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 screen and testing for COVID-19, including the antibody test. This waiver of cost sharing also applies to FDA-approved home test kits, in-network and out-of-network hospital, emergency department, urgent care and provider office visits where the purpose of the visit is to be screened and/or tested for COVID-19.
Through July 31st, Nippon Life Benefits will be waiving cost sharing for surveillance testing, which is testing used for public health or social purposes such as employment (return to workplace), education, travel, or entertainment. This provision amendment will expire on July 31st, after which only medically necessary testing will be covered.
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