| Indemnity Benefits |
Bronze |
Silver |
Gold |
Platinum |
 |
Doctor’s Office Visits |
5 visits/yr.
Your plan pays
$60 for each visit |
5 visits/yr.
Your plan pays
$80 for each visit |
5 visits/yr.
Your plan pays
$100 for each visit |
10 visits/yr.
Your plan pays
$100 for each visit |
 |
Lab Tests Ordered At Doctor Visit |
$50 per visit
$250/yr. |
$100 per visit
$500/yr. |
$100 per visit
$600/yr. |
$150 per visit
$1000/yr. |
 |
Daily In-Hospital Reimbursement |
$100/day up to $20,000 per year
Plus First Day Hospital Benefit |
$300/day up to $100,000 per year
Plus First Day Hospital Benefit |
$500/day up to $100,000 per year
Plus First Day Hospital Benefit |
$1000/day up to $100,000 per year
Plus First Day Hospital Benefit |
|
Additional First Day
Hospital Benefit |
$1000 once per year |
$2000 once per year |
$2000 once per year |
$2500 once per year |
 |
Intensive Care |
No Coverage |
No Coverage |
No Coverage |
$1000/day up to $30,000 per year |
 |
Surgery |
No Coverage |
No Coverage |
Up to $3500 |
Up to $5000 |
 |
Anesthesia |
No Coverage |
No Coverage |
Up to 20% of surgery payment |
Up to 20% of surgery payment |
 |
Off-the-Job
Accident Injury |
Actual charges up to $500 per accident; 5 accidents/yr. |
Actual charges up to $500 per accident; 5 accidents/yr. |
Actual charges up to $500 per accident; 5 accidents/yr. |
Actual charges up to $500 per accident; 5 accidents/yr. |
 |
Critical Illness
Lump Sum Benefit |
$5,000 |
$7,500 |
$15,000 |
$20,000 |
 |
Wellness Visits |
$100 once per year |
$150 once per year |
$200 once per year |
$250 once per year |
| |
|---|
| Additional Benefits |
|
 |
Vision Benefits |
Included in plan - see CASA Membership details below |
Included in plan - see CASA Membership details below |
Included in plan - see CASA Membership details below |
Included in plan - see CASA Membership details below |
 |
Prescription Benefits provided by IdealScripts |
$10/$20/$40 tiers; savings of 20-40% on generic and brand name drugs. |
$10/$20/$40 tiers; savings of 20-40% on generic and brand name drugs. |
$10/$20/$40 tiers; savings of 20-40% on generic and brand name drugs. |
$10/$20/$40 tiers; savings of 20-40% on generic and brand name drugs. |
 |
Dental Options |
Coverage varies based on the plan you select |
Coverage varies based on the plan you select |
Coverage varies based on the plan you select |
Coverage varies based on the plan you select |
| |
|---|
 |
eDocAmerica plus
24-hour nurse hotline |
24/7 Service via internet or phone |
24/7 Service via internet or phone |
24/7 Service via internet or phone |
24/7 Service via internet or phone |
 |
Beech Street PPO
Membership included
at all benefit levels
|
Join with over 16 million Americans getting best rate access at more than 560,000 health care providers. You pay what their biggest customers pay.
|
 |
Your CASA membership includes these additional benefits. |
Diabetics save 25-40% on test equipment and supplies.
Eye Care savings--$50 per exam, 15-40% savings on glasses and frames.
Lasik Surgery savings up to 50% off average national costs.
Financial Help & Counseling from AskAFS.
Work and Family Counseling from Horizon Health.
Medical Questions & Information -- Get your questions answered 24/7 on eDocAmerica or through 24/7 Nurse Hotline. |
