TN STATE SPECIFIC REQUIREMENTS
If you are covered by a Tennessee State fully-insured plan or a Tennessee State self-insured non-ERISA plan, your request for a prescription drug may require certain utilization management (UM) criteria or rules to be reviewed prior to coverage. These rules may include Step Therapy Protocol Exceptions. If your prescription is rejected, your health care provider may request an exception to the Step Therapy Protocol Exception by completing and submitting the applicable prior authorization (PA) form. Have your provider contact the CVS Caremark® Prior Authorization Department for the appropriate PA form or download the criteria form from the CVS Caremark website. As part of the authorization process, we will review the information submitted by your provider and determine if your request meets the requirements for exception based on the information received and medical necessity. Step Therapy Protocol Exception requests will be processed within 2 business days of receipt of complete clinical information
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.
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.