Dental Rate Card Kentucky Group Size Areas 1-3 Effective Dates 10/1/ /15/2017

Transcription

1 Dental Rate Card Kentucky Group Size Areas 1-3 Effective Dates 10/1/ /15/2017 NLB

2 KENTUCKY - Rate Area 1: 400,401,403,404,407,408,409,411,412,413,414,415,416,417,418,419,420,421,422,423,424,425,426,427,428,429 All Plans are customizabale down to 2 enrolled lives. Rates assume prior coverage. For additional information please contact your sales representative below. Effective dates 10/1/ /15/2017 OPTION 1 OPTION 2 OPTION 3 OPTION 4 OPTION 5 DEDUCTIBLE (ind/fam) $50/$150 $50/$150 $50/$150 $0/$50* $0/$50* PREVENTIVE 100/ / /10 100/50 100/50 BASIC 100/100 80/80 100/10 100/50 NC MAJOR 100/100 50/50 50/10 NC NC UCR 90th 90th 90th 60th 60th ORTHO (optional) 50% to $ % to $ % to $1000 N/A N/A TIER RATES BY ANNUAL MAXIMUMS (without Orthodontia) $1,000 $1,500 $2,000 $1,000 $1,500 $2,000 $1,000 $1,500 $2,000 $500 $1,000 $500 EMPLOYEE (EE) $38.91 $42.86 $44.66 $28.83 $31.76 $33.09 $18.38 $19.76 $20.37 $13.44 $15.50 $6.98 EMPLOYEE/ SPOUSE (ES) $79.61 $87.71 $91.38 $58.99 $64.99 $67.71 $37.62 $40.43 $41.67 $27.49 $31.71 $14.27 EMPLOYEE/CHILD(ren) (EC) $91.73 $ $ $67.98 $74.89 $78.02 $43.35 $46.59 $48.02 $31.68 $36.54 $16.45 FAMILY (FF) $ $ $ $98.11 $ $ $62.56 $67.25 $69.31 $45.73 $52.74 $23.74 TIER RATES BY ANNUAL MAXIMUMS (with Orthodontia) EMPLOYEE (EE) $38.91 $42.86 $44.66 $28.83 $31.76 $33.09 $18.38 $19.76 $20.37 N/A N/A N/A EMPLOYEE/ SPOUSE (ES) $79.61 $87.71 $91.38 $58.99 $64.99 $67.71 $37.62 $40.43 $41.67 N/A N/A N/A EMPLOYEE/CHILD(ren) (EC) $96.38 $ $ $72.62 $79.54 $82.67 $47.94 $51.19 $52.62 N/A N/A N/A FAMILY (FF) $ $ $ $ $ $ $68.29 $72.98 $75.04 N/A N/A N/A PLAN OPTIONS 60 UCR N/A N/A ENDO/PERIO TO BASIC N/A N/A N/A * Deductibles for these plans are for In/Out of Network services, not ind/fam. DENTAL RATE CARD UNDERWRITING ASSUMPTIONS Contributory plans require at least 50% employer contribution Deductible applies to basic and major services only (except for option 4 and 5) Dependents are covered to age 26 Orthodontia is limited to children under age 19 Rates guaranteed for 12 months Includes Implants Includes Rollover Includes Open Enrollment Includes Aetna Dental Administrators Network Groups without Prior Coverage Load 8% to the rate (except option 4 and 5) $2,000 max not available QUESTIONS? Contact your Nippon Life Benefits Sales Representative TODAY! Visit our website for more information:

3 NIPPON LIFE BENEFITS: DELIVERING INNOVATIVE EMPLOYEE BENEFITS FOR MORE THAN 25 YEARS. Nippon Life Benefits is proud to serve clients in the 2+ life marketplace and provide a full suite of benefit options: Dental, Vision, Life, and Disability. Our strength and stability is proven with an AM Best rating of A- (Janaury 2017). We are a subsidiary of Nippon Life Insurance Company in Japan, the largest Life Insurer in Japan with over $520 billion in assets and is ranked #111 in the Global Fortune 500 (July 2017). Our foundational values are built with Harmony, Honor, and Humanity and are integrated into everything we do. SIC ADJUSTMENT KEY: 43xx US Postal Service 58xx Restaurants 63xx 64xx 66xx 67xx Insurance Carriers and Agencies Investments and Banking 70xx Hotels and Motels 72xx 95xx 96xx Laundry, Photo Studios, Beauty Shops, Shoe Repair, Funeral Services, and Tax Returns Financial Services 55xx Automobile Sales and Service xx Communications 83xx 84xx 87xx Social Services Museums, Art Galleries Accounting, Publications, Engineering, Architecture, Research and Development 92xx Police, Public Protection, Fire 93xx 94xx Taxation, Finance, Economic Programs 65xx Real Estate 78xx 79xx 81xx 82xx Motion Pictures Entertainers, Amusements, Recreation, Sports Teams Legal Services Education 91xx Executive and Legislation All Other % % -99% % - 64% 2 50% -59% % - 49% % - 44% TO CALCULATE YOUR MONTHLY RATE: 1. Using your business zip code, confirm the correct Rating Area is being used. 2. After you have chosen your plan, write Tier Rates (EE, ES, EC and FF) into column Using our SIC Code List (nature of business), insert SIC Factor in column To modify Plan Options: Insert UCR Factor in column 3 Insert Perio/Endo Factor in column 4 Insert Participation Factor in column 5 Use 1.0 as default factor in columns 3 and/or 4 if not modifying Plan Options 5. Based on census, complete # Enrolled column and calculate the Monthly Totals. NOTE: Groups without prior coverage, load 8% to the rate. CALCULATION WORKSHEET Tier Rate SIC Factor UCR Factor Perio/Endo Factor Participation Factor Total Rate # Enrolled Monthly Total EXAMPLE $30 x x 1.00 x 1.03 x 2 = $33.22 x 5 = $ EE: x x x x = x = ES: x x x x = x = EC: x x x x = x = FF: x x x x = x = Total: Dental Policy Series NP700 1 (J), et al, and Booklet Certificate Series NBD100-1 (J), et al is underwritten by - 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 ). Nippon Life Benefits is responsible for its own financial condition and contractual obligations. Nothing herein is a guarantee of benefits or eligibility. All terms, provisions, conditions, limitations and exclusions shown in your Nippon Life Insurance Company of America certificate booklet and master policy will govern. These product features are subject to change by us without notice, and may vary by state and/or market-segment. Additional underwriting rules and/or policies may also apply. NLB (8/17)

4 KENTUCKY - Rate Area 2: 402 All Plans are customizabale down to 2 enrolled lives. Rates assume prior coverage. For additional information please contact your sales representative below. Effective dates 10/1/ /15/2017 OPTION 1 OPTION 2 OPTION 3 OPTION 4 OPTION 5 DEDUCTIBLE (ind/fam) $50/$150 $50/$150 $50/$150 $0/$50* $0/$50* PREVENTIVE 100/ / /10 100/50 100/50 BASIC 100/100 80/80 100/10 100/50 NC MAJOR 100/100 50/50 50/10 NC NC UCR 90th 90th 90th 60th 60th ORTHO (optional) 50% to $ % to $ % to $1000 N/A N/A TIER RATES BY ANNUAL MAXIMUMS (without Orthodontia) $1,000 $1,500 $2,000 $1,000 $1,500 $2,000 $1,000 $1,500 $2,000 $500 $1,000 $500 EMPLOYEE (EE) $42.22 $46.51 $48.46 $31.28 $34.47 $35.91 $19.95 $21.44 $22.10 $14.58 $16.82 $7.57 EMPLOYEE/ SPOUSE (ES) $86.39 $95.17 $99.16 $64.02 $70.52 $73.48 $40.82 $43.88 $45.22 $29.84 $34.41 $15.49 EMPLOYEE/CHILD(ren) (EC) $99.54 $ $ $73.76 $81.26 $84.66 $47.04 $50.56 $52.11 $34.38 $39.65 $17.85 FAMILY (FF) $ $ $ $ $ $ $67.89 $72.97 $75.21 $49.62 $57.24 $25.76 TIER RATES BY ANNUAL MAXIMUMS (with Orthodontia) EMPLOYEE (EE) $42.22 $46.51 $48.46 $31.28 $34.47 $35.91 $19.95 $21.44 $22.10 N/A N/A N/A EMPLOYEE/ SPOUSE (ES) $86.39 $95.17 $99.16 $64.02 $70.52 $73.48 $40.82 $43.88 $45.22 N/A N/A N/A EMPLOYEE/CHILD(ren) (EC) $ $ $ $78.81 $86.31 $89.71 $52.03 $55.55 $57.10 N/A N/A N/A FAMILY (FF) $ $ $ $ $ $ $74.11 $79.19 $81.43 N/A N/A N/A PLAN OPTIONS 60 UCR N/A N/A ENDO/PERIO TO BASIC N/A N/A N/A * Deductibles for these plans are for In/Out of Network services, not ind/fam. DENTAL RATE CARD UNDERWRITING ASSUMPTIONS Contributory plans require at least 50% employer contribution Deductible applies to basic and major services only (except for option 4 and 5) Dependents are covered to age 26 Orthodontia is limited to children under age 19 Rates guaranteed for 12 months Includes Implants Includes Rollover Includes Open Enrollment Includes Aetna Dental Administrators Network Groups without Prior Coverage Load 8% to the rate (except option 4 and 5) $2,000 max not available QUESTIONS? Contact your Nippon Life Benefits Sales Representative TODAY! Visit our website for more information:

5 NIPPON LIFE BENEFITS: DELIVERING INNOVATIVE EMPLOYEE BENEFITS FOR MORE THAN 25 YEARS. Nippon Life Benefits is proud to serve clients in the 2+ life marketplace and provide a full suite of benefit options: Dental, Vision, Life, and Disability. Our strength and stability is proven with an AM Best rating of A- (Janaury 2017). We are a subsidiary of Nippon Life Insurance Company in Japan, the largest Life Insurer in Japan with over $520 billion in assets and is ranked #111 in the Global Fortune 500 (July 2017). Our foundational values are built with Harmony, Honor, and Humanity and are integrated into everything we do. SIC ADJUSTMENT KEY: 43xx US Postal Service 58xx Restaurants 63xx 64xx 66xx 67xx Insurance Carriers and Agencies Investments and Banking 70xx Hotels and Motels 72xx 95xx 96xx Laundry, Photo Studios, Beauty Shops, Shoe Repair, Funeral Services, and Tax Returns Financial Services 55xx Automobile Sales and Service xx Communications 83xx 84xx 87xx Social Services Museums, Art Galleries Accounting, Publications, Engineering, Architecture, Research and Development 92xx Police, Public Protection, Fire 93xx 94xx Taxation, Finance, Economic Programs 65xx Real Estate 78xx 79xx 81xx 82xx Motion Pictures Entertainers, Amusements, Recreation, Sports Teams Legal Services Education 91xx Executive and Legislation All Other % % -99% % - 64% 2 50% -59% % - 49% % - 44% TO CALCULATE YOUR MONTHLY RATE: 1. Using your business zip code, confirm the correct Rating Area is being used. 2. After you have chosen your plan, write Tier Rates (EE, ES, EC and FF) into column Using our SIC Code List (nature of business), insert SIC Factor in column To modify Plan Options: Insert UCR Factor in column 3 Insert Perio/Endo Factor in column 4 Insert Participation Factor in column 5 Use 1.0 as default factor in columns 3 and/or 4 if not modifying Plan Options 5. Based on census, complete # Enrolled column and calculate the Monthly Totals. NOTE: Groups without prior coverage, load 8% to the rate. CALCULATION WORKSHEET Tier Rate SIC Factor UCR Factor Perio/Endo Factor Participation Factor Total Rate # Enrolled Monthly Total EXAMPLE $30 x x 1.00 x 1.03 x 2 = $33.22 x 5 = $ EE: x x x x = x = ES: x x x x = x = EC: x x x x = x = FF: x x x x = x = Total: Dental Policy Series NP700 1 (J), et al, and Booklet Certificate Series NBD100-1 (J), et al is underwritten by - 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 ). Nippon Life Benefits is responsible for its own financial condition and contractual obligations. Nothing herein is a guarantee of benefits or eligibility. All terms, provisions, conditions, limitations and exclusions shown in your Nippon Life Insurance Company of America certificate booklet and master policy will govern. These product features are subject to change by us without notice, and may vary by state and/or market-segment. Additional underwriting rules and/or policies may also apply. NLB (8/17)

6 KENTUCKY - Rate Area 3: 405,406,410 All Plans are customizabale down to 2 enrolled lives. Rates assume prior coverage. For additional information please contact your sales representative below. Effective dates 10/1/ /15/2017 OPTION 1 OPTION 2 OPTION 3 OPTION 4 OPTION 5 DEDUCTIBLE (ind/fam) $50/$150 $50/$150 $50/$150 $0/$50* $0/$50* PREVENTIVE 100/ / /10 100/50 100/50 BASIC 100/100 80/80 100/10 100/50 NC MAJOR 100/100 50/50 50/10 NC NC UCR 90th 90th 90th 60th 60th ORTHO (optional) 50% to $ % to $ % to $1000 N/A N/A TIER RATES BY ANNUAL MAXIMUMS (without Orthodontia) $1,000 $1,500 $2,000 $1,000 $1,500 $2,000 $1,000 $1,500 $2,000 $500 $1,000 $500 EMPLOYEE (EE) $45.58 $50.22 $52.32 $33.78 $37.21 $38.77 $21.54 $23.15 $23.86 $15.74 $18.16 $8.17 EMPLOYEE/ SPOUSE (ES) $93.27 $ $ $69.11 $76.14 $79.33 $44.07 $47.37 $48.82 $32.21 $37.15 $16.72 EMPLOYEE/CHILD(ren) (EC) $ $ $ $79.64 $87.73 $91.41 $50.78 $54.58 $56.25 $37.12 $42.81 $19.27 FAMILY (FF) $ $ $ $ $ $ $73.29 $78.78 $81.19 $53.57 $61.79 $27.81 TIER RATES BY ANNUAL MAXIMUMS (with Orthodontia) EMPLOYEE (EE) $45.58 $50.22 $52.32 $33.78 $37.21 $38.77 $21.54 $23.15 $23.86 N/A N/A N/A EMPLOYEE/ SPOUSE (ES) $93.27 $ $ $69.11 $76.14 $79.33 $44.07 $47.37 $48.82 N/A N/A N/A EMPLOYEE/CHILD(ren) (EC) $ $ $ $85.08 $93.18 $96.85 $56.17 $59.97 $61.64 N/A N/A N/A FAMILY (FF) $ $ $ $ $ $ $80.01 $85.50 $87.91 N/A N/A N/A PLAN OPTIONS 60 UCR N/A N/A ENDO/PERIO TO BASIC N/A N/A N/A * Deductibles for these plans are for In/Out of Network services, not ind/fam. DENTAL RATE CARD UNDERWRITING ASSUMPTIONS Contributory plans require at least 50% employer contribution Deductible applies to basic and major services only (except for option 4 and 5) Dependents are covered to age 26 Orthodontia is limited to children under age 19 Rates guaranteed for 12 months Includes Implants Includes Rollover Includes Open Enrollment Includes Aetna Dental Administrators Network Groups without Prior Coverage Load 8% to the rate (except option 4 and 5) $2,000 max not available QUESTIONS? Contact your Nippon Life Benefits Sales Representative TODAY! Visit our website for more information:

7 NIPPON LIFE BENEFITS: DELIVERING INNOVATIVE EMPLOYEE BENEFITS FOR MORE THAN 25 YEARS. Nippon Life Benefits is proud to serve clients in the 2+ life marketplace and provide a full suite of benefit options: Dental, Vision, Life, and Disability. Our strength and stability is proven with an AM Best rating of A- (Janaury 2017). We are a subsidiary of Nippon Life Insurance Company in Japan, the largest Life Insurer in Japan with over $520 billion in assets and is ranked #111 in the Global Fortune 500 (July 2017). Our foundational values are built with Harmony, Honor, and Humanity and are integrated into everything we do. SIC ADJUSTMENT KEY: 43xx US Postal Service 58xx Restaurants 63xx 64xx 66xx 67xx Insurance Carriers and Agencies Investments and Banking 70xx Hotels and Motels 72xx 95xx 96xx Laundry, Photo Studios, Beauty Shops, Shoe Repair, Funeral Services, and Tax Returns Financial Services 55xx Automobile Sales and Service xx Communications 83xx 84xx 87xx Social Services Museums, Art Galleries Accounting, Publications, Engineering, Architecture, Research and Development 92xx Police, Public Protection, Fire 93xx 94xx Taxation, Finance, Economic Programs 65xx Real Estate 78xx 79xx 81xx 82xx Motion Pictures Entertainers, Amusements, Recreation, Sports Teams Legal Services Education 91xx Executive and Legislation All Other % % -99% % - 64% 2 50% -59% % - 49% % - 44% TO CALCULATE YOUR MONTHLY RATE: 1. Using your business zip code, confirm the correct Rating Area is being used. 2. After you have chosen your plan, write Tier Rates (EE, ES, EC and FF) into column Using our SIC Code List (nature of business), insert SIC Factor in column To modify Plan Options: Insert UCR Factor in column 3 Insert Perio/Endo Factor in column 4 Insert Participation Factor in column 5 Use 1.0 as default factor in columns 3 and/or 4 if not modifying Plan Options 5. Based on census, complete # Enrolled column and calculate the Monthly Totals. NOTE: Groups without prior coverage, load 8% to the rate. CALCULATION WORKSHEET Tier Rate SIC Factor UCR Factor Perio/Endo Factor Participation Factor Total Rate # Enrolled Monthly Total EXAMPLE $30 x x 1.00 x 1.03 x 2 = $33.22 x 5 = $ EE: x x x x = x = ES: x x x x = x = EC: x x x x = x = FF: x x x x = x = Total: Dental Policy Series NP700 1 (J), et al, and Booklet Certificate Series NBD100-1 (J), et al is underwritten by - 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 ). Nippon Life Benefits is responsible for its own financial condition and contractual obligations. Nothing herein is a guarantee of benefits or eligibility. All terms, provisions, conditions, limitations and exclusions shown in your Nippon Life Insurance Company of America certificate booklet and master policy will govern. These product features are subject to change by us without notice, and may vary by state and/or market-segment. Additional underwriting rules and/or policies may also apply. NLB (8/17)