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Enrollment Kit - Nippon Life Benefits (Medical)

This checklist is provided as a guide. The carrier may require additional items and documentation. Please refer to the carrier's underwriting guidelines for a complete list of requirements. Please use the latest version of forms.
Our goal is to process your new group enrollment easily and efficiently in order to provide you and your client with a quick approval.  The following list outlines Nippon Life Benefits' case submission requirements.
  • Signed Employer Application for Group Insurance
  • Binder-Premium Check - first month's premium based on the sold rate(s)
    • Indicate amount to be applied to each division (unit) on case submission requirements form

  • Completed Policy Issue Checklist (case submission requirements form linked above)
  • Copy of Proposal or plan of benefits requested
  • Option Coverage (Must Offer) form (if applicable, form is contained in the formal proposal)
  • Company census data (name, DOB/age, gender, coverage type, zip code) provided on Nippon Life Benefits' template (available to groups 50+)
  • Passive Enrollment Agreement (if Census is being provided)
  • Enrollment forms (with statements of health)
  • Waivers and reason for waiver for employee and dependents who do not elect coverage
  • COBRA Election Forms - if any COBRA participants
  • Current plan design, current rates
  • Renewal Rates (with the  carrier's calculation or letter - if available)
  • Carrier / Rate history
  • Experience information (premium, lives, claims for 2 years - if available)
  • Large claims info, with diagnosis / prognosis - if available
  • ER contribution
Start-Up Groups that do not have prior group coverage - the following is required:
  • Article of Incorporation
  • Office lease agreement
  • Workers Comp bill
  • U.S.A bank account to prepare Binder-Premium Check

  • Tax and Wage forms or K-1 forms (owners/partners) - provide current quarter (not required for 100+ enrolled)
  • W-4 forms for any new hire not listed on Tax & Wage
  • Copy of prior carrier's booklet (required for 100+ enrolled)
  • RAQ - Risk Appraisal Questionnaire (groups under 150+ enrolled in approved states)
Employer should retain copy of enrollment forms.
If Census - Employer should retain original Enrollment forms

After approval, prior carrier termination letter must be submitted by the employer or broker.

For other useful or older documents, please refer to the Forms database.

Important Reminder: To help your client comply with ACA requirements, provide a copy of the appropriate Summary of Benefits and Coverage (SBC) to each employee at the Enrollment Meeting, via email or by posting on an internal company website.  For the most recent information regarding Nippon Life Benefits’ SBCs, please go to the SBC Page or contact your Word & Brown Representative.