Medical Plans

 
 

Benefits Summary Plan Description

Medical Plans

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Medical Plans

Leidos offers eligible employees two comprehensive Consumer Directed Health Plans (CDHP) featuring a Health Savings Account (HSA):

  • Healthy Focus Advantage Plan
  • Healthy Focus Essential Plan

In addition, employees living in certain areas may also be eligible to elect medical coverage through Health Maintenance Organizations (HMOs) or CIGNA International Plans. For more information about those medical plan options, refer to Other Medical Plans.

*Self-insured means that Leidos fully funds the plans.

For more information, download the Medical Plan Options.

How the Plans work
       
Precertification
       
Coordination of Benefits
       
Mental Health/Substance Abuse
       
Leidos Healthy Focus Medical Plans
       
Health Maintenance Organizations
       
Other Medical Plans
       
Medicare
       
Continuing Coverage



How the Plans work

With a number of medical plans available, Leidos employees can choose the medical plan that works best for their personal situation.

Employees can choose between plans that offer significant choice in doctors, hospitals, and other providers and those that are more managed because they only cover network services. For example, when a participant enrolls in a self-insured medical plan, he or she can choose any provider and pay a portion of the cost for covered services. The participant will pay less if he or she uses a network provider. When a participant enrolls in an HMO, he or she must coordinate all care through a primary care physician in order for services to be covered by the HMO plan.

Pre-existing condition clauses do not apply to any of Leidos's medical plans. For more information about the medical plan options that Leidos offers, participants should read the information in this summary.



Precertification

If a participant is enrolled in the Leidos medical plans and needs hospitalization, skilled nursing care, home health care, hospice care or convalescent facility care, the participant is responsible for following the requirements for Preadmission Certification and Continued Stay Review (also known as "precertification"). Preadmission Certification and Continued Stay Review are procedures used to certify the medical necessity and length of any hospital confinement for inpatient care.

If a participant or a dependent is scheduled for a hospital admission, the participant should call the number on his or her Medical ID card before admission and request precertification. Obtaining precertification is the participant's responsibility. Even if the doctor agrees to initiate admission, the participant must follow up to ensure that it has been accomplished.

A PPO network customer service representative will work with a participant's doctor to ensure that the hospitalization is appropriate, medically necessary, and timely, and then let the participant know the number of days for which admission has been certified.



Coordination of Benefits

If a participant or a participant's dependents are covered under more than one medical plan, all of the medical plans that provide coverage can work together to coordinate benefits. The participant is responsible for filing or submitting any necessary paperwork to the appropriate plans.

Under Leidos's coordination of benefits provisions, the plans will pay benefits up to the level which would have been paid if the Leidos plan had been the primary plan. This coordination of benefits provision applies to all of Leidos's medical plans.

When one of the Leidos medical plans is the primary plan, benefits are paid first without regard to any other plans. The participant is responsible for coordinating any benefits by submitting the Explanation of Benefits and itemized bill to the secondary plan.

For additional coordination of benefits, such as third party recovery (subrogation), overpayments, etc.

Determining Which Plan Pays First

Leidos uses the following insurance industry guidelines for determining the primary and secondary payers for employees and dependents.

Employees

The plan that covers the participant as an employee is the primary payer. The plan that covers the participant as a dependent is the secondary payer.

Dependents

For an employee's spouse or registered domestic partner, a plan that covers him or her as an employee is the primary payer for his or her claims. If an employee has elected coverage for his or her spouse or registered domestic partner as a dependent and he or she has coverage through another employer, the Leidos medical plan is the secondary payer.

For an employee's dependent children, the plan of the parent whose birthday occurs first in the calendar year is usually the primary payer. If the plan of an employee's spouse or registered domestic partner plan does not follow this "birthday rule," then the "gender rule" applies. That is, the plan covering the child's father as an employee pays first.

In the case of divorced or separated parents, benefits are determined in the following order:

  • The plan of the parent who has financial responsibility by court decree;
  • The plan of the stepparent who is the spouse of the parent who has custody of the child; and
  • The plan of the parent who does not have custody of the child.

When none of these rules establishes order, benefits are paid first by the plan that has covered the person for the longer period of time. An exception is a plan that covers a laid-off or retired employee. That plan is secondary to a plan that covers a person as an active employee.