COVID-19 Benefit Information
Nippon Life Benefits will be covering, without cost-sharing, a covered member’s and dependent’s COVID-19 vaccination(s) regardless of in or out of network provider or pharmacy.
To receive reimbursement for the vaccine, a completed claim form must be submitted along with proof of payment and a copy of the vaccination card. Medical claim forms can be found under the member service tab on our web portal or visit www.nipponlifebenefits.com/member-service
COVID-19 booster vaccine recommendations and eligibility continue to be considered and reviewed by the FDA and CDC. We are regularly monitoring for updates regarding this topic. Please be aware that COVID-19 booster vaccines will be covered without cost sharing for all covered members who meet the requirements as they are established and authorized by the FDA and/or CDC, regardless of in or out of network provider or pharmacy.
More information about the vaccines, please refer to the Center for Disease Control’s Vaccine Information page at https://www.cdc.gov/coronavirus/2019-ncov/vaccines
Nippon Life Benefits will waive in-network and out-of-network cost-sharing (including, but not limited to, co-pays, deductibles and co-insurance) for screening and testing for COVID-19 when the purpose of the testing is for the individualized diagnosis or treatment of COVID-19. This coverage is provided without imposing any prior authorization or other medical management requirements.
Coverage also is provided for items and services furnished during an in-network or out-of-network office visit (whether in-person or using telehealth, and including facility fees), urgent care center visit, or emergency room visit that results in an order for or administration of COVID-19 testing. These items and services are covered only to the extent they relate to screening you or a covered dependent to determine if testing is needed, or for providing or administering a COVID-19 test.
Is the COVID-19 antibody test covered?
Yes. Nippon Life Benefits covers in vitro diagnostic testing to detect COVID-19 (including testing to detect antibodies against COVID-19), and the administration of these tests.
Is COVID-19 surveillance testing covered?
Unless required by state law, Nippon Life Benefits does not cover COVID-19 testing, including OTC COVID-19 tests, for general workplace health and safety, employment purposes, public health surveillance, or other purposes not primarily intended for the individual diagnosis or treatment of COVID-19.
How are COVID-19 OTC tests covered?
Nippon Life Benefits covers FDA approved, cleared or authorized OTC COVID-19 tests that are available without a physician's order or individualized clinical assessment. This coverage is provided without imposing any cost-sharing requirements, preauthorization or other medical management requirements. This applies for tests purchased before January 15th, 2022 and tests purchased on or after January 15th, 2022.
Nippon Life Benefits has implemented a program with the help of CVS/Caremark to assist our insured members with obtaining up to 8 OTC COVID-19 tests (per consecutive 30-day period) with no upfront out of pocket cost at point of service. Members can also order tests at www.CVS.com or www.Caremark.com to have shipped to their home without any out of pocket expense.
Receipts for OTC COVID-19 test kits purchased on or after January 15th, 2022 can be submitted to CVS Caremark for reimbursement. Tests not purchased through this program (via CVS/Caremark) will be subject to a $12 reimbursement (as of 4/1/2022)
COVID-19 OTC Test Coverage FAQs:
Are there preferred pharmacies where I can get OTC COVID-19 tests without paying upfront?
Yes. Members can obtain an OTC COVID-19 test with no upfront out of pocket cost simply by presenting their prescription benefit ID card to any in network pharmacy that is participating in this program. Please confirm with your pharmacy whether they are participating in the CVS/Caremark program.
How do I submit a claim to CVS/Caremark for reimbursement up to the 8 tests per individual per consecutive 30 day maximum purchased after January 15th, 2022?
To submit a claim electronically, please follow the below steps:
- Log into the Nippon Life Benefits’ Member Portal.
- If you have not yet registered on our portal, you will have to do so in order to file your claim.
- Once logged into the portal, there is a section on the dashboard called My Links. Click on the CVS Pharmacy Network link which will take you directly to the CVS/Caremark website.
- Visit the Plan & Benefits tab and select “Submit Prescription Claim.” If you’re eligible, you will see a link on the page that reads “Submit at-home COVID-19 test reimbursement claim.”
For more detailed steps and screenshots about submitting an online claim, please view this document.
For tests purchased before January 15th, 2022 please refer to question #4 below.
To submit a claim via mail to CVS/Caremark, please follow the steps on the claim reimbursement form which can be found here.
What if my physician indicates I need additional OTC Tests in excess of the 8 tests per individual per consecutive 30 day maximum?
Additional testing benefits may be available under your medical plan for reimbursement beyond the 8 tests per individual per consecutive 30 day maximum. OTC COVID-19 tests, ordered by a physician, in addition to the 8 tests per individual per consecutive 30 day maximum can be submitted directly to Nippon Life Benefits.
To submit a claim, please follow the steps above.
It is important to be reminded that unless required by state law, Nippon Life Benefits does not cover COVID-19 testing, including OTC COVID-19 tests, for general workplace health and safety, employment purposes, public health surveillance, or other purposes not primarily intended for the individual diagnosis or treatment of COVID-19 even with a physician’s order.
How much will I be reimbursed for an OTC COVID-19 test if I purchase the test upfront and then submit a claim for reimbursement?
If you purchase an OTC COVID-19 test from a pharmacy, store, or online retailer and are charged for your test, keep your receipt and submit a claim for reimbursement and you will be reimbursed the amount of the cost of the test. Tests not purchased through the program mentioned above (via CVS/Caremark) will be subject to a $12 reimbursement (as of 4/1/2022)
What if I already bought and paid for at-home over-the-counter COVID-19 tests? Can I still get reimbursement for those?
Yes, claims are eligible for reimbursement. Your Nippon Life Benefits plan has been providing such coverage for at-home OTC COVID-19 tests purchased before January 15th as a part of its COVID 19 testing coverage. For tests purchased PRIOR to January 15, 2022, please submit the claim directly to Nippon Life Benefits. Please refer to the instructions above for claim submission of tests purchased on or after January 15, 2022.
What if I buy more than one COVID-19 OTC test at a time?
Your Nippon Life Benefits plan will provide reimbursement for 8 tests per consecutive 30-day period for each individual on the plan, regardless of whether the tests are bought all at once or at separate times throughout the month.
You can also order four free OTC COVID-19 tests from the federal government. You can visit their website here.
For the treatment of those insureds that may not need a hospital stay, we will also cover the treatment of COVID-19 in accordance with and governed by the insured person’s Nippon Life Benefit’s booklet-certificate and applicable law - notably, if we do not have a health care provider in an insured person’s network with the appropriate training and experience to meet the particular health care needs of the insured, an insured may visit an out-of-network provider at the in-network cost-sharing level, in accordance with the insured person’s booklet-certificate.
Changes to FSA/HSA Eligible Expenses
The CARES act includes a permanent change that allows for purchase of over-the-counter medications and feminine hygiene products using your flexible spending account (FSA), health reimbursement arrangement (HRA), or health savings account (HSA). A prescription is no longer needed for reimbursement. This change is effective for expenses incurred on or after January 1, 2020. Please allow time for these changes to be reflected at local retailers. If you have difficulties at time of purchase, you can manually submit your claim(s) for reimbursement by using the www.nipponlifebenefits.com link, or mail to:
Nippon Life Benefits
P.O. Box 2968
Clinton, IA 52733
The provision allowing for no cost share of telemedicine visits has concluded on 3/31/2021 unless otherwise noted in state-specific mandates. For details regarding telemedicine and how it relates to your specific plan coverage including state-specific mandates, please contact the Customer Service number on your ID card.
Short Term Disability Eligibility
COVID-19 related illnesses are handled the same as any other illness and will be considered according to the applicable plan provisions. The Families First Coronavirus Response Act (FFCRA) requires certain employers to provide employees with paid sick leave or expanded family and medical leave for specified reasons related to COVID-19.
Nippon Life Benefits’ short term disability benefits will be coordinated accordingly, as long as the employee meets the disability requirements as designated by their plan coverage.
In order to prevent delays in claims processing, Nippon Life Benefits asks for a completed Disability Claim form which can be found at https://www.nipponlifebenefits.com/member-service
* some OTC COVID-19 tests are sold in packages containing more than one test. In applying the quantity limit of 8, plans and issuers may count each test separately, even if multiple tests are sold in one package.
Premium Payment Leniency
Our current premium payment policy will remain in place and includes a 31-day grace period, but allows 60 days to make the payment prior to cancellation. We are in compliance with applicable law and regulatory mandates regarding COVID-19 and will continue to closely monitor updates that may be enacted related to this concern for premium payment extension. If you have specific needs or requests, please contact us directly with specific information so that we can clearly understand any business impact needs you may have.
For groups in New Jersey, please follow the link below in reference to Executive Order 123 and emergency grace period protections. https://www.nipponlifebenefits.com/new-jersey-emergency-grace-period/
Lay-offs Due to COVID-19
Nippon Life Benefits has waived the coverage requirement that employees must be actively working in order to receive benefits under the condition that the monthly premium payment is received. That provision has concluded on June 30, 2021.
Enrollment Changes Due to COVID-19
If you had continued paying premium for non-active employees, the time period ended June 30, 2021. Please report all non-active employees as terminated as of 6/30/2021, as they are no longer eligible for continuation. Please submit through our web portal at www.nipponlifebenefits.com or email to email@example.com or fax directly to 913-387-5920.
If you have non-COVID-19 specific eligibility updates, please submit through our web portal at www.nipponlifebenefits.com or email to firstname.lastname@example.org or fax directly to 913-387-5920.
Continuation of Coverage
Employees have options for continuation of coverage. Employees may elect to continue coverage under COBRA or any applicable State Continuation programs by following standard notice and election procedures as long as one person remains actively employed. Please refer to your contact/booklet for details on these requirements. However, if there is not a single active employee, the plan is terminated and COBRA and/or State Continuation programs are not an option.
Nippon Life Benefits has waived the waiting period requirement for furloughed employees who were rehired through June 30, 2021. This provision will not be extended.
For furloughed employees, if the plan requires the person to complete a waiting period, furloughed days will contribute to the overall waiting period for medical coverage. However, for ancillary coverages, furloughed days will not contribute to the eligibility waiting period.
Short-Term Disability Claims
The Families First Coronavirus Response Act (FFCRA) requires certain employers to provide employees with paid sick leave or expanded family and medical leave for specified reasons related to COVID-19. Nippon Life Benefits’ short term disability benefits will be coordinated accordingly, as long as the employee meets the disability requirements as designated by their plan coverage.
In order to prevent delays in claims processing, Nippon Life Benefits asks for a completed Disability Claim form which can be found at:
Nippon Life Insurance Company of America is continuously monitoring, and implementing policy and procedures to comply with, applicable federal and state law and directives related to the COVID-19 pandemic. This information is subject to change, at any time and without notice, by Nippon Life Insurance Company of America. Further, the policies and procedures summarized herein may vary based upon your policy situs state and/or state of residence. Please contact Customer Service for additional details. This material and information is intended for informational purposes only – the material and information provided on this website does not, and is not intended to, constitute legal or medical advice.