Proposal prepared for: New York Merchant

Transcription

1 Customizable Ancillary Benefit Solutions: Another great reason to choose Nippon Life Benefits. Proposal prepared for: New York Merchant Proposal Date: Effective Date: Sales Rep: Broker: Quote ID SIC Code: State: March 28, 2017 April 1, 2017 Cary Salkin Andrew Guarini NY 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 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, Vision 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. Dental Customizable Ancillary Benefit Options 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: 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. Vision Vision 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 Vision 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 Dental Plan Name NLB Dental 1 NLB Dental 2 Employer Contribution 75% 75% Prior Coverage (Takeover): Yes - Takeover Yes - Takeover Dental Network ADA Network ADA Network Deductible IN/OON IN/OON Type I - Preventive $0/$0 $0/$0 Type I - Copay No Copay No Copay Type II - Basic $50/$50 $50/$50 Type III - Major $50/$50 $50/$50 Family Deductible 3X 3X Deductible - Combined/Split Combined Combined Coinsurance IN/OON IN/OON Type I - Preventive 100%/100% 100%/100% Type II - Basic 80%/80% 80%/80% Type III - Major 50%/50% 50%/50% Annual Maximum (Combined) $3,000 $2,000 Child Orthodontic Benefit 50% to $1,500 None Adult Orthodontic Benefit None None Options Flouride - Children under 16 1 per 12 months 1 per 12 months Cleaning 1 every 6 months 1 every 6 months Endodontic In Basic In Basic Surgical Perio & appliances In Basic In Basic Surgical Perio & appliances 1 per 36 Months 1 per 36 Months Complex Oral Surgery In Basic In Basic Relining/Rebasing Dentures 1 per 36 Months 1 per 36 Months Reimbursement (OON) 90th Percentile 90th Percentile Rollover $750 up to $2,500 $500 up to $2,000 Add'l, $1,500 Add'l, $1,000 treshold treshold Rollover Maximum Amount $5,500 $4,000 Timely Entrant WP None None Open Enrollment Not Included Not Included Implants (Major) Covered Included Included Remove Prev from Maximum No No Dependent Age Limits To Age 26 To Age 26 4 Tier Rates 36PA013502JJ8GN56140KN 36PA013502JJ6GD06140KN Employee Only $44.67 $43.62 Employee & Spouse $ $ Employee & Child(ren) $94.71 $83.99 Family $ $ Enrollment Count Count Employee Only 4 4 Employee & Spouse 0 0 Employee & Child(ren) 1 1 Family 8 8 Monthly Total Premium $1, $1, Rate Guarantee 2 Years 2 Years Plan Selection Name: Signature: Title: Date:

5 Dental Continued Type I - Preventive Services Preventive Exams Once per 6 months Cleanings Bitewing Xrays Once per 12 months Panoramic/Full Mouth Xrays One set per 60 months Flouride treatment Dependent children under age 16 Sealants Dependent children under age 16, once per 36 months Type II - Basic Services Plan sold with Preventive Services only do not include Basic or Major Services Crowns (Stainless Steel) Only if tooth cannot be restored by filing, once per 84 months Minor Oral Surgery No limitation Oral cancer screenings Once per 24 months Periodontal prophylaxis Twice per 12 months Problem Focused Exams Extraoral Xrays Once per 6 months Occlusal/Periapical Xrays Restoration/fillings Once per 24 months Simple Extractions Space Maintainers Dependent children under age 16 Type III - Major Services Plan sold with Preventive Services only or Preventive & Basic Service only do not include Major Services Crowns (other than steel) Single restorations/fillings, once per 84 months Dentures/Bridges/Repairs Fixed once per 84 months, Removable Once per 60 months Emergency Treatment Inlays/Onlays Once per 84 months for Gold Inlays/Onlays Dental Plan Rollover Benefits (if Selected): The Rollover Benefits is established at the claimant level. As long as the total benefits paid for a member do not exceed the Threshold Amount (half the Calendar Year Amount) in any year, the member qualifies to the "rollover" benefits up to a maximum limit The additional benefit that can be accumulated under the Rollover provision is the lesser of the annual maximum or $2500. Under most programs, members would be able to double their dental maximum over time. Qualifications Applies to Diagnostic/Preventive, Basic and Major calendar year maximum. Members with fourth quarter effective dates (Oct 1 - Dec 31) begin qualifying for rollover at the beginning of the next calendar year. Members who have not met their late entrant or case level waiting premium don't qualify. Rate Assumptions The rates quoted assume 85% - 89% participation for all eligible employees The dental rates illustrated are guaranteed for two years provided that there is no change to the plan of benefits and that the number of members covered under the plan does not change by more than 25% from the number used in preparing this proposal. If Dual Plan Option is selected: Minimum case size is 10 enrolled employees. At least one employee must be enrolled in each benefit offering. This proposal presents only a brief summary of the benefit plan being quoted. For a more detailed description of the benefits, limitations and exclusions contained in the plan, a sample booklet is available upon request. 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 Basic Life Plan Name NLB Life 1 Class Description Life Benefits All Eligible Employees Flat $15,000 Maximum $15000 Bonuses and commissions are not included in annual earnings. Benefit Rounding Up to Next $1000 Accidental Death & Same as Basic: Dismemberment Standard 24-Hour Guarantee Issue up to Portability Waiver of Premium Definition Under Age 70 $50,000: Age 70+ $20,000 Not Included Waiver if disabled prior to 60, terms at normal retirement age Accelerated Death Benefits Included Except for Life Benefit of less than $10,000. Age Reduction Schedule Age 55 and younger Age 55 to 59 Age 60 to 64 Age 65 to 69 Age 70 to 74 Age 75 and older Basic Life Rate Basic AD&D Rate Rate Guarantee Basic Life Volume Monthly Premium Basic Life Basic AD&D Dependent Life Plan Selection 100% 100% 100% 75% 35% 25% $0.073 Per $1000 $0.021 Per $ Years $195,000 $14.24 $4.10 None Name: Signature: Title: Date: 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.

7 Vision NLB Vision 1 Reimbursement Schedule Maximums Examination* $50 Single Lenses** $50 Bifocal Lenses** $75 Trifocal Lenses** $100 Lenticular Lenses** $150 Contacts*** $150 Frames**** $100 * Limited to one per 12 consecutive months ** Limited to two lenses per person during any 12 consecutive months *** The maximum payment for a pair of contact lenses will be $150 if the lenses are prescribed after cataract surgery or if vision in the better eye can be corrected to 20/70 or better only by use of contact lenses. In all other cases, the maximum payment of a pair of contact lenses will be equal to the maximum payment for Single Vision Lenses plus Frames. **** Limited to one pair per person during any 24 consecutive months 4 Tier Rates NLB Vision 1 Employee Only $4.20 Employee & Spouse $10.51 Employee & Child(ren) $9.76 Family $16.07 Census Count Employee Only 13 Employee & Spouse 0 Employee & Child(ren) 0 Family 0 Total Premium $54.60 Vision must be sold with another Nippon Life Benefit product, and cannot be Voluntary. Minimum employer contribution of 50% of the employee rate is required. 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. Rate Guarantee: 1 Year Plan Selection Name: Signature: Title: Date:

8 Rate Page Summary - Census Detail Name Gender Age NLB Dental 1 NLB Vision 1 NLB Life 1 Dental Premium Vision Premium Life/AD&D Premium Total Frankel F 20 $0.00 $0.00 $0.00 $0.00 Gladstone M 38 $ $4.20 $1.41 $ Gruber M 44 $ $4.20 $1.41 $ Hernandez M 44 $94.71 $4.20 $1.41 $ Ilowitz M 36 $ $4.20 $1.41 $ Lefkowitz M 24 $0.00 $0.00 $0.00 $0.00 Myski M 31 $44.67 $4.20 $1.41 $50.28 Oberlander F 22 $44.67 $4.20 $1.41 $50.28 Pollak M 32 $ $4.20 $1.41 $ Simmonds F 32 $44.67 $4.20 $1.41 $50.28 Weiser M 55 $ $4.20 $1.41 $ Weiser M 41 $ $4.20 $1.41 $ Weiss M 37 $ $4.20 $1.41 $ Wolodarsky M 31 $44.67 $4.20 $1.41 $50.28 Zlotowitz M 40 $ $4.20 $1.41 $ Group Premium $1, $54.60 $18.33 $1,580.88