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Indiana

IN State Specific Requirements

    • A covered individual may at any time ask the health carrier for an estimate of the amount the health carrier will pay for or reimburse to a covered individual for nonemergency health care services that have been ordered for the covered individual or the applicable benefit limitations of the ordered nonemergency health care services a covered individual is entitled to receive from the health carrier. The law requires that an estimate be provided within 5 business days.
    • Applicable to:
      • Individuals insured by a Nippon Life Insurance Company of America comprehensive major medical insurance policy that is issued in Indiana and subject to Indiana law; and
      • Indiana residents insured by a Nippon Life Insurance Company of America comprehensive major medical insurance policy, irrespective of the situs state of the policy.

According to Indiana law, Nippon Life Benefits must credit toward a member's deductible and annual maximum out-of-pocket expenses any amount the member pays directly to any health care provider for a medically necessary covered health care service if:

  • A claim for the health care service is not submitted to the company; and
  • The amount paid by the covered individual to the health care provider is less than the average discounted rate for the health care service paid to a health care provider in the company’s network

To submit a claim for this credit, members must fill out a standard claim form. That form is located here: Member Service
Members may use the data on average or typical rates reported on the Indiana All Payer Claims Database (APCD) to determine the average discounted rate for a health care service. The Indiana APCD is located here: https://apcd.idoi.in.gov

SAMPLE EMPLOYER-GROUP MEDICAL INSURANCE BOOKLET-CERTIFICATES
Nippon Life Insurance Company of America® is providing prospective policyholders, members and dependents the opportunity to view sample employer-group medical insurance Booklet-Certificates.
Please note that these Booklet-Certificates are only representative samples, and do not constitute an actual insurance policy or contract. Any Booklet-Certificates actually issued may significantly vary from the samples provided based upon final plan selection and other factors. If there is any conflict between the samples provided and your issued Booklet-Certificate, the issued Booklet-Certificate will control. Sample Booklet-Certificates are subject to change.
If you are already a member, please sign in or register to view your group-specific Booklet-Certificate.
IMPORTANT NOTE:
NOTHING HEREIN IS A GUARANTEE OF BENEFITS OR ELIGIBILITY. ALL TERMS, PROVISIONS, CONDITIONS, LIMITATIONS AND EXCLUSIONS SHOWN IN YOUR ISSUED NIPPON LIFE INSURANCE COMPANY OF AMERICA BOOKLET-CERTIFICATE AND MASTER POLICY WILL GOVERN.