Proposal prepared for: MacInnis Group, LLC

Transcription

1 Customizable Ancillary Benefit Solutions: Another great reason to choose Nippon Life Benefits. Proposal prepared for: MacInnis Group, LLC Proposal Date: Effective Date: Sales Rep: Broker: Quote ID SIC Code: State: September 21, 2017 January 1, 2018 Brittany Gemmell PA Plan features, options, combinations, availability, rates, and benefits may vary by location. Exclusions and limitations apply please see plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features are subject to change. Nothing herein is a guarantee of benefits or eligibility. All terms, provisions, conditions, limitations and exclusions shown in the issued booklet-certificate and master policy will govern. All content included on this website is subject to change without notice. Premium rates shown/proposed are not guaranteed or final, are subject to change/modification by Nippon Life Insurance Company of America, and are subject to final underwriting approval by Nippon Life Insurance Company of America. All group policies offered through this website are underwritten by Nippon Life Insurance Company of America - marketing name Nippon Life Benefits, NAIC number 81264, licensed & authorized in all states plus DC, except not ME, NH or WY, domiciled in Iowa, with a principal place of business at 655 Third Avenue, 16th floor, NY, NY , member company of Nippon Life Insurance Company ( Nissay ). Nippon Life Benefits is responsible for its own financial condition and contractual obligations. Underwritten by Nippon Life Insurance Company of America

2 Dental WE CAN MEET ALL YOUR NEEDS. Nippon Life Benefits is grounded in our Japanese heritage. The hallmarks of our business are based on respect, honor, and dignity. This is what makes us unique. This is what sets us apart. Founded in 1991, we are the United States subsidiary of Nippon Life Insurance Company of Japan 1, one of the world's largest mutual life insurance companies. Nippon Life Benefits has an "A-"(Excellent) rating from AM Best*. (* current as of January 2016) With our Unique Solutions portfolio you will find comprehensive and flexible medical and ancillary benefits. Employee benefit options include Dental, Life, Disability, and large group medical in select states. All priced and designed with your unique needs in mind. Employer funded and voluntary options are available. We believe in delivering the highest level of service to you and your employees. We offer multi-lingual customer support, in both language and culture, in English, Japanese, Korean, and Spanish. We provide unique and flexible dental solutions designed to stretch your benefit dollars, while offering comprehensive coverage with extraordinary service. Our dental coverage includes plan that cover Type I/Preventive, Type II/Basic, Type III/Major and Orthodontia Services. Dental Networks: Customizable Ancillary Benefit Options Aetna Denta l Administrators boasts than 160,500 provider locations across the United States and is operated and maintained by Aetna, one of the largest dental benefit administrators in the nation. Dental Health Alliance, L.L.C. (DHA ) specializes in dental healthcare and boasts access to more 74,500 unique providers. Not available in all states. First Dental Health (CA only) boasts being one of the leading independent PPO dental networks in California since 1995, and offers access to over 35,000 First Dental Health PPO access points.

3 Life We offer affordable Basic, Dependent and Supplemental Life insurance coverage to employees and their families. Let us protect what matters most to you. Accidental Death and Dismemberment (AD&D) We provide your employees with Accidental Death and Dismemberment (AD&D) coverage for only pennies per month. With AD&D, employees receive additional coverage for the accidental loss of life, limb(s), or eyesight. Disability Nippon Life Benefits offers Short-Term and Long-Term disability coverage, which includes an exceptional return-to-work claims process. insurance from Nippon Life Benefits makes it easy and inexpensive for employees to get regular eye exams. It has been proven that good visual health plays an important role in contributing to overall health! 2 coverage includes an allowance toward exams, lenses, frames, and contacts. Online Benefit Management for You and Your Employees Nippon Life Benefits simplifies benefit management for you and your employees through our easy-to-use website, Additionally, we offer a mobile app that assists members with their medical, dental, and vision coverage. It is easy to use and always available when on the go! Nippon Life Insurance Company of America - marketing name Nippon Life Benefits, NAIC number 81264, licensed & authorized in all states plus DC, except not ME, NH or WY, domiciled in Iowa, with a principal place of business at 655 Third Avenue, 16th floor, NY, NY , Member Company of Nippon Life Insurance Company of Japan ( Nissay ). 1 Nippon Life Benefits is responsible for its own financial condition and contractual obligations. 2

4 Plan Options Employer Contribution Network Exam with Dilation as Necessary Eyeglasses lenses: Single Bifocal Trifocal Lenticular Standard Progressive Lenses Premium Progressive Lenses* (varies by tier) Frames Contact Lenses: Conventional Disposable Medically Necessary Contact Lenses fittings/follow-up:** Standard $0 copay / $40 reimbursement $0 copay, 10% discount then $40 Premium allowance / $40 reimbursement Retinal Imaging Benefit Laser Correction*** Frequency: Examination Lenses or Contact Lenses Frames Lens Options 12/12/12 $130 50% EyeMed Insight In-Network / Out-of-Network $0 copay / $30 reimbursement $0 copay / $18 reimbursement $0 copay / $28 reimbursement $65 copay / $28 reimbursement Reduced Fixed Pricing 12/12/12 $150 50% EyeMed Insight In-Network / Out-of-Network $0 copay / $30 reimbursement $0 copay / $18 reimbursement $0 copay / $28 reimbursement $85 to $110 copay / $28 reimbursement $85 to $110 copay / $28 reimbursement $130 allowance / $65 reimbursement $130 allowance / $104 reimbursement $130 allowance / $104 reimbursement $0 copay, paid in full / $210 reimbursement Up to $39 / NA 15% off retail $65 copay / $28 reimbursement $150 allowance / $75 reimbursement $150 allowance / $120 reimbursement $150 allowance / $120 reimbursement $0 copay, paid in full / $210 reimbursement $0 copay / $40 reimbursement $0 copay, 10% discount then $40 allowance / $40 reimbursement Up to $39 / NA 15% off retail Reduced Fixed Pricing 4-Tier Rates Employee Only Employee & Spouse Employee & Child(ren) Family Enrollment Employee Only Employee & Spouse Employee & Child(ren) Family Total Premium Voluntary or Non Voluntary One year rate guarantee Plan Selection 12/12/12 $130 $6.75 $14.85 $14.18 $26.33 Count $1, NV 43Vis03NV1 12/12/12 $150 $7.33 $16.13 $15.39 $28.59 Count $1, NV 43Vis05NV1 Name: Signature: Title: Date:

5 OON is reimbursement amount. Member Reimbursement Out-of-Network will be the lesser of the listed amount or the member s actual cost from the out-of-network provider. In certain states members may be required to pay the full retail rate and not the negotiated discount rate with certain participating providers. Please see EyeMed s online provider locator to determine which participating providers have agreed to the discounted rate. *Depending on which tier of Progressive lenses are selected, the pricing will be different ** Contact lens fitting and two follow-up visits are available once a comprehensive eye exam has been completed. ***when Lasik or PRK from U.S. Laser Network is used If under 5 enrolled lives, must be sold with another Nippon Life Benefit product. This Proposal is subject to underwriting approval by Nippon; coverage should not be cancelled until the application has been approved in writing. This information is intended to present only a general overview of the benefits. Not all details, limitations and exclusions are included. Nippon s standard policy provisions will apply.

6 Rate Page Summary - Cens 12/12/12 $130 Name Gender/ Age Premium Total Employee M/27 $6.75 $6.75 Employee M/33 $6.75 $6.75 Employee M/53 $14.85 $14.85 Employee M/49 $6.75 $6.75 Employee M/23 $6.75 $6.75 Employee M/31 $26.33 $26.33 Employee M/34 $26.33 $26.33 Employee M/37 $6.75 $6.75 Employee M/57 $26.33 $26.33 Employee M/57 $6.75 $6.75 Employee M/45 $14.18 $14.18 Employee F/53 $6.75 $6.75 Employee M/30 $26.33 $26.33 Employee M/53 $14.85 $14.85 Employee M/23 $0.00 $0.00 Employee M/37 $6.75 $6.75 Employee M/24 $6.75 $6.75 Employee M/45 $14.18 $14.18 Employee F/36 $14.85 $14.85 Employee M/47 $14.18 $14.18 Employee M/28 $6.75 $6.75 Employee M/63 $14.85 $14.85 Employee M/64 $14.85 $14.85 Employee M/62 $0.00 $0.00 Employee M/46 $14.85 $14.85 Employee M/29 $6.75 $6.75 Employee M/26 $0.00 $0.00 Employee M/29 $26.33 $26.33 Employee M/45 $6.75 $6.75 Employee M/54 $14.85 $14.85 Employee M/72 $0.00 $0.00 Employee M/39 $0.00 $0.00 Employee M/38 $26.33 $26.33 Employee M/66 $26.33 $26.33 Employee M/52 $14.18 $14.18 Employee M/53 $0.00 $0.00 Employee M/50 $14.18 $14.18 Employee M/64 $14.85 $14.85 Employee M/36 $0.00 $0.00 Employee M/42 $6.75 $6.75 Employee M/45 $14.18 $14.18 Employee M/34 $14.18 $14.18

7 Rate Page Summary - Cens Employee M/24 $6.75 $6.75 Employee M/53 $14.85 $14.85 Employee M/55 $6.75 $6.75 Employee M/68 $14.85 $14.85 Employee M/32 $14.18 $14.18 Employee M/33 $6.75 $6.75 Employee M/57 $26.33 $26.33 Employee F/29 $14.18 $14.18 Employee M/63 $6.75 $6.75 Employee M/44 $0.00 $0.00 Employee F/52 $6.75 $6.75 Employee M/24 $0.00 $0.00 Employee M/25 $26.33 $26.33 Employee M/54 $14.18 $14.18 Employee M/50 $6.75 $6.75 Employee M/28 $6.75 $6.75 Employee M/61 $6.75 $6.75 Employee M/56 $14.85 $14.85 Employee F/59 $26.33 $26.33 Employee M/59 $14.85 $14.85 Employee M/63 $6.75 $6.75 Employee M/49 $14.85 $14.85 Employee M/53 $6.75 $6.75 Employee M/32 $0.00 $0.00 Employee M/55 $0.00 $0.00 Employee M/26 $6.75 $6.75 Employee M/44 $26.33 $26.33 Employee M/67 $6.75 $6.75 Employee M/42 $14.18 $14.18 Employee M/39 $6.75 $6.75 Employee M/25 $6.75 $6.75 Employee M/41 $14.85 $14.85 Employee M/41 $0.00 $0.00 Employee M/31 $6.75 $6.75 Employee M/59 $14.85 $14.85 Employee M/33 $14.85 $14.85 Employee M/43 $14.18 $14.18 Employee M/40 $6.75 $6.75 Employee M/28 $26.33 $26.33 Employee M/45 $26.33 $26.33 Employee M/61 $6.75 $6.75 Employee M/56 $14.85 $14.85 Group Premium ####### $1,472.36