Coordination of Benefits

 
 

Benefits Summary Plan Description

Coordination of Benefits

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Coordination of Benefits

The following information pertains to group health care plans that may be coordinating how benefits are paid between a Leidos health care plan and another plan:

Releasing and Obtaining Information

The health care plans reserve the right to release to, or obtain from, any other insurance company or other organization or person any information that, in its opinion, it needs for the purpose of coordination of benefits.

Subrogation

If the participant or the participant's dependent suffers an injury or illness through the fault of a third party (such as in an automobile accident), he or she may use the benefits from a Leidos health care and disability plans. Then, the plan will contact the insurer of the person who was at fault in the accident and/or that person's insurance company to seek reimbursement for plan benefits that were attributable to the accident.

In most cases, the plan will not be reimbursed directly. Normally, the claim with the injured person (that is, the participant or the participant's dependent) will be settled. Therefore, if the participant's claims are paid by the plan and then he or she receives a settlement from the other party or the other party's insurer, the participant must reimburse the plan for the amount of claims paid by the Leidos plan. The plan's right of subrogation and reimbursement is a first-priority right of reimbursement, to be satisfied before payment of any other claims, including attorney fees and costs.

This arrangement allows the participant to receive prompt payment of benefits and, at the same time, places the expense of medical coverage where it belongs — with the person who caused the injury. As a condition of receiving benefits under this plan, the participant or the participant's dependents are expected to cooperate with the plan manager or administrator in recovering any amounts for which the plan is entitled to be reimbursed, and to repay the plan any amounts that the participant may have received to which the plan has a right to reimbursement.

Recovery of Overpayment

If one of the Leidos health care or disability plans makes an overpayment, it will have the right at any time to recover that overpayment from the participant to whom or on whose behalf it was made, or to offset the amount of overpayment from a future claim payment.