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NJ STATE SPECIFIC REQUIREMENTS

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NJ STATE SPECIFIC REQUIREMENTS

  • ESTIMATE OUT-OF-NETWORK OUT-OF-POCKET COSTS

Nothing herein is a guarantee of benefits or eligibility. All terms, provisions, conditions, limitations and exclusions shown in your Nippon Life Insurance Company of America certificate booklet and master policy will govern.

You may estimate your anticipated out-of-pocket costs for out-of-network covered medical services by contacting your provider for the amount that he/she will charge, or by visiting *www.fairhealthconsumer.org to determine the usual and customary cost for these services in your geographic area or zip code, and comparing it to our estimated payment - you may contact us at 1-800-374-1835 to request our estimated payment for a specific out-of-network service covered under your plan.

Please note that these payment amounts and charges are only an estimate based on the information submitted and not a guaranteed amount. Your actual out-of-pocket costs may differ based on a number of factors, including, for example, your actual plan provisions and benefits, your eligibility, the actual services provided to you, whether the services are covered by your plan, whether the services are medically necessary, the procedure codes submitted by your provider, whether other providers render services to you, the location of the services, your cost-sharing requirements, or other variables that may impact the cost of services. Also, even though your provider may bill separately for multiple procedure codes, we may determine that there is a single code that should have been billed for all of the procedures and we will pay for only that code. At all times, all terms, provisions, conditions, limitations and exclusions shown in your certificate-booklet and master policy will apply and govern.

*Please note that this link (www.fairhealthconsumer.org ) is being provided for informational purposes only, and does not constitute an endorsement or approval by Nippon Life Insurance Company of America as to any of the opinions of FAIR Health, Inc. Nippon Life Insurance Company of America bears no responsibility for the accuracy, legality or content of this external site or for that of any subsequent links.


DISCLAIMERS

Please note that any out-of-pocket amounts shown are only an estimate and not a guaranteed amount. Your actual out-of-pocket costs may differ based on a number of factors, including, for example, your actual plan provisions and benefits, your eligibility, the actual services provided to you, whether the services are covered by your plan, whether the services are medically necessary, the procedure codes submitted by your provider, whether other providers render services to you, the location of the services, your cost-sharing requirements, or other variables that may impact the cost of services. Also, even though your provider may bill separately for multiple procedure codes, we may determine that there is a single code that should have been billed for all of the procedures, and we will pay for only that code.

NOTHING HEREIN IS A GUARANTEE OF BENEFITS OR ELIGIBILITY. ALL TERMS, PROVISIONS, CONDITIONS, LIMITITATIONS AND EXCLUSIONS SHOWN IN YOUR NIPPON LIFE INSURANCE COMPANY OF AMERICA CERTIFICATE AND MASTER POLICY WILL GOVERN.

THIS INFORMATION IS PROVIDED FOR GENERAL INFORMATIONAL PURPOSES ONLY AND IS NOT INTENDED TO OFFER LEGAL, TAX, BENEFITS, MEDICAL OR ANY OTHER PROFESSIONAL ADIVICE.

 

 

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.