Prescription weight loss medications are eligible for coverage. Please note, specific criteria will apply for Prior Authorization (PA) requirements related to weight loss medications. This change is allowed for all NY clients and membership regardless of the individual client's renewal dates. Updated documents will be posted shortly.

Drug List/Formulary – Q3 2025 NY – For groups with renewal dates of 7/1/25, 8/1/25, and 9/1/2025

Drug List/Formulary – Q4 2025 NY - For groups with renewal dates of 10/1/2025, 11/1/2025 and 12/1/2025

Drug List/Formulary Q1 2026 NY – For groups with renewal dates of 1/1/2026, 2/1/2026 and 3/1/2026

Drug List/Formulary – Q2 2026 NY – For groups with renewal dates of 4/1/2026, 5/1/2026, and 6/1/2026

Drug List/Formulary – Q3 2026 NY – For groups with renewal dates of 7/1/26 and later

Specific Drug Listings for Texas group contracts:

2026

Available upon each group's 2026 renewal

Drug List/Formulary – 2026 TX

Prior Authorization and Specialty RX Guidelines – 2026 TX

Notice of Changes – 2026 TX

Prior Authorization Request Form for Prescription Drug Benefits - TX

2025

Available upon each group's 2025 renewal

Drug List/Formulary – 2025 TX

Prior Authorization and Specialty RX Guidelines – 2025 TX

Notice of Changes – 2025 TX

Prior Authorization Request Form for Prescription Drug Benefits - TX

Medical Provider Networks: Network information is available on the member ID card.

Member Guide: Aetna Medical Provider Network

Share this guide with medical providers if they have questions about network, eligibility & claims

Provider Guide to Network, Eligibility and Claims

Dental Provider Networks: Network information is available on the member ID card.

Member Guide: Aetna Dental Administrators AND Maximum Care plus Connection Dental Network

Member Guide: Aetna Dental Administrators ONLY

Share these guides with dental providers if they have questions about network, eligibility & claims

Provider Guide to Network, Eligibility and Claims: Aetna

Provider Guide to Network, Eligibility and Claims: Network Access

Flu Shot Program

Flu shots made easy! Review below to learn more.

Flu Shot Program 2026-2027

Flu Shot Program 2026-2027 (Japanese)

Flu Shot Program 2026-2027 (Spanish)

State-specific Requirements:

Claim forms:

Looking for a claim form? You may print or download one of the following forms to use.

Claim Payment Overview

Standard Claim Forms

CVS Caremark Prescription Reimbursement Claim Form

FSA Request for Reimbursement Form

Limited Purpose FSA Claim Form

Member or Members Dependent Authorization for Disclosure of Health Information

Aetna International Claim Form

Medical

Medical Claim Form

Medical Claim Form - CA

Member or Members Dependent Authorization for Disclosure of Health Information

Ningen Dock Claim Form

Aetna International Ningen Dock Claim Form (ONLY FOR CLAIMS FOIR SERVICES PROVIDED OUTSIDE OF THE USA)

Aetna International Claim Form

Dental

Dental Claim Form

Dental Claim Form - CA

Dental Claim Form - NJ

Member or Members Dependent Authorization for Disclosure of Health Information

Vision

Vision Claim Form

Vision Claim Form - CA

EyeMed Vision Care Out of Network Claim Form

Life

Life Insurance Claim Form

Life Insurance Beneficiary Quick Reference Guide

Life Insurance Beneficiary Designation/Change Form

Life Insurance Community Property Consent Form

Life Insurance Affidavit

Disability

Disability Claim Form

Continuance of Disability Form

Why Precertification?

For hospital admissions, some outpatient procedures, and some medications, Nippon Life Benefits requires precertification. This process helps to reduce unnecessary medical expenses and ensure coverage is available should you or a family member require inpatient or outpatient care.

Member Requirements

Depending on your benefit program, failure to obtain precertification may result in reduced benefits. Please check your benefit booklet-certificate for details. Your benefit booklet-certificate can be found on the member portal. Keep in mind that all eligible services are subject to medical necessity requirements and plan provisions.

If you or a family member are in need of care, members should call the number located on the back of their benefits card.

Outpatient

View the list of outpatient services that require precertification, as well as FAQs about the outpatient precertification process.

Inpatient

Non-Emergency Stays

You, a family member, your doctor, or facility must call the Precertification number on the back of your ID card prior to any stay. Please be prepared to provide your benefits program ID number, the patient’s name, a reason for admission, the date of expected admissions, the doctor’s name and phone number, and the facility’s name and phone number. The utilization review staff considers the patient’s condition and proposed treatment plan to determine the number of days authorized for stay.

Emergencies

If you or a family member is admitted due to an emergency, you must call the precertification number on the back of your ID card within two working days of admission.

Maternity Delivery

New mothers and newborns receive automatic authorization for a minimum 48-hour stay including the day of delivery for a normal delivery or a minimum 96-hour stay including day of delivery for a caesarian section. If a longer stay is medically necessary, the patient or their representative must call before the end of the authorized time frame.

Please Note: The member or the provider can call for precertification.