Navigating Your Nippon Life Benefits
Overview of Nippon Life Benefits
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!
World-Class Financial Strength
Overview of Nippon Life Benefits
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 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 - Network Access: Aetna Dental Administrators (ADA), Careington, Connection Dental, and DenteMax
• 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.
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.
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.
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
Understanding Your ID Card: Vision Powered by EyeMed
Medical Benefits
Medical Plan Highlights (Evolution Value- Base Plan)
Medical Plan Highlights (Evolution - Buy Up Plan)
Medical Plan Highlights
Key Terms
Deductible
The amount you pay each year before your plan starts to pay for certain services
Copay
The fixed dollar amount you pay for certain services during the plan year
Coinsurance
The cost share amount for certain services, usually payable after meeting the deductible
Out-of-Pocket Maximum
The cost share amount for certain services, usually payable after meeting the deductible
Premium
The monthly amount you pay for yourself and your enrolled dependents, after the employee contribution is considered
Medical Network - Aetna Signature Administrators®
Overview of Nippon Life Benefits
• 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.
• More than 1 million participating physicians and 6,400 hospitals including UCLA, Cedar Sinai, St. Joseph’s, City of Hope, etc.
• Access to care management solutions, utilization case management, and maternity and disease management services.**
• Access to thousands of first-in-class providers throughout the nation.
Find A Provider: ASA or Network Access
Go to www.nipponlifebenefits.com, and click the Provider Search tab on the right-hand side of the screen.
1. Choose Medical or Dental coverage, then select “Aetna Signature Administrators (ASA)” for medical or “Network Access” 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.
Preventive Care
Overview of Nippon Life Benefits
It’s often forgotten that routine preventive care visits are included in medical benefits*
• Early detection of health problems
• Testing, examinations, screenings, and immunizations
• Fully covered visits when in-network
*Please refer to your carrier’s preventive care services guidelines for a more in-depth list of services.
Included in Medical Programs
Overview of Nippon Life Benefits
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
• Prenatal Program by Special Delivery
• Active & Fit Direct®
• Aetna International
Prescription Coverage Highlights (Evolution Value- Base Plan)
Coverage Network – CVS Caremark
• CVS Caremark is your pharmacy benefit manager (PBM) and one of the largest PBM’s in the country.
• More than 66,000 participating pharmacies, such as CVS, Walgreens. Costco, Sams club, and Safeway.
Prescription Coverage Highlights (Evolution - Buy Up Plan)
Prescription Coverage Network – CVS Caremark
• CVS Caremark is your pharmacy benefit manager (PBM) and one of the largest PBM’s in the country.
• More than 66,000 participating pharmacies, such as CVS, Walgreens. Costco, Sams club, and Safeway.
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 – PPO Plan
Overview of Nippon Life Benefits
• QuestSelect offered through Quest Diagnostics a consumer-driven benefit that allows you to obtain outpatient laboratory testing services at no cost to you.
• 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
Safeguards the health of each pregnant member. Help to gives babies a healthy start.
• 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
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
Active & Fit Direct®
Put Some More “Fit” in Your Benefits
• 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
Members participating in our Nippon Medical program will also have access to the following value-added programs: TELADOC 24/7 doctor visits via phone or mobile app. www.Teladoc.com No cost for PPO plan
members NIPPON LIFE BENEFITS Network: Aetna Signature Administrators , Provider Search www.nipponlifebenefits.com
Active & Fit Direct: one-on-one lifestyle coaching in areas such as fitness, nutrition, stress, and sleep Just $28 a month!* To find an eligible fitness center near you, visit www.activeandfitdirect.com
Prenatal Program Designed to promote the health and well-being of babies and soon-to-be moms to help prevent health issues during pregnancy.
• No cost to members
• $100 reward to participants who enroll during the first 20 weeks of pregnancy
• Call to enroll 1-833-462-0090
International Coverage: https://www.aetnainternational.com/en/nippon_life_benefits.html
Copayments are not recognized outside the US; The INN Deductible and coinsurance apply instead. You must meet the US in-network and international deductible independently each year.
Dental
Dental Plan Highlights
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
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
• 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.
Vision Plan Highlights (EyeMed plans)
Life/AD&D
Employee Assistance Program (EAP)
EAP through TELUS Health
• 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
• Immediately access 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
EAP can help you:
• Strengthen relationships and improve communication
• Work towards life goals
• Address marital and relationship difficulties
• Understand grief and bereavement
• Cope with isolation and loneliness
• Address alcohol and drug misuse
• Deal with stress, anxiety, and depression
• Resolve personal and emotional difficulties
• Adapt across cultures
• Find solutions for work-related issues
• Identify and cope with culture shock
• Access crisis and trauma support
Benefits & Coverage/Personal Information
View personal information, such as home address, phone number, and change your EOB delivery method.
Costs
At-a-glance chart how much your plan covers vs. you paid out of your pocket. Click View All expenses to see your claim history.
Overview of Nippon Life Benefits Member Portal – Functions After Login
My Account
Update your password and e-mail address.
Plan Information
The list of the covered individuals. Click View Plan Details to see your benefit summary information.
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 – “User Profile” Page
Mobile 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
Customer Service Contacts
Our dedicated Customer Service team can assist you in English, Spanish, Japanese, or Korean. Customer Service Center (M-F, 8:00 am – 7:00 pm/CST)
(press 3 for members’ inquiries)
(press 5) For English speakers, please send your inquiries within the Member Portal. Register today if you haven’t!
