Your Group Insurance Benefits Solution
Who We Are 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: PPO options for regional, national, and global coverage with Aetna Signature Administrators® , PHCS, and more.
Eligible Groups
• Any group where there is clear employee/employer relationship.
• Local Large Group - total active eligible employees 51 or more in most states/NY & CA 101 or more
• Affiliated and Rotational Trust – 1 eligible employee or more enrolling.
Employee Eligibility
• Eligible employees are full-time employees working 30 hours or more per week.
• Owners, sole proprietors, partners, officers, trustees, and directors are eligible only if they qualify as full-time employees.
Dependent Eligibility
• Eligible dependents of an employee are a lawful spouse and children up to age 26.
Our medical products are available in the following states:
Medical Plan Options
• Evolution PPO Plans: offer a variety of deductible, coinsurance, copays, and out-of-pocket options so you can customize a benefit solution to meet your needs.
• Evolution PPO Value Plans: similar to our Evolution PPO Plans with higher out-of-network limits to encourage in-network usage.
• Evolution High Deductible Health Plans (HDHP): high-quality, cost-effective coverage, meant to save premium dollars, promote health advocacy.
• Evolution HDHP Value Plans: similar to our Evolution HDHP Plans but include higher out-of-network limits to encourage in-network usage - drives down premium even further.
• Qualified HDHP plans: can be paired with an HSA (Health Savings Account).
Medical Plan Networks
National PPO Networks
• Aetna Signature Administrators ® (ASA).
• ASA is a national PPO network with more than one million participating physicians and approximately 6,400 hospitals.
• It is one of the country’s most comprehensive PPO network and holds NCQA accreditation.
Private Healthcare Systems (PHCS)
• PHCS is one of the largest PPO networks, with over one million providers and 4,700 hospitals.
• It provides nationwide access to providers and facilities and holds NCQA and URAC accreditation.
Lab Testing – QuestSelect - Advanced and Plus
Outpatient lab work through Quest Diagnostics®, fully accredited, certified, and licensed facilities that perform most diagnostic outpatient laboratory tests.
For PPO members:
• Option to have covered outpatient lab testing performed at no cost (Provider collection and handling fees may not be covered at 100%).
• We pay the full amount of covered and approved lab services.
• No deductibles, copays, or coinsurance costs.
For HDHP members:
• Deeply discounted testing.
Tests Include:
– Blood, cholesterol, and urine tests
– Pap smears.
– Biopsies
– Cultures
– Other cytological and pathological tests
Prescription Drugs
• Prescription drug benefits are provided through CVS Caremark, the largest provider of prescriptions in the country.
• More than 68,000 participating pharmacies nationwide (both CVS and non-CVS pharmacies).
• CVS Caremark Prescription Mail Service pharmacy for home delivery.
• Specialty Pharmacy Services for the treatment of rare or complex conditions.
• Discount program for high-cost injectable drugs.
• Fast Start / Phone Option.
• Order Form Option / Mail with 90 Day Script.
• Auto Refill Option / Maintenance Medications.
Care Management
Aetna Active Health/Suite of Medical Management Solutions
• Pre-admission Authorization.
• Large Case Management.
• Utilization Management.
Care Management
• Pre-admission certification.
• Discharge planning.
• Concurrent hospital review.
• Retrospective hospital review.
• Large Case Management identification and implementation.
• Alternative care intervention.
Teladoc®
• Provides 24/7 access to a national network of U.S. board-certified physicians for non-emergency medical issues or mental health visits via phone or online video.
• Oldest and largest telemedicine company in U.S.
• Services all 50 states*.
• Meet via phone or video chat with board-certified, state-licensed physicians for non-emergency issues.
• Available for all members who request medical coverage.
• PPO-No Cost for regular and MH Teledoc visits.
• HDHP-Standard Visits: $55
MH cost: Psychiatrist Initial Visit: $220
Psychiatrist Ongoing Visits: $100
Psychologist, Counselor, or Therapist Visits: $90
Active & Fit Direct®
• Access to 8,100+ online workout videos for home or on-the-go exercise.
• Low one-time enrollment and a monthly fee.
• 17,500+ standard fitness centers.
• Unlimited one-on-one personalized lifestyle coaching via phone in fitness, nutrition, stress, and sleep. No long-term contract required.
• No long-term contract.
• Just $28 a month*.
*Plus $28 enrollment fee.
Wellness Services (Powered by ActiveHealth)
Core Package is included in Medical plan at no additional cost.
CareEngine: Identifies opportunities for better care, gaps in care, or medical errors, and offers solutions to members and their provider to improve their care plan, for instance:
• Suggests medical screenings, tests, or treatments.
• Alerts of potential drug interaction issues.
Wellness Portal: Provides online health assessment, personal health record and extensive health education and resources.
• Easy access through Nippon Life Benefits’ member site and Mobile App (log-in required).
• All members age 18 and older have their own access to the portal.
• Dependents under 18 are included in the employee’s portal.
Additional Buy-Up Programs
Wellness Buy-Up Packages (Core package included with medical plans)
• Buy-up Package A: Core + Online Rewards Center, Incentive Report.
• Buy-up Package B: Core + A + Biometrics Screening.
• Buy-up Package C: Core + A + B + Telephonic Lifestyle Coaching.
Wellness Portal
• Easy-to-use tips, tools, and trackers
• Simple dashboards to track progress.
• Action items, reminders, health assessments, and more
Wellness Portal CareEngine
Rewards Center
Biometric Screening
Telephonic Lifestyle Coaching
with Plan purchase)
Additional Buy-Up Programs
Employee Assistance Program through Telus ($1.15/employee)
• 24/7 best-in-class counseling.
• Immediate telephone support from specialized professionals in counseling, social work, psychology or human services.
• Virtual counseling: Video, Telephonic & SMS/Text.
• Immediate access to an EAP counselor through video and phone for confidential and secure virtual sessions.
• Face-to-face, in-person, counseling.
• Referrals to the LifeWorks extensive network of master’s level clinical counselors and affiliates.
Employer Portal
Manage your group plan 24 hours a day, 7 days a week
• View and download premium statement.
• View benefit details.
• Print temporary ID card for members.
• Add, terminate, or change member eligibility.
• Download all forms you need.
• Review online eligibility activities.
Member Portal
Manage benefits 24 hours a day, 7 days a week
• View claim activities and benefit details.
• Access the wellness portal.
• Print temporary ID card for members.
• View eligibility.
• Download all forms you need.
• Easily access other resources.
®
Mobile App
Access to benefits anytime, anywhere.
Find a provider
• Medical, dental, vision
View ID Card
• Medical, Dental, Vision
Message customer service
Check claim status
View your benefits
• Medical, Dental, Vision
Access the Wellness Portal
• Medical
NLB Global: Medical, Vision and Ningen Dock
We excel at navigating employee benefits for foreign owned companies because we are one.
Qualifications and Underwriting Guidelines
Policies must be sitused in:
• Company must be owned by a foreign parent*.
• The company must be a member of a controlled group of a foreign parent company (for example, a parent company owns at least 80% of the stock).
• The total number of employees among the affiliated companies (including the parent company) must exceed 100 worldwide.
• Additional discounts may be available for groups meeting certain criteria based upon underwriting review.
Global Coverage with Aetna International
Scope of Coverage
• Medical and prescription coverage while traveling outside the U.S.
• Extends from routine check-ups to emergency treatments.
• Members can visit any provider without requiring referrals.
• Access to 165,000 providers outside the U.S.
• Coinsurance, deductibles, and out-of-pocket cost sharing are the same as the in-network cost-sharing within the U.S. plan benefits.
• 24/7 member service in 240 languages.
Traditional East Asian Medicine
Benefit Enhancement
• Provides additional coverage for a variety of services such as acupressure and herbal supplements.
Sample of covered services
• Acupuncture
• Acupressure
• Hypnotherapy
• Massage Therapy
• Cupping
• Tai Chai
Sample of covered supplements
• Ginseng
• Fucoidan
• White Flower Oil
• Tiger Balm
Ningen Dock for NLB Global Members
Helping You Navigate Your Ningen Dock Journey
Ningen Dock services are fully covered.
Ningen Dock Coverage
A comprehensive checkup program that promotes preventive healthcare and serves to improve health outcomes by detecting potential health issues early.
Scope of Coverage*
• Exclusively available to expatriate employees—Non-U.S. citizens temporarily working in the United States.
• Covers annual employer-required routine physical exams, eligible services and treatments in the U.S.
• Option to include dependent coverage*
• PPO and Non-PPO Providers: 100% of eligible charges, no deductible/copay, up to $2,000 per person annually.
• $4,000 buy-up option for enhanced coverage.
• Vision coverage included.
*Excluding children.
Ningen Dock Covered Tests and Examinations
Category Covered Tests and Examinations
Physical Examination
Periodic Comprehensive Preventive Examination
Complete Physical Examination
Intake Analysis of Medical Questionnaire
Ningen-Dock Results Report
Depression Scale
Body Measurement
Audiometry
Ophthalmologic Exam
Respiratory System Exam
Height Measurement
Weight Measurement
Body Mass Index
Air Displacement Plethysmography (ADP)
Pure-Tone
Audiometry (R・ L)
Eyesight (R・ L)
Ocular Fundus (R・ L)
Eye Pressure (R・ L)
Chest X-ray
Spirometry
Sputum Exam
Ningen Dock Covered Tests and Examinations
Category Covered Tests and Examinations
Cardiovascular System Exam Blood Pressure
Cardiac Electrogram (at rest)
Carotid Ultrasound
Cardiovascular System Exam
Digestive System Examination Upper Gastrointestinal X-ray, Upper Abdominal Tests, Esopho-Gastro-Duodenoscopy, Colonoscopy (Esophagus, Stomach, Duodenum, Large Intestines), Abdominal Ultrasound, (Liver・ Gallbladder・
Pancreas・Kidney), Rectal Examination, Gastroscopy (Esophageal or Nasal), Ova and Parasite Test
Urinalysis
Ph, Specific Gravity, Protein, Ketones, Nitrite Glucose, Occult Blood, Bilirubin, Urobilinogen
Stool Test Occult Blood in Stool
Urinary System
Gynecologic Examination
Prostatic Examination
P S A
Kidney Ultrasound Sedimentation
Pap Smear
Mammogram
CA125 (Ovarian Tumor Marker)
Estradiol (blood test)
Post Menopausal (FSH)
Transvaginal Ultrasound
Ningen Dock Covered Tests and Examinations
Category Covered Tests and Examinations
Comprehensive
Blood Biochemistry
HIV/AIDS Test
Leukemia Blood Test
Pancreatic Function Serum Amylase
Kidney
Ningen Dock Covered Tests and Examinations
Category Covered Tests and Examinations
Gout
Hepatitis Panel
Lipid
Uric Acid
Hepatitis A Antigen
Hepatitis B Antigen
Hepatitis B Antibody
Total Cholesterol
Triglycerides
Thyroid
HCV Hepatitis C Antibody
Syphilis Test
L D L Cholesterol
H D L Cholesterol
T S H
Thyroid Ultrasound
Misc. Venipuncture
Specimen Collection
Iron
Phosphate
C-Reactive Protein
Rheumatoid Factor
Vitamin D Hydroxy
Dexa Scan Calcium Sodium
Chlamydia
CT Scan
Gonorrhea
Herpes
HPV Test
Lower Extremity Ultrasound and Color Doppler
MRI/MRA
Nippon Contacts
New Business Sales & RFP requests
Davin Laurino – Regional Director, D-Laurino@nipponlifebenefits.com, 347-380-3109
Kim Izzo – Sales Associate, K-izzo@nipponlifebenefits.com
A ccount Management:
Employers enrolled in Medical will be assigned an account manager upon installation
Administration & Billing Inquiries for in force groups - Admin-info@nipponlifebenefits
