This section describes plan provisions and/or regulations that are applicable to most or all of the Leidos employee benefit plans. For complete details, download the Plan Information document.
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.
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.
Uniformed Services Employment and Reemployment Rights Act (USERRA)
If the participant is on a military leave of less than 31 days, health care coverage for the participant and the participant's eligible dependents continues as long as the participant continues paying the applicable portion of the cost of coverage. If the participant's leave is longer than 31 days, the participant may continue coverage under rules similar to those for COBRA coverage.
The participant may continue coverage for 24 months or the period of duty, whichever is less. (This period also counts toward COBRA coverage, if applicable.) The participant pays the full cost of coverage for him- or herself and his or her dependents plus a 2% administration fee (102% of the premium). When the participant's leave ends, he or she will not be subject to a waiting or pre-existing condition period except for illnesses or injuries incurred or aggravated during the participant's leave duties.
If the participant is a member of the ready reserve of the armed forces and is called to active duty as a result of Executive Order 13223, special provisions regarding the participant's leave and health care coverage may apply. For more information, contact Leidos Employee Services.
Health Plan Regulations
The following federally mandated regulations are required of all group health plans and health insurance issuers.
Breast Reconstruction Following a Mastectomy
Federal law requires that group health plans provide coverage for breast reconstruction in connection with mastectomy as follows:
- Reconstruction of the breast on which the mastectomy has been performed;
- Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
- Prosthesis and treatment of physical complications of all stages of mastectomy, including lymphedemas.
Hospitalization in Connection with Childbirth
Group health plans and health insurance issuers generally may not, under federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to:
- Less than 48 hours following a vaginal delivery; or
- Less than 96 hours following a Caesarean section; or
- Require that a provider obtain authorization from the plan or insurance issuer for prescribing a length of stay that falls within that time period.
The law does not prohibit an attending provider of the mother or newborn, in consultation with the mother, from discharging the mother or newborn earlier than 48 or 96 hours after delivery, as applicable.
Premium Assistance Under Medicaid and the Children’s Health Insurance Program (CHIP)
If you or your children are eligible for Medicaid or CHIP and you're eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren't eligible for Medicaid or CHIP, you won't be eligible for these premium assistance programs but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov.
If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available.
If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877-KIDS-NOW or www.insurekidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan.
If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren't already enrolled. This is called a "special enrollment" opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 1-866-444-EBSA (3272).
Paperwork Reduction Act Statement
According to the Paperwork Reduction Act of 1995 (Pub. L. 104-13) (PRA), no persons are required to respond to a collection of information unless such collection displays a valid Office of Management and Budget (OMB) control number. The Department notes that a Federal agency cannot conduct or sponsor a collection of information unless it is approved by OMB under the PRA, and displays a currently valid OMB control number, and the public is not required to respond to a collection of information unless it displays a currently valid OMB control number. See 44 U.S.C. 3507. Also, notwithstanding any other provisions of law, no person shall be subject to penalty for failing to comply with a collection of information if the collection of information does not display a currently valid OMB control number. See 44 U.S.C. 3512.
The public reporting burden for this collection of information is estimated to average approximately seven minutes per respondent. Interested parties are encouraged to send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employee Benefits Security Administration, Office of Policy and Research, Attention: PRA Clearance Officer, 200 Constitution Avenue, N.W., Room N-5718, Washington, DC 20210 or email email@example.com and reference the OMB Control Number 1210-0137.
Qualified Medical Child Support Orders (QMCSOs)
A QMCSO is a judgment, decree or order issued either by a court of competent jurisdiction or through an administrative process established under state law which has the force and effect of law in that state. It directs the plan administrator to cover the participant's child for benefits under the medical, dental, and/or vision plans, if available. Federal law provides that a Medical Child Support Order must meet certain form and content requirements in order to be a QMCSO. When an order is received, each affected participant and each child (or the child's representative) covered by the order will be given notice of the receipt of the order. Coverage under the plan pursuant to a QMCSO won't become effective until the plan administrator determines that the order is a QMCSO.