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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 –

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Presentation on theme: "Etori U.S.A., Inc. Presented by:. 2 Sumitomo Life Insurance Agency America, Inc. Effective May 1, 2011: Insurance carrier remained the same: Medical –"— Presentation transcript:

1 Etori U.S.A., Inc. Presented by:

2 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

3 3 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) 3

4 4 Sumitomo Life Insurance Agency America, Inc. PlanTypeEmployee Premium MedicalEmployee only EE+SP and / or Dependants 10% 50% DentalEmployee only EE+SP and / or Dependants 10% 50% Short Term Disability Employee only50% Basic term LifeEmployee only (All Employee are Eligible Automatically) 0% AD & DEmployee 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

5 5 Sumitomo Life Insurance Agency America, Inc. Monthly premium MEDICAL Monthly premiu m DENTAL Monthly premium SHORT TERM DISABILITY Monthly premium BASIC TERM LIFE Monthly premium AD&D Monthly Premium Total Employee Only $29$2.9Weekly salary / $10 X $0.40 x 12 /52 = -50% $0 $31.90 + STD Employee + Spouse $86$6.9N/A $92.90 + STD Employee + Child(ren) $66$5.6N/A $71.60 + STD Family $122$9.2N/A $131.20 + STD

6 6 Sumitomo Life Insurance Agency America, Inc.

7 7 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

8 8 Sumitomo Life Insurance Agency America, Inc. Medical Coverage – Nippon Life Insurance

9 9 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)

10 10 Sumitomo Life Insurance Agency America, Inc. In-Network Out-of-Network Office Visits Primary Care Specialist $30 Copayment 70% after Deductible Deductible Individual Maximum Family Overall Max $1,500 $4,500 $3,000 $9,000 CoinsurancePlan pays 80%Plan pays 60% Out-of-Pocket Maximum Individual Family $2,000 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 60% after Deductible Outpatient Services Facility Charges Physician Charges Diagnostic Services 80% 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.

11 11 Sumitomo Life Insurance Agency America, Inc. Dental Coverage – Nippon Life Insurance

12 12 Sumitomo Life Insurance Agency America, Inc. Dental Plan Summary - Nippon Life 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-NetworkOut-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

13 13 Sumitomo Life Insurance Agency America, Inc. Basic Life & AD&D Coverage Nippon Life Insurance Nippon Life Insurance

14 14 Sumitomo Life Insurance Agency America, Inc. Basic Life & AD&D Summary - UNUM Basic Life and AD&D Insurance Mitsukoshi 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 PROVIDED AT 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.

15 15 Sumitomo Life Insurance Agency America, Inc. Short Term Disability Coverage Nippon Life Insurance

16 16 Sumitomo Life Insurance Agency America, Inc. Disability Plan Summary Nippon Life Insurance Short-Term Disability Benefits will begin on the 1 st 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.

17 17 Sumitomo Life Insurance Agency America, Inc. Questions and Comments Thank You for Attending!!


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