to out-of-pocket max.	50% after deductible up to out-of-pocket max.
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered; Specialist Visit: Not covered	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered; Specialist Visit: Not covered
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered; Specialist Visit: Not covered	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Not covered; Specialist Visit: Not covered
Deductible	Individual: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

Great American — PPO Value 2500 with Dental

A comparison of the PPO Value 2500 with Dental offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	70% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)	50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Visits 1-2 $30 copay, deducible waived; Visit 3+ 70% after deductible. Spec. and non-spec share visit max (Unlimited visits); Specialist Visit: Visits 1-2 $30 copay, deducible waived; Visit 3+ 70% after deductible. Spec. and non-spec share visit max (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist: 50% after deductible (Unlimited visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): Visits 1-2 $30 copay, deducible waived; Visit 3+ 70% after deductible. Spec. and non-spec share visit max (Unlimited visits); Specialist Visit: Visits 1-2 $30 copay, deducible waived; Visit 3+ 70% after deductible. Spec. and non-spec share visit max (Unlimited visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist: 50% after deductible (Unlimited visits)
Deductible	Individual: $2,500, Family: $5,000	Individual: $5,000, Family: $10,000

Great American — PPO Value 10000 with Dental

A comparison of the PPO Value 10000 with Dental offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

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

Great American — PPO 1500 with Medical $50K CYM with Dental

A comparison of the PPO 1500 with Medical $50K CYM with Dental offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible ($0 once out-of-pocket max. is satisfied)	50% after deductible ($0 once out-of-pocket max. is satisfied)
Office Visit	Non-Specialist Office Visit: $25 Copay (Unlimited visits), Specialist Visit: $50 Copay (Unlimited visits) Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $25 copay (Unlimited Visits); Specialist Visit: $50 copay (Unlimited Visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited Visits); Specialist Visit: 50% after deductible (Unlimited Visits)
Copay	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $25 copay (Unlimited Visits); Specialist Visit: $50 copay (Unlimited Visits)	Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited Visits); Specialist Visit: 50% after deductible (Unlimited Visits)
Deductible	Individual: $1,500, Family: $3,000	Individual: $3,000, Family: $6,000

Great American — PPO 2500 with Medical $50K CYM with Dental

A comparison of the PPO 2500 with Medical $50K CYM with Dental offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible $0 once out-of-pocket max is satisfied.	50% after deductible $0 once out-of-pocket max is satisfied.
Office Visit	Non-Specialist Office Visit: $25 copay (Unlimited visits), Specialist Office Visit: $50 copay (Unlimited visits)	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist: 50% after deductible (unlimited visits)
Copay	Non-Specialist Office Visit: $25 copay (Unlimited visits), Specialist Office Visit: $50 copay (Unlimited visits)	Non-Specialist Office Visit: 50% after deductible (Unlimited visits), Specialist Office Visit: 50% after deductible (Unlimited visits)
Deductible	Individual: $2,500, Family: $5,000	Individual: $5,000, Family: $10,000

Great American — PPO 7500 with Unlimited Primary Care Visits plus Dental

A comparison of the PPO 7500 with Unlimited Primary Care Visits plus Dental offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible, up to out-of-pocket max. $0 once out-of-pocket max. is satisfied.	50% after deductible, up to out-of-pocket max. $0 once out-of-pocket max. is satisfied.
Office Visit	Non-Specialist Office Visit: $30 copay deductible waived (unlimited visits), Specialist Visit: 80% after deductible (unlimited visits).	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits).
Copay	Non-Specialist Office Visit: $30 copay deductible waived (unlimited visits), Specialist Visit: 80% after deductible (unlimited visits).	Non-Specialist Office Visit: 50% after deductible (unlimited visits), Specialist Visit: 50% after deductible (unlimited visits).
Deductible	Individual: $7,500, Family: $15,000	Individual: $10,000, Family: $20,000

Great American — MedOne Plus- PPO Benefit Plan

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

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	Subject to deductible, then coinsurance
Copay	see brochure	see brochure
Deductible	$2,500(2 per family maximum)	$5,000(2 per family maximum)

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

A comparison of the MedOne Plus- PPO Benefit Plan w/Rx Opt $0/$15/50% offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	Subject to deductible, then coinsurance.
Copay	see brochure	see brochure
Deductible	$2,500(2 per family maximum)	$5,000(2 per family maximum)

Great American — MedOne- HSAvings Individual

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

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	Subject to deductible, then coinsurance.	Subject to deductible, then coinsurance.
Copay	N/A	N/A
Deductible	$2,800	$5,600

Great American — MedOne Plus- PPO Benefit Plan

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

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	Subject to deductible, then coinsurance
Copay	see brochure	see brochure
Deductible	$2,500(2 per family maximum)	$5,000(2 per family maximum)

Great American — MedOne- HSAvings Individual with Wellness

A comparison of the MedOne- HSAvings Individual with Wellness offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	Plan pays 100%	Plan pays 70%
Office Visit	Subject to deductible, then coinsurance.	Subject to deductible, then coinsurance.
Copay	N/A	N/A
Deductible	$2,800	$5,600

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

A comparison of the MedOne Plus- PPO Benefit Plan w/Rx Opt $0/$15/50% offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	Subject to deductible, then coinsurance.
Copay	see brochure	see brochure
Deductible	$2,500(2 per family maximum)	$5,000(2 per family maximum)

Great American — MedOne Security- PPO Facility Copay Plan

A comparison of the MedOne Security- PPO Facility Copay Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	$30 Copay then 100%	Subject to deductible, then 70% coinsurance.
Copay	$30	N/A
Deductible	$1,000(2 per family maximum)	$2,000(2 per family maximum)

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

A comparison of the MedOne Security- PPO Facility Copay Plan w/Rx Opt $0/$15/50% offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	Subject to deductible, then coinsurance.
Copay	see brochure	see brochure
Deductible	$1,000(2 per family maximum)	$2,000(2 per family maximum)

Great American — MedOne Security- PPO Facility Copay Plan

A comparison of the MedOne Security- PPO Facility Copay Plan offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	$30 Copay then 100%	Subject to deductible, then 70% coinsurance.
Copay	$30	N/A
Deductible	$1,000(2 per family maximum)	$2,000(2 per family maximum)

Great American — MedOne Plus- PPO Benefit Plan

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

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	Subject to deductible, then coinsurance
Copay	see brochure	see brochure
Deductible	$2,500(2 per family maximum)	$5,000(2 per family maximum)

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

A comparison of the MedOne Security- PPO Facility Copay Plan w/Rx Opt $0/$15/50% offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	Subject to deductible, then coinsurance.
Copay	see brochure	see brochure
Deductible	$1,000(2 per family maximum)	$2,000(2 per family maximum)

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

A comparison of the MedOne Plus- PPO Benefit Plan w/Rx Opt $0/$15/50% offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	see brochure	see brochure
Office Visit	see brochure	Subject to deductible, then coinsurance.
Copay	see brochure	see brochure
Deductible	$2,500(2 per family maximum)	$5,000(2 per family maximum)

Great American — QHDHP 90% $1200 w/o HSA (includes Dental)

A comparison of the QHDHP 90% $1200 w/o HSA (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	90% after deductible	50% after deductible
Office Visit	90% after deductible	50% after deductible
Copay	N/A	N/A
Deductible	Individual: $1,200, Family: $2,400	Individual: $2,400, Family: $4,800

Great American — QHDHP 90% $2000 w/o HSA (includes Dental)

A comparison of the QHDHP 90% $2000 w/o HSA (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	90% after deductible	50% after deductible
Office Visit	90% after deductible	50% after deductible
Copay	N/A	N/A
Deductible	Individual: $2,000, Family: $4,000	Individual: $4,000, Family: $8,000

Great American — QHDHP 90% $3000 w/o HSA (includes Dental)

A comparison of the QHDHP 90% $3000 w/o HSA (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	90% after deductible	50% after deductible
Office Visit	90% after deductible	50% after deductible
Copay	N/A	N/A
Deductible	Individual: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

Great American — QHDHP 80% $1200 w/o HSA (includes Dental)

A comparison of the QHDHP 80% $1200 w/o HSA (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible	50% after deductible
Office Visit	80% after deductible	50% after deductible
Copay	N/A	N/A
Deductible	Individual: $1,200, Family: $2,400	Individual: $2,400, Family: $4,800

Great American — QHDHP 80% $3000 w/o HSA (includes Dental)

A comparison of the QHDHP 80% $3000 w/o HSA (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible	50% after deductible
Office Visit	80% after deductible	50% after deductible
Copay	N/A	N/A
Deductible	Individual: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

Great American — QHDHP 90% $1200 w HSA (includes Dental)

A comparison of the QHDHP 90% $1200 w HSA (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	90% after deductible	50% after deductible
Office Visit	90% after deductible	50% after deductible
Copay	N/A	N/A
Deductible	Individual: $1,200, Family: $2,400	Individual: $2,400, Family: $4,800

Great American — QHDHP 80% $1200 w HSA (includes Dental)

A comparison of the QHDHP 80% $1200 w HSA (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible	50% after deductible
Office Visit	80% after deductible	50% after deductible
Copay	N/A	N/A
Deductible	Individual: $1,200, Family: $2,400	Individual: $2,400, Family: $4,800

Great American — QHDHP 90% $2000 w HSA (includes Dental)

A comparison of the QHDHP 90% $2000 w HSA (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	90% after deductible	50% after deductible
Office Visit	90% after deductible	50% after deductible
Copay	N/A	N/A
Deductible	Individual: $2,000, Family: $4,000	Individual: $4,000, Family: $8,000

Great American — QHDHP 90% $3000 w HSA (includes Dental)

A comparison of the QHDHP 90% $3000 w HSA (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	90% after deductible	50% after deductible
Office Visit	90% after deductible	50% after deductible
Copay	N/A	N/A
Deductible	Individual: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

Great American — QHDHP 80% $3000 w HSA (includes Dental)

A comparison of the QHDHP 80% $3000 w HSA (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible	50% after deductible
Office Visit	80% after deductible	50% after deductible
Copay	N/A	N/A
Deductible	Individual: $3,000, Family: $6,000	Individual: $6,000, Family: $12,000

Great American — QHDHP 100% $1250 w/o HSA (includes Dental)

A comparison of the QHDHP 100% $1250 w/o HSA (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	50% after deductible
Office Visit	Primary Care Visit- $15 Copay after deductible, Specialist Visit- $25 Copay after deductible	50% after deductible
Copay	Primary Care Visit- $15 Copay after deductible, Specialist Visit- $25 Copay after deductible	50% after deductible
Deductible	Individual: $1,250, Family: $2,500	Individual: $2,500, Family: $5,000

Great American — QHDHP 100% $2500 w/o HSA (includes Dental)

A comparison of the QHDHP 100% $2500 w/o HSA (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	50% after deductible
Office Visit	100% after deductible	50% after deductible
Copay	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Deductible	Individual: $2,500, Family: $5,000	Individual: $5,000, Family: $10,000

Great American — QHDHP 100% $3750 w/o HSA (includes Dental)

A comparison of the QHDHP 100% $3750 w/o HSA (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	50% after deductible
Office Visit	Primary Care Visit- $15 Copay after deductible, Specialist Visit- $25 Copay after deductible	50% after deductible
Copay	Primary Care Visit- $15 Copay after deductible, Specialist Visit- $25 Copay after deductible	50% after deductible
Deductible	Individual: $3,750, Family: $7,500	Individual: $7,500, Family: $15,000

Great American — QHDHP 100% $1250 w HSA (includes Dental)

A comparison of the QHDHP 100% $1250 w HSA (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	50% after deductible
Office Visit	100% after deductible	50% after deductible
Copay	Primary Care Visit- $15 Copay after deductible, Specialist Visit- $25 Copay after deductible	50% after deductible
Deductible	Individual: $1,250, Family: $2,500	Individual: $2,500, Family: $5,000

Great American — QHDHP 100% $2500 w HSA (includes Dental)

A comparison of the QHDHP 100% $2500 w HSA (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	50% after deductible
Office Visit	100% after deductible	50% after deductible
Copay	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Deductible	Individual: $2,500, Family: $5,000	Individual: $5,000, Family: $10,000

Great American — QHDHP 100% $3750 w HSA (includes Dental)

A comparison of the QHDHP 100% $3750 w HSA (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100%	50%
Office Visit	Primary Care Visit- $15 Copay after deductible, Specialist Visit- $25 Copay after deductible	50% after deductible
Copay	Primary Care Visit- $15 Copay after deductible, Specialist Visit- $25 Copay after deductible	50% after deductible
Deductible	Individual: $3,750, Family: $7,500	Individual: $7,500, Family: $15,000

Great American — Copay 100% $0 $25/$50 PCP/SP (includes Dental)

A comparison of the Copay 100% $0 $25/$50 PCP/SP (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	50% after deductible
Office Visit	Primary Care Visit- $25 Copay, Specialist- $50 Copay	50% after deductible
Copay	Primary Care Visit- $25 Copay, Specialist- $50 Copay	50% after deductible
Deductible	None	Individual: $5,000, Family: $10,000

Great American — Deductible 80% $500 (includes Dental)

A comparison of the Deductible 80% $500 (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible	50% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	N/A	N/A
Deductible	Individual: $500, Family: $1,000	Individual: $1,000, Family: $2,000

Great American — Deductible 80% $750 (includes Dental)

A comparison of the Deductible 80% $750 (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	80% after deductible	50% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	N/A	N/A
Deductible	Individual: $750, Family: $1,500	Individual: $1,500, Family: $3,000

Great American — Deductible 100% $5000 (includes Dental)

A comparison of the Deductible 100% $5000 (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	50% after deductible
Office Visit	Subject to deductible and coinsurance	Subject to deductible and coinsurance
Copay	N/A	N/A
Deductible	Individual: $5,000, Family: $10,000	Individual: $10,000, Family: $20,000

Great American — Copay 100% $0 (includes Dental)

A comparison of the Copay 100% $0 (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	50% after deductible
Office Visit	Primary Care Visit- $20 Copay, Specialist Visit- $40 Copay	50% after deductible
Copay	Primary Care Visit- $20 Copay, Specialist Visit- $40 Copay	50% after deductible
Deductible	None	$5,000 Individual, $10,000 Family

Great American — Copay 90% $1000 / $2K OOPM (includes Dental)

A comparison of the Copay 90% $1000 / $2K OOPM (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	90% after deductible	50% after deductible
Office Visit	Primary Care Visit- $20 Copay, Specialist Visit- $40 Copay	50% after deductible
Copay	Primary Care Visit- $20 Copay, Specialist Visit- $40 Copay	50% after deductible
Deductible	$1,000 Individual, $2,000 Family	$2,000 Individual, $4,000 Family

Great American — Copay 90% $1000 / $3K OOPM (includes Dental)

A comparison of the Copay 90% $1000 / $3K OOPM (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	90% after deductible	50% after deductible
Office Visit	Primary Care Visit- $20 Copay, Specialist Visit- $40 Copay	50% after deductible
Copay	Primary Care Visit- $20 Copay, Specialist Visit- $40 Copay	50% after deductible
Deductible	$1,000 Individual, $2,000 Family	$2,000 Individual, $4,000 Family

Great American — Copay 100% $1200 (includes Dental)

A comparison of the Copay 100% $1200 (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	100% after deductible	50% after deductible
Office Visit	Primary Care Visit- $20 Copay, Specialist Visit- $40 Copay	50% after deductible
Copay	Primary Care Visit- $20 Copay, Specialist Visit- $40 Copay	50% after deductible
Deductible	$1,200 Individual, $2,400 Family	$2,400 Individual, $4,800 Family

Great American — Copay 90% $2000 (includes Dental)

A comparison of the Copay 90% $2000 (includes Dental) offered by Great American is detailed out below for both Network and Non-Network coverage.

	Network	Non-Network

Network	See Provider	See Provider
Coinsurance	90% after deductible	50% after deductible
Office Visit	Primary Care Visit- $20 Copay, Specialist Visit- $40 Copay	50% after deductible
Copay	Primary Care Visit- $20 Copay, Specialist Visit- $40 Copay	50% after deductible
Deductible	Individual: $2,000, Family: $4,000	Individual: $4,000, Family: $8,000