Hawaii Office

Eligibility

Full-Time/Part-Time Office Employees:

You are eligible for BAYADA’s group medical/prescription drug/dental, and vision benefits on the first of the following month after working for 4 consecutive weeks with 20 or more hours each week. To maintain eligibility you must work 80 hours each month.

Dependent Eligibility

You may enroll your eligible dependents, including your legal spouse and your children up to age 26. Dependents must be enrolled in the same plans you choose for yourself, but tiers can vary between benefit offerings. For example, you may add your spouse to vision and not medical.

Print Guide

The choices you make upon eligibility or during Open Enrollment remain in effect through the end of the plan year: December 31, 2024. Once you are enrolled, you must wait until the next open enrollment period to change your benefits or add/remove coverage for yourself or your dependents, unless you have a qualified life event as defined by the IRS.

A qualified life event is a change in circumstances that may allow you to enroll in benefits outside of open enrollment. Examples of a qualified life event include, but are not limited to, the following:

Marriage, divorce, legal separation, or annulment
Birth or adoption of a child
Gain/loss of other health insurance coverage
Dependent gaining/losing other health insurance coverage

The IRS mandates that changes to your coverage, due to a qualifying life event, must be made within 31 days of that life event. Proof of the qualifying life event is required (eg, marriage certificate, divorce decree, birth certificate, or loss of coverage letter). Note: Any change you make to your coverage must be consistent with the qualified life event.

You love what you do, but to take care of what’s important—at work and at home—you need to take care of you. We’re not a one-size-fits-all type of company. Neither are our benefits. That’s why we offer a range of benefits options designed to fit different budgets, lifestyles, and health needs. The importance of having health insurance should not be underestimated. A decline in your health status can mean a loss of earnings if you are not able to work, and it can also mean medical bills are piling up. Medical and prescription drug insurance may help you avoid or limit your medical costs, and contribute to a healthier lifestyle. BAYADA provides medical insurance through Horizon HMSA and Kaiser.

Who is Eligible?

You are eligible if you are a full-time office employee or if you are a part-time office employee who works more than 80 hours per month.

Plan Choices

BAYADA offers two Medical Plan choices: Kaiser (HMO) or HMSA (PPO). See below for some helpful tips when you’re choosing the Medical Plan for you:

Kaiser HMO

The Kaiser plan offers low copays for both a primary care physician office visit as well as a specialist office visit.

HMSA PPO

The HMSA PPO network offers discounted rates with groups of “in-network” medical providers.

Medical Plan Design – What You Pay

Hawaii Plan Summary Comparison 2024

This document is intended to merely highlight or summarize certain aspects of the employer’s bene t program(s). It is not a Summary Plan Description (SPD) or an official plan document. Your rights and obligations under the program(s) are set forth in the official plan documents. All statements in this summary are subject to the terms of the official plan documents, as interpreted by the appropriate plan fiduciary. In the case of an ambiguity or outright conflict between a provision in this summary and a provision in the plan documents, the terms of the plan documents control. The employer reserves the right to review, change, or terminate the plan, or any benefits under it, for any reason, at any time, and without advance notice to any person.

The Kaiser and HMSA medical plans both include prescription drug coverage.

Prescription Drug Plan Design – What You Pay

	HMSA PPO PLAN	KAISER PERMANENTE HMO PLAN
	In-Network / Out-of-Network	In-Network Only
Generic	$7	Generic Maintenance = $3
Brand non-formulary	$30	Other Generics = $10
Brand formulary	$30 + $45 (Other Brand Name Cost Share)	Brand = $45
Mail Order (90 day supply)	$11/$65/$200 for 90 day supply	2 times retail for a 90 day supply

This document is intended to merely highlight or summarize certain aspects of the employer’s benefit program(s). It is not a Summary Plan Description (SPD) or an official plan document. Your rights and obligations under the program(s) are set forth in the official plan documents. All statements in this summary are subject to the terms of the official plan documents, as interpreted by the appropriate plan fiduciary. In the case of an ambiguity or outright conflict between a provision in this summary and a provision in the plan documents, the terms of the plan documents control. The employer reserves the right to review, change, or terminate the plan, or any benefits under it, for any reason, at any time, and without advance notice to any person.

Who is Eligible for FSAs?

You are eligible for FSAs if you are a full-time office employee.

What is a Flexible Spending Account (FSA)?

A Healthcare FSA lets you use pre-tax dollars to pay for certain health care expenses not covered by your insurance plan. This account is pre-funded by BAYADA, and your contributions will be deducted from your paychecks in equal installments throughout the plan year.

Healthcare FSA

Dependent Care FSA

The Dependent Care FSA enables you to pay for dependent daycare costs with pre-tax dollars. This account is not pre-funded; only the funds deposited weekly from your pay are available for use. Your contributions will be deducted from your paychecks in equal installments throughout the year and deposited into your account.

Reimbursement from Your FSAs

Each FSA account functions separately. When you have eligible expenses, you can use your Ameriflex card or submit a claim for reimbursement from the appropriate FSA account.

Medical and Dependent Care FSA Program Provisions

	Medical Account	Dependent Care Account
Eligible Expenses	Eligible out-of-pocket healthcare expenses that are not covered by a medical, prescription drug, dental or vision care plan, including deductibles, copayments, and coinsurance.	Eligible out-of-pocket day care expenses so you (or your spouse, if you are married) can work or attend school full-time. Eligible dependent care expenses include care for children under age 13, and care for dependents of any age who are physically or mentally incapable of self-care (includes day care for elderly dependents, but not nursing home expenses).
How can I use the money?	You can use it to pay for medical, dental, and vision expenses, including deductibles, coinsurance, prescriptions, and other eligible expenses.	You can use it for eligible expenses at licensed day care centers, nursery schools, day camps, and home care with valid tax ID numbers.
Making Midyear Changes	The medical FSA and DCA can be decreased as well as increased with a qualifying event. The change needs to be consistent with the event; for example, the birth of a child can trigger an increase in the FSA, but not decrease. Further, a divorce (one fewer dependent to cover) can trigger a decrease in the election amount.
Claims Reimbursement	Optum Financial card – use at point of service Submit online or paper claim forms. You have until 03/31/2024 to submit expenses incurred prior to 01/01/2024.
What happens if there is money left at the end of the plan year?	The FSA will have a carryover feature allowing up to $610 of your unused health care FSA balance to be carried into the next plan year.. Any funds over the $610 rollover will be forfeited if not used by 03/31/2024 to submit expenses incurred prior to 01/01/2024.	If you have not spent all the funds in your DCA by the end of the plan year, you may continue to submit expenses through 03/31/2024 for expenses incurred prior to 01/01/2024. Any funds not used by 03/31/2024 to submit expenses incurred prior to 01/01/2024 are forfeited.
Do I need to keep my receipts?	Yes
Administrator	Optum Financial

Access to good oral health care can help keep your overall health costs down. Regular oral health exams can help detect significant medical conditions before they become serious.

BAYADA’s dental coverage is offered through HMSA or Kaiser HDS. The dental coverage is connected with the medical/prescription drug plan.

Who is Eligible?

You are eligible for BAYADA’s dental benefits if you are a full-time office employee or if you are a part-time office employee who works more than 80 hours per month.

Dental Plan Design – What You Pay

	HMSA	KAISER PERMANENTE (HDS)
Preventative & Diagnostic
Examinations	100% twice per calendar year	100% once per calendar year
Cleanings	100% twice per calendar year	100% twice per calendar year
Bitewing x-rays	100% once per calendar year	100% twice per calendar year
Fluoride (age 18 & younger)	100% twice per calendar year	70%
Space Maintainers	70% Age 13 and under	70% Through age 17
Other x-rays	70%	70%
Other Services
Endodontics	70%	70%
Periodontics	70%	70%
Prosthodontics	50%	50%
Calendar Year Maximum	$1,500	$1,200

Eye care is a critical element to overall health. Annual eye exams can check and correct your eyesight. BAYADA’s vision insurance is offered through EyeMed (INSIGHT Network).

Who is Eligible?

You are eligible for BAYADA’s Vision benefits if you are a full-time office employee or if you are a part-time office employee who works more than 80 hours per month.

Plan Changes

The frames allowance remains at $150.
Vision programs that will continue this year:
- Freedom Pass Program
  - There are no out-of-pocket costs ($0) for frames purchased at Target or Sears (*offer not valid at Sears Optical stores affiliated with US Vision)
- Contact Lens Booster
  - Members receive an additional $20 contact lens allowance when they use contactsdirect.com
  - Current contact lens allowance is $130

Vision Plan Design – What You Pay

	In-Network	Out-of-Network Reimbursement
Exam	$10 copay	Up to $25
Retinal Imaging	Up to $39	N/A
Frames	$150 allowance; 20% off balance over $130	Up to $65
Standard Plastic Lenses
Single Vision	$15 copay	Up to $14
Bifocal	$15 copay	Up to $28
Trifocal	$15 copay	Up to $53
Standard Progressive Lens	$80	Up to $28
Premium Progressive Lens	$100-$125	Up to $28
Other Lens Options
UV Treatment	$15	N/A
Tint	$15	N/A
Standard Plastic Scratch Coating	$0	Up to $11
Standard Polycarbonate	$40	N/A
Standard Polycarbonate (children under 19)	$0	Up to $28
Standard Anti-Reflective Coating	$45	N/A
Premium Anti-Reflective Coating	$57-$68	N/A
Photochromic/Transitions	$75	N/A
Polarized	20% off retail price	N/A
Other Add-Ons & Services	20% off retail price	N/A
Contact Lens Fit & Follow-Up
Standard	Up to $55	N/A
Premium Progressive Lens	10% off retail	N/A
Conventional	$0 copay; $130 allowance; 15% off balance over $130	Up to $104
Disposable	$130 copay; $130 allowance; plus balance over additional $20 allowance using contactsdirect.com	Up to $104
Medically Necessary	$0 copay; Paid-in-Full	Up to $200
Laser Vision Correction	15% off retail price or 5% off promotional price	N/A
Frequency
Examination	Once Every 12 months
Lenses or Contact Lenses	Once Every 12 months
Frames	Once Every 24 months

Retirement Plan Information

Life and Accidental Death and Dismemberment (AD&D) Insurance

Insurance Who is Eligible?
You are eligible for life and AD&D insurance if you are a full-time office employee.

Plan Information

BAYADA provides Basic Life Insurance benefit and an Accidental Death and Dismemberment benefit through MetLife, at no cost to you. See the below chart for eligibility and benefit coverage.

Basic Life and AD&D
Eligibility (Class)	All active employees working 1,000 hours in the previous calendar year
Waiting Period	90 days of service
Guaranteed Issue	$15,000
Maximum Benefit	$15,000
Age-based Reduction	70 or older, reduced to 60% of Life Benefit
Term Illness Benefit	50% of maximum

Supplemental Life Insurance (Voluntary Life Insurance)

Who is Eligible?
You are eligible for voluntary life insurance if you are a full-time office employee.

Plan Information
Voluntary Life Insurance can be purchased through MetLife in increments of $10,000 up to $300,000.

Evidence of Insurability (EOI) or proof of good health is required under the following circumstances:

Late entrant: you have previously waived the opportunity to elect this coverage and are now electing coverage for the first time
Current participant: you currently have this coverage and are requesting an increase to your current coverage amount

Hawaii TDI

You are eligible for the Hawaii state disability if you have at least 14 weeks of Hawaii employment in which you were paid for 20 hours or more, earned no less than $400 in the 52 weeks preceding the first day of disability, and are currently employed. The state disability plan covers 58% of average weekly wages up to the maximum of $650 per week.

Short-Term Disability (STD)

Who is Eligible?
You are eligible for Short-Term Disability insurance if you are a full-time office employee with one year of employment.

If you are not a full-time office employee, but you are a resident of New York, New Jersey, Rhode Island, California, or Hawaii, you may qualify for state-mandated short-term disability insurance.

Plan Information

Short-term disability insurance can help provide financial security until you get back on your feet and return to work. Short-term disability coverage is offered through MetLife. The plan covers 85% of your pre-disability earnings up to $903 (subject to change each year) per week for a maximum of 26 weeks.

You are also covered under the state disability plan. To be eligible you must have at least 14 weeks of Hawaii employment in which you were paid for 20 hours or more, earned no less than $400 in the 52 weeks pre- ceding the rst day of disability, and are currently employed. The state disability plan covers 58% of average weekly wages up to the maximum of $620 per week.

Long-Term Disability (LTD)

Who is Eligible?
You are eligible for Long-Term Disability insurance if you are a full-time of ce employee with three years of employment.

Plan Information
BAYADA offers a LTD plan through Cigna at no cost to you. Eligible employees receive a benefit equal to 60% of your monthly salary, up to a maximum of $5,000 per month. The cost of the plan is paid by BAYADA, so the benefit will be taxable.

Coinsurance

Coinsurance: Your share of the costs of a covered healthcare service, calculated as a percentage (for example, 30%) of the allowed amount for the service. Your coinsurance will begin after you have met your deductible. For example, if the charge for an office visit is $100, and you have met your deductible, your coinsurance payment of 30% would be $30. Your health insurance pays the rest of the allowed amount.

Copay

A copay is a fixed-dollar amount you pay for a healthcare service. The amount can vary by the type of service. Your copays will not count towards your deductible but will count towards your out-of-pocket maximum.

Covered Expenses

These are the services that are reimbursed through the insurance plans.

Deductible

The amount you owe for covered healthcare services before your plan begins to pay benefits. For example, if your deductible is $1,000, your plan won’t pay anything until you’ve paid the rest $1,000 of the bill for your covered healthcare services subject to the deductible. Preventive Care is not subject to the deductible as it is covered 100% by all medical plan options.

Diagnostic Procedures

Doctors use medical tests and procedures to identify—or diagnose—what’s making you sick. Your doctor will ask you questions about your symptoms, and might even recommend additional lab or other tests. It’s important to understand that diagnostic care is covered differently from preventive care.

Explanation of Benefits (EOB)

This is a statement from the insurance company showing how claims were processed. The EOB tells you what portions of the claim were paid to the doctor or hospital and what portion of the payment, if any, you are responsible for paying.

Generic Drugs

Generic drugs contain the same active ingredient as brand-name drugs, but they generally cost a lot less.

Health Savings Account (HSA)

An HSA is an account available to employees who enroll in the High Deductible Health Plan. An HSA lets you save money for health care expenses on a before-tax basis (before taxes are deducted from your paycheck). When you go to the doctor or pharmacy, you can use the money in your account to pay for your visit or prescription. That’s an automatic savings because the money you put aside in your HSA comes out before taxes. Best of all, you own 100% of the money in your account—even if you change jobs or retire. And any money you don’t use during the year stays in your HSA—earning interest—for you to use in the future.

HealthSherpa

An organization dedicated to making it easy for Americans to find quality, affordable health insurance. HealthSherpa has plans from over 200 carriers—all the same plans at the same prices as healthcare.gov. You can get free help from a representative by calling 855-772-2663, or visit HealthSherpa.com to explore your options. Live chat is also available.

Hospitalization

Care in a hospital that requires admission as an inpatient, and usually requires you to spend one or more nights in the hospital.

In-Network (Also Known as Network)

A network is comprised of all contracted providers. Insurers request providers to participate in their network, and, in return, providers agree to offer discounted services to their patients. If you pick an out-of-network provider, your claims could cost more because you will not receive the discounts that an in-network provider offers.

Maintenance drug

Prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines.

Mylo

Mylo insurance experts will help you find the coverage you need, answering your questions and guiding you in the right direction. You can get free help by calling 844-863-5950 or go to the Mylo website at choosemylo.com.

Nonpreferred Brand-Name Drugs

A drug that has a trade name that is protected by a patent. Because only the company that holds the patent can produce and sell the drug, they are generally more expensive than generic and preferred brand-name drugs.

Out-of-Network

Health care professionals, hospitals, clinics, and labs that do not belong to your health care plan’s network. You’ll typically pay more and might have to pay in full at the time of your visit and then le a claim with the health plan for reimbursement. And because out-of-network providers may charge more, you might not be reimbursed for the full cost.

Out-of-Pocket Maximum

The out-of-pocket maximum is designed to protect you in the event of a catastrophic illness or injury. Your out-of-pocket maximum includes your deductible, coinsurance, and copays that you pay for out of your own pocket. After you have paid the speci ed out-of-pocket maximum during a policy year, your health insurance pays the remaining covered services at 100%.

POS (Point-of-Service) Plan

A hybrid medical plan where you may select any physicians and hospitals in and outside the plan’s network of preferred providers.

PPO (Preferred Provider Organization)

A group of doctors, hospitals, labs, and other health care providers who have agreed to charge less for their services.

Preferred Brand-Name Drugs

These are drugs for which generic equivalents are not available. However, they have been on the market for a time and are widely accepted. They cost more than generics but are less expensive than nonpreferred brand-name drugs.

Premium

The premium is the amount that’s deducted out of your paycheck each week for the cost of coverage.

Preventive Care

Routine healthcare services that can minimize the risk of certain illnesses or chronic conditions. Examples of Preventive Care services include, but are not limited to: physical, mammogram, u vaccine, prostate test, smoking cessation, etc.

Primary Care Physician (PCP)

In the POS Core, POS Buy-Up, and POS High Deductible Health Plans, Primary Care Physician (PCP) refers to the doctor you see for regular preventive care and when you have a minor illness. This is often referred to as your family doctor. In the HMO offered to Hawaii employees, a PCP is the doctor you must see for routine care. Your PCP is also the doctor who will give you referrals to specialists and other types of care.

Qualified Life Event

Certain changes in your life mean you can make changes to your benefits during the year. In the benefits world, these changes are known as qualified life events. They include having a baby or adopting a child; getting married, legally separated, or divorced; if your spouse gains or loses coverage; or if your child reaches the maximum age for coverage. If you have a qualified life event, contact the Benefits office at 877-291-3000 or by email at benefits@bayada.com.

Specialist

A doctor with additional training who specializes in a certain area of medicine. Specialists include gynecologists and obstetricians, orthopedists, and oncologists.

Telemedicine

The use of telecommunications technologies to provide medical information and services.

To enroll or make changes to your current benefit elections online, use Workday. Any additional questions may be directed to the BAYADA Benefits office at HRCareCenter@bayada.com, or by calling (877) 291-3000.

Following is a comprehensive list of BAYADA’s carriers and their contact information.

Carrier Contact List – Hawaii

Eligibility

Who is Eligible?

Plan Choices

Prescription Drug Plan Design – What You Pay

Who is Eligible for FSAs?

What is a Flexible Spending Account (FSA)?

Healthcare FSA

Dependent Care FSA

Reimbursement from Your FSAs

Medical and Dependent Care FSA Program Provisions

Who is Eligible?

Dental Plan Design – What You Pay

Who is Eligible?

Plan Changes

Vision Plan Design – What You Pay

Life and Accidental Death and Dismemberment (AD&D) Insurance

Supplemental Life Insurance (Voluntary Life Insurance)

Short-Term Disability (STD)

Long-Term Disability (LTD)

Coinsurance

Copay

Covered Expenses

Deductible

Diagnostic Procedures

Explanation of Benefits (EOB)

Generic Drugs

Health Savings Account (HSA)

HealthSherpa

Hospitalization

In-Network (Also Known as Network)

Maintenance drug

Mylo

Nonpreferred Brand-Name Drugs

Out-of-Network

Out-of-Pocket Maximum

POS (Point-of-Service) Plan

PPO (Preferred Provider Organization)

Preferred Brand-Name Drugs

Premium

Preventive Care

Primary Care Physician (PCP)

Qualified Life Event

Specialist

Telemedicine

Learn about online enrollment.

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