General Description

YourCorp offers two Indemnity Plan options, Option A and Option B. Both Indemnity Plan options include an Outpatient Care Network (OCN), and a Preferred Provider Organization (PPO) in some locations, in addition to other programs.

Employees may also be offered one or more HMO options where geographically available.

Indemnity Plan Overview

OCN/PPO Network Information

Eligibility

YourCorp employees on U.S. payroll who are Regular Full-time employees, or Regular Part-time employees. Residents of Hawaii (except Foreign Service Employees) are not eligible for the YourCorp Medical Plan. Foreign Service Employees who do not reside in the U.S. but are on U.S. payroll are eligible for the YourCorp Medical Plan (excluding HMO).

Eligibility

Coverage for Relatives

Coverage is available for your spouse, eligible domestic partner, unmarried Children who are under the Limiting Age or who are Disabled, and children of your eligible domestic partner.

Eligible Dependents

Coverage Begins

Coverage begins on your first day Actively at Work, provided you enroll within 30 days of hire. If you do not enroll or decline benefits within 30 days of your initial eligibility date, you will automatically be enrolled in YourCorp Medical Plan Option B.

Rehire

Return From Leave

Dependent Coverage Begins

Amount of Benefit

Coverage is generally based on a percentage of the Usual, Customary and Reasonable (UCR) amount subject to the Plan's deductibles and maximums. For certain services, coverage depends on whether or not you use a preferred or network provider.

Benefits Pay Schedule

Maximum Dollar or Frequency Amounts

Services Covered

Various services are covered under the Plan. However, certain services are not covered or are subject to Plan limitations.

Covered Services

Coverage Limitations and Exclusions

Hospitalization

How do I...

• Enroll?

Complete a Health Plan Enrollment/Change Form and return it to the Employee Services Organization. If you are enrolling a domestic partner, also complete and return a Declaration of Domestic Partnership.

Enrollment Procedure

Waive Coverage/Delayed Enrollment

• Change Coverage Options?

Complete a Health Plan Enrollment/Change Form and return it to the Employee Services Organization. If you are enrolling a domestic partner, also complete and return a Declaration of Domestic Partnership.

• Add a Dependent?

Complete a Health Plan Enrollment/Change Form and return it to the Employee Services Organization. If you are adding a domestic partner, also complete and return a Declaration of Domestic Partnership Form.

Add a Dependent

• Drop Coverage or Drop a Dependent?

Complete a Health Plan Enrollment/Change Form and return it to the Employee Services Organization. If your domestic partnership is ending, also complete and return a Termination of Domestic Partnership Form. If your change is due to a Change in Family Status and you are adjusting your pretax premiums outside open enrollment, also complete and return a Change in Family Status Form.

Drop Coverage

Drop a Dependent

• File a Claim?

When you use an Outpatient Care Network or PPO provider, there is no claim to file. For other expenses, complete an Computer Sciences Corporation Claim Form and send it with itemized bills to the Claims Administrator.

Claim

• Handle a Denied Claim?

If you have your Explanation of Benefits (EOB) that relates to the claim it will list the reason for the denial or benefit reduction. You may contact the Claims Administrator to request a copy of the EOB, or ask one of their service representatives for a further explanation of why your claim was denied or reduced. If you disagree with the benefit payment, you have the right to appeal.

Claim Denied/Reduced

• Convert Coverage?

In general, coverage may not be converted; COBRA may be available when Computer Sciences Corporation-sponsored coverage ends.

COBRA Info at a Glance

• Get ID Cards (I haven't received my cards)?

You will receive your ID card by mail at your home approximately four to six weeks after you enroll. Call the Employee Services Organization if you do not receive it.

ID Cards

• Find a Doctor? (OCN/PPO Only)

You can get a list of OCN/PPO providers in the First Health Network from the Health Plan Connection or by calling the Claims Administrator.

Claims Administrator

Cost

For regular, full-time employees, you and YourCorp share the cost of coverage. Rates depend on your location, who you cover in your plan and the option (A or B) you elect. If you are an eligible part-time employee, you pay the full-time employee cost plus a pro rata portion of Computer Sciences Corporation's cost based on your standard scheduled work hours.

Cost of Coverage

Approvals

You should obtain a pre-certification or pre-approval when it is required or recommended by the Plan. A penalty will be applied to any benefits if you fail to obtain a required pre-approval.

The Plan also offers a voluntary Pre-determination Program, which allows you to find out if a procedure will be covered and how much of it will be covered.

Pre-certification/Pre-approvals

For additional information:

YourCorp Medical Plan Claims Administrator