Medical Plans

 
 

Benefits Summary Plan Description

Medical Plans

Back

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 Plan. 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.

Eligibility
       
How the Plans work
       
Precertification
       
Coordination of Benefits
       
Mental Health/Substance Abuse
       
Leidos Healthy Focus Medical Plans
       
Health Maintenance Organizations
       
Cigna International
       
Medicare
       



 

Eligibility

Participation in Leidos' benefit programs is available to eligible employees and their eligible dependents:

Employees
       
Dependents
       
Registered Domestic Partners

Employees

A Leidos employee is eligible to enroll in Leidos benefit programs under the following conditions:

Type of Coverage Eligibility Requirements
  • Must be an active, regular full-time employee working at least 30 hours per week; or
  • Must be a part-time employee, regularly scheduled to work at least 12 hours per week but less than 30 hours per week; and
  • Must live in the geographic area served by a particular plan.

Consulting employees, temporary employees, leased workers, payrollees and people classified by Leidos as independent contractors are not eligible to participate in Leidos benefit programs.

Dependents

Participants may also enroll their eligible dependents in some Leidos benefit programs. Dependents that are eligible to be enrolled in these programs are:

  • The participant's legal spouse or registered domestic partner (if proof of registration with a state or local domestic partner registry is provided or if a Declaration of Domestic Partnership form is submitted).
  • Each child of the participant or registered domestic partner* younger than age 26**, including:
    • A natural child or stepchild***;
    • An adopted child (coverage begins as of the earlier of the date the child was placed in the participant's home or the date of final adoption); and
    • Any other child who depends on the participant for support and lives with the participant in a parent-child relationship, if the participant provides proof of legal guardianship.
  • Unmarried children, age 26 and older who are incapable of self-sustaining employment because they are mentally or physically disabled, as long as:
    • The mental or physical disability existed while the child was covered under the plan and began before age 26;
    • The child is primarily dependent on the participant for support; and
    • The participant provides periodic evidence of incapacity.

Participants must notify Leidos Employee Services, in writing, within 31 days of any change in dependent eligibility.

If a Participant's Spouse, Registered Domestic Partner or Dependent Is a Leidos Employee

No one can receive "double coverage" under Leidos's benefit programs. Therefore, participants may not cover a spouse, registered domestic partner or dependent child if that spouse, registered domestic partner or child is also a Leidos employee and has elected his or her own coverage.

If a participant and his or her spouse or registered domestic partner are both Leidos employees, each can choose individual coverage or one can cover the other as a dependent — but not both. If the participant has children, only the participant or spouse or registered domestic partner can choose coverage for dependent children.

Dependent Eligibility Verification (DEV) Process

As a government contractor the company is required by the Defense Contract Audit Agency (DCAA) to demonstrate that our claims for benefit costs are legitimate and ensure that we provide health and welfare benefit coverage only to eligible dependents of our employees. This ongoing verification also assures that the company does not bill the customer for medical costs associated with ineligible dependents.

To support this ongoing effort, the company maintains a Dependent Eligibility Verification (DEV) program which is administered by a third-party administrator, Budco. Throughout the year, Budco verifies that any dependent added to our plans is, in fact, eligible for coverage. This includes dependents who are enrolled as a result of new employees joining the company, a qualifying life event (i.e., marriage, birth), as well as new dependents added to our plans during the annual Open Enrollment (OE) period in the fall.

In addition to the ongoing verification process, the company is also required to perform random dependent verifications - even if an employee's dependents were previously verified. This is necessary in order to ensure that a dependent's eligibility remains unchanged.

If an employee receives a request from Budco to verify current dependents, even if the dependent has been verified before, it is critical that the request is not ignored. Failure to provide the requested documentation within the specified timeframe, will result in the dependent(s) being deemed ineligible and removed from our plans.

Covering ineligible dependents is a violation of the company's Code of Conduct and could expose the company to sanctions from the government. The company's eligibility verification process helps ensure that we are compliant with our requirements as a government contractor.

Questions about the dependent eligibility verification program may be directed to Budco at 866-488-2001, or Leidos Employee Services at 855-553-4367, option 3 or AskHR@leidos.com.



Registered Domestic Partners

The participant may enroll his or her registered domestic partner and the registered domestic partner's eligible dependent children in participating medical, dental and vision plans in which the participant is enrolled. Dependent life insurance is also available to registered domestic partners and their children.

For purposes of Leidos coverage, a registered domestic partnership is a committed same-sex or opposite-sex relationship, in which registered domestic partners:

  • Live together at the same address and have lived together continuously for at least one year;
  • Are not legally married to one another or anyone else;
  • Do not have another registered domestic partner and have not signed a registered domestic partner declaration with another within the past year;
  • Are mentally competent to consent to a contract or affidavit;
  • Are not related by blood in such a way as would prohibit legal marriage; and
  • Are jointly responsible for each other's common welfare and are financially interdependent.

If you have not registered with a state or local domestic partner registry, a Declaration of Domestic Partnership must be completed, notarized and submitted with any other required documents in order to enroll a registered domestic partner. The Declaration must be presented to insurers upon request. Contact Leidos Employee Services for additional information on enrolling with registered domestic partner coverage. The Declaration of Domestic Partnership form can be found on Prism. If you have registered with a state or local domestic partner registry, simply provide a copy of the registration document issued by the state or local registry.

Registered domestic partner coverage is different from spouse coverage. For instance:

  • Participant contributions for registered domestic partner coverage and their eligible children must be paid on an after-tax basis;
  • The value of benefits provided to a registered domestic partner and/or his or her eligible children is considered taxable income. As a result, the Leidos employee must pay any state, federal, FICA and other applicable tax withholding in the form of imputed income. This amount is based on the value of the coverage Leidos provides to the partner.


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. A great online resource to help you learn, plan and make the best informed decision for you and your family is the Healthy Focus web site.

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 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' 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.