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Etori U.S.A., Inc.
Presented by:
2
Sumitomo Life Insurance Agency America, Inc.
Effective May 1, 2011:
• Insurance carrier remained the same:
Medical – Nippon Life Insurance
• Insurance carrier changed:
Dental – Nippon Life Insurance
Life/AD&D – Nippon Life Insurance
Disability - Nippon Life Insurance
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Sumitomo Life Insurance Agency America, Inc.
Aging population who are staying in the work place longer;
Advances in medical technology;
Inflation or Health Care Trend;
Government regulations; health care reform changes in 2010 including extension of dependent age to age 26, 100% coverage for preventive services, no pre-existing condition exclusions for children to age 19 and no longer any lifetime benefit maximum.
Larger volumes of prescription drugs and expensive bio-tech drugs;
Over-utilization of health care services (e.g. office visits, ER visits, etc.);
Changes in Health Status – More Chronic Diseases (e.g. Cancers, Diabetes, Heart Disease, Asthma, Obesity)
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Sumitomo Life Insurance Agency America, Inc.
Plan Type Employee Premium
Medical Employee onlyEE+SP and / or Dependants
10%50%
Dental Employee onlyEE+SP and / or Dependants
10%50%
Short Term Disability
Employee only 50%
Basic term Life
Employee only(All Employee are Eligible Automatically)
0%
AD & D Employee only(All Employee are Eligible Automatically)
0%
An employee will be eligible for the insurance benefits after 3 months of his/ her hire date . Insurance plans and the contribution percentages offered for employee at Etori USA , Inc. are as follows
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Sumitomo Life Insurance Agency America, Inc.
Monthly premium
MEDICAL
Monthly premium
DENTAL
Monthly premium
SHORT TERMDISABILITY
Monthly premium
BASIC TERMLIFE
Monthly premium
AD&D
MonthlyPremium
Total
Employee Only
$29 $2.9 Weekly salary / $10 X $0.40 x 12 /52 = -50%
$0 $0 $31.90 +
STD
Employee + Spouse
$86 $6.9 N/A N/A $92.90 +
STD
Employee + Child(ren)
$66 $5.6 N/A N/A $71.60 +
STD
Family $122 $9.2 N/A N/A $131.20 +
STD
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Sumitomo Life Insurance Agency America, Inc.
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Sumitomo Life Insurance Agency America, Inc.
What you can do to save MONEY!What you can do to save MONEY!
Use IN-NETWORK providers whenever possible – Medical & Dental
Request GENERIC DRUGS
Utilize MAIL ORDER PRESCRIPTION DRUGS
PRECERTIFY all inpatient visits & procedures
Request DENTAL PREDETERMINATION LETTER
Ask your doctor about ALTERNATIVE TREATMENTS & MEDICINES
Ask what services cost and become a more KNOWLEDGEABLE CONSUMER
Lead a HEALTHIER LIFESTYLE
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Sumitomo Life Insurance Agency America, Inc.
Medical Coverage – Nippon Life InsuranceMedical Coverage – Nippon Life Insurance
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Sumitomo Life Insurance Agency America, Inc.
PREFFERED PROVIDER ORGANIZATION…
This plan allows you to see any service provider, either in-network or out-of-network, and still receive benefits. However, in most cases benefits for services from out-of-network providers are paid at a reduced benefit level and will not contain a discount. You and the company end up paying more for medical services.
Find a Participating Doctor or Hospital
www.nipponlifebenefits.com
1-877-210-5518 (English / Spanish)
1-800-447-8208 (Japanese)
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Sumitomo Life Insurance Agency America, Inc.
In-Network Out-of-Network
Office Visits
Primary Care
Specialist
$30 Copayment
$30 Copayment
70% after Deductible
70% after Deductible
Deductible
Individual Maximum
Family Overall Max
$1,500
$4,500
$3,000
$9,000
Coinsurance Plan pays 80% Plan pays 60%
Out-of-Pocket Maximum
Individual
Family
$2,000 after deductible is met
$4,000 after deductible is met
$4,000 after deductible is met
$8,000 after deductible is met
Emergency Room $50 Copayment + 80% Coinsurance $100 Copayment + 60% Coinsurance
Inpatient Services
Facility Charges
Physician Charges
80% after Deductible
80% after Deductible
60% after Deductible
60% after Deductible
Outpatient Services
Facility Charges
Physician Charges
Diagnostic Services
80% after Deductible
80% after Deductible
80% after Deductible
60% after Deductible
60% after Deductible
60% after Deductible
Medical Plan Design (summary)
Certain exclusions and limitations apply. Complete details are contained in the Plan Document. If there is any conflict between this exhibit and the actual plan provisions, the terms of the Plan Document will govern.
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Sumitomo Life Insurance Agency America, Inc.
Dental Coverage – Nippon Life InsuranceDental Coverage – Nippon Life Insurance
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Sumitomo Life Insurance Agency America, Inc.
Dental Plan Summary - Nippon Life Dental Plan Summary - Nippon Life Insurance Insurance
Certain exclusions and limitations apply. Complete details are contained in the Plan Document. If there is any conflict between this exhibit and the actual plan provisions, the terms of the Plan Document will govern.
In-Network Out-of-Network
Calendar Year Deductible
$50 per Person$150 per Family Maximum
Calendar Year Max $1,500 per Person
Preventive Care Cleaning Exam X-Rays
Plan pays 100% of Contracted Fee
Plan pays 100% of Reasonable &
Customary
Basic Care Extraction Filling Periodontic Endodontic
After you pay Deductible,
Plan pays 80% of Contracted Fee
After you pay Deductible,
Plan pays 80% of Reasonable &
Customary
Major Care Crown Bridge Dentures
After you pay Deductible,
Plan pays 50% of Contracted Fee
After you pay Deductible,
Plan pays 50% of R&C
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Sumitomo Life Insurance Agency America, Inc.
Basic Life & AD&D Coverage Basic Life & AD&D Coverage Nippon Life InsuranceNippon Life Insurance
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Sumitomo Life Insurance Agency America, Inc.
Basic Life & AD&D Summary - UNUMBasic Life & AD&D Summary - UNUM
Basic Life and AD&D InsuranceMitsukoshi offers life and accident benefits to give your family a financial cushion and peace of mind if anything should happen to you. All full-time Employees receive benefits in the amount of $15,000.
Example
Life Insurance Benefit = $60,000 ( = $30,000 x 2 )
AD&D Benefit = $60,000
Death due to Illness - > $60,000
Death due to Accident - > $120,000
Have you designated or
updated a
Beneficiary?
THIS COVERAGE IS PROVIDEDAT NO COST TO YOU.
Certain exclusions and limitations apply. Complete details are contained in the Plan Document. If there is any conflict between this exhibit and the actual plan provisions, the terms of the Plan Document will govern.
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Sumitomo Life Insurance Agency America, Inc.
Short Term Disability Coverage Short Term Disability Coverage Nippon Life InsuranceNippon Life Insurance
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Sumitomo Life Insurance Agency America, Inc.
Disability Plan Summary Disability Plan Summary Nippon Life Insurance Nippon Life Insurance
Short-Term DisabilityBenefits will begin on the 1st day for injury and 8th day for sickness. Your STD benefits substitute 60% of your eligible weekly pay up to $1500 per week up to 26-weeks.
Please refer to your plan booklet for additional details.
Certain exclusions and limitations apply. Complete details are contained in the Plan Document. If there is any conflict between this exhibit and the actual plan provisions, the terms of the Plan Document will govern.
Remember your disability benefits are NOT meant to replace your income. They only
partially SUBSTITUTE income until you are able to return to work.
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Sumitomo Life Insurance Agency America, Inc.
Questions and Comments
Thank You for Attending!!Thank You for Attending!!