Navigating Your Nippon Life Benefits
Navigating Your Nippon Life Benefits
Navigating Your Nippon Life Benefits
The information contained in this presentation is intended as a summary. In all cases master contracts, plan documents or company policy will govern. This overview does not guarantee benefits or eligibility.
We are Nippon Life Benefits
We hold ourselves to the highest level of service and Incorporate our core values –Harmony, Honor, and Humanity – into all that we do.
We are here to help you feel more comfortable with your new insurance benefits. If you have any questions, please do not hesitate to ask us.
It is pleasure to meet you and we look forward to working with you!
Our Mission Is To Bring Humanity Back To Healthcare
• Nippon Life Benefits was founded and incorporated in 1991
• Corporate Headquarters in New York
• Specialization in Employee Benefits - Medical, Vision, Dental, Life, STD and LTD
• Licensed in all states except ME, NH, and WY
• Regional offices in Atlanta, Chicago, Los Angeles, and Ohio
• Known for providing high-quality services
World-Class Financial Strength
Founded in 1889, Nippon Life is headquartered in Osaka and Tokyo, Japan* with $645 billion in assets*
Employees:
• 47,937 Sales Representatives
• 20,135 Non-Sales
Main Lines of Business
• Individual & group life insurance
• Supplemental medical insurance
• Individual & group annuity
• Disability insurance Nippon Life Insurance Ratings and Rankings*
• Ranked the third largest mutual life insurance company in the world by
Who We Are Company Overview
• Founded in the US in 1991 - over 33 years
• Headquarters: New York City, with regional offices around the country
• Multilingual customer phone service and member support materials in English, Spanish, Japanese, and Korean
• Rated A- Excellent by AM Best, 2/2024
• Products:
Networks: • Dental: Aetna Dental Administrators (ADA), DenteMax and First Dental Health (FDH) • Vision: EyeMed Insight Network
Understanding Your ID Card
8. DEDUCTIBLE AND OUT-OF-POCKET AMOUNTS Deductible and out-of-pocket amounts for both in and out of network are displayed. If the member has family coverage, those amounts will be displayed as well.
9. QUEST SELECT This is an optional benefit designed to save you money on outpatient laboratory needs covered by your medical plan. Please note this is not available on all plans.
5. BENEFIT PH # Your ID card is not a guarantee of coverage. Your provider should call this number for verification of coverage.
6. CVS CAREMARK Your Pharmacy Network. To locate a participating pharmacy, go to: www.caremark.com.
7. PROVIDER NETWORK Your Medical, Dental, and/or Vision networks. If your plan doesn’t use a network, these sections will be left blank.
10. CLAIMS ADDRESS In most cases, your provider will submit claims for you. However, you may mail it to the address on your ID card if you need to submit a claim.
11. INTERNATIONAL COVERAGE For outside of the U.S. care and claims, please contact Aetna International at 1-800-231-7729 or visit https://www.aetnainternational.com
* The image above is an ID Card sample is for illustrative only. Your card may vary depending on your plans, vendors or state of residence.
Benefits listed are intended to serve only as an overview. If there is any discrepancy between this summary and your policy and/or booklet-certificate the later will govern. Nothing herein guarantees benefits and/or eligibility; all terms, including conditions, limitations, and exclusions in your policy and/or booklet-certificate will be controlling. This information is provided for general informational purposes only and is not intended to offer legal, tax, benefits, medical or any professional advice.
Medical Benefits
Medical Plan Highlights
• More than 60,000 participating pharmacies, such as CVS, Duane Reade and Walgreens. Prescription Coverage Highlights
Prescription Coverage Network – CVS Caremark
• CVS Caremark is your pharmacy benefit manager (PBM) and one of the largest PBM’s in the country.
Medical Network - Aetna Signature Administrators®
• Access to the largest most comprehensive proprietary PPO Network as measured by providers and members.
• Large case medical management that offers cost-appropriate clinical reviews of high-dollar medical treatments.
• Access to 726,000 participating physicians and 6,400 hospitals, including Memorial Sloan Kettering Cancer Center, Montefiore Medical Center, the Cleveland Clinic, and St. Jude Children’s Research Hospital.
• URAC-accredited “ActiveHealth” medical case management, utilization case management, maternity management, and disease management services.
• First national insurer to hold NCQA accreditation for its PPO plan offering.
Find A Provider: ASA or ADA
1. Go to www.nipponlifebenefits.com, and click the Provider Search tab on the right-hand side of the screen.
2. Choose Medical or Dental coverage, then select “Aetna Signature Administrators (ASA) ” for medical or “Aetna Dental Administrators (ADA)” for dental in the network list.
3. Type in the location (zip, city, county, or state) you want to search and select one option in the list, then click Search.
4. Two ways to search the providers
1. Option 1: Enter a keyword (name of the doctor/facility or specialty).
2. Option 2: Click the appropriate category, then select a specific specialty or facility.
Included in Medical Programs
We offer a range of programs to help ensure your members receive the most appropriate healthcare in the most cost-efficient manner.
• Prescription Benefits
• Teladoc
• Lab Testing
• Wellness (Core Program)
• Prenatal Program by Special Delivery
• Care Management
• Transplant Networks
In partnership with Teladoc, Nippon Life Benefits offers a telehealth service to all our medical members.
• Teladoc provides you:
• Provides 24/7 access to national network of U.S. board-certified physicians for non-emergency medical issues or mental health visits via phone or online video to receive medical advice, diagnoses and basic prescription medications.
• No cost for PPO plan members
• Registration Teladoc.com is required
• Go to www.nipponlifebenefits.com/teladoc for more details
Lab Testing – QuestSelect – Advanced and Plus
• QuestSelect offered through Quest Diagnostics a consumer-driven benefit that allows you to obtain outpatient laboratory testing services at no cost to you. (Provider collection and handling fees may not be covered at 100%)
• Nippon Life Benefits pays the full amount of covered and approved laboratory services - which means members incur no deductibles, copayments, or coinsurance costs.
• Quest Diagnostics utilizes fully accredited, certified, and licensed facilities that perform most diagnostic outpatient laboratory tests, such as:
• Blood, cholesterol, and urine tests
• Pap smears
• Biopsies
• Cultures
• Other cytological and pathological tests
Prenatal Program
• Designed to promote the health and well-being of soon-to-be moms and babies to help prevent health issues from occurring during pregnancy.
• No cost to members for participation in this program.
• $100 reward to participants who enroll during the first 20 weeks of pregnancy.
• Simply call to enroll: #1-833-462-0090
Active & Fit Direct®
Some More “Fit” in Your Benefits
• Active & Fit Direct®
• Industry-leading provider of fitness-focused programs and fitness center access
• Access to 4,000+ digital workout videos so you can workout at home or on the go
• Receive unlimited one-on-one lifestyle coaching in areas such as fitness, nutrition, stress, and sleep
• Select from 11,000+ standard fitness centers
• Select from 5,000+ premium fitness centers and studios: Yoga, Rowing, Climbing, Spinning and more! (Extra Fee)
• No long-term contract
• Just $28 a month!*
• To find an eligible fitness center near you, visit www.activeandfitdirect.com
• Medical members can enroll through the member portal.
Global Coverage with Aetna International
How it works
• Aetna International Plan Benefits: Coinsurance, deductibles, and out of pocket cost sharing is the same as the in-network cost sharing within the U.S. plan benefits. Benefits do not cross accumulate.
• When traveling outside of the U.S., go to any provider (no referrals required). Although, it is recommended to use a provider within the direct settlement network.
• Aetna has established arrangements with about 165,000 health care providers outside of the U.S. where bills will be directly submitted to Aetna so the member doesn’t need to pay upfront.
• Before traveling, the member should register on the Aetna International website and download the mobile app so they are prepared should health care be needed while traveling.
• For outside of the US care and claims, please contact Aetna International at 1-800-231-7729 or visit www.aetnainternational.com
Dental
Dental Plan Highlights
Calendar Year Deductible (applies to Unit 2 and Unit 3 only)
Unit 1 - Preventive & Routine Services
Preventive Exam, Bitewing X-rays, Cleanings, Fluoride Treatment, Sealants
Unit 2 - Basic Services
Crowns (stainless steel), Minor Oral Surgery, Problem Focused Exams, Simple Extraction
Unit 3 - Major Services Crowns (other than steel), Inlays/Onlays, Bridges, Denture, General Anesthesia, Implants
Unit 4 - Orthodontia
(Not subject to deductible)
Vision Plan Highlights (EyeMed plans)
Vision benefits never looked so good!
Overview of Nippon Life Benefits
• Nippon Life Benefits now offers vision coverages powered by EyeMed
• In EyeMed Insight Network,
• 96,000+ total providers
• 79,383 total provider access points
• 55,000+ independent providers
• 41,000+ retail providers, such as Lens Crafters®, Pearle Vision®, Target Optical®, Sears Optical® and more.
• 97% in-network provider utilization
• Access to top brands like Ray-Ban, Oakley and many more!
* Provider location counts are provided by the Network to Nippon Life Benefits. The Network is responsible for the accuracy of the numbers provided.
Benefits listed are intended to serve only as an overview. If there is any discrepancy between this summary and your policy and/or booklet-certificate the later will govern. Nothing herein guarantees benefits and/or eligibility; all terms, including conditions, limitations, and exclusions in your policy and/or booklet-certificate will be controlling. This information is provided for general informational purposes only and is not intended to offer legal, tax, benefits, medical or any professional advice. ®
Vision Plan Highlights (EyeMed plans)
STD (Short Term Disability) Plan Highlights
LTD (Long Term Disability) Plan Highlights
Elimination Period 90 days; end of sick leave, salary continuation, or STD
Member Portal: Manage benefits 24 hours a day, 7 days a week
Before log-in
• Provider search
• Download claim forms
• Submit claim correspondence
After log-in
• View temporary ID card
• Ordering additional ID cards
• View claim activities
• View benefit summaries
• Access to Wellness Services
• Send/receive the messages within the portal
Member Portal – Functions After Login
About Me
View personal information, such as home address, phone number, and change your EOB delivery method.
My
benefits
The list of the covered individuals. Click View my benefits to see your benefit summary information.
My Profile
Update your password and e-mail address.
My costs
At-a-glance chart how much your plan covers vs. you paid out of your pocket. Click View my expenses to see your claim history.
My links
Quick access to the other features, such as search your providers, print your temporary ID Card or claim forms, Wellness Portal etc.
Member Portal – About Me Page
Click Edit to change your
• Email address,
• Mobile/alternate phone number, and
• EOB delivery method (paper or electronic).
Member Portal – Messages Page
Member Portal – My Costs Page
Application Easy access to health care information no matter where you are!
• To download the app, search ‘Nippon Life Benefits’ in the Apple App Store℠ or on Google Play for Android
• You can log in with the same username and password you use for web member page.
• If you haven’t set up your account, you can register as a new user.
• Visit www.nipponlifebenefits.com/gomobile for more information
Thank You
