Medical

If you work an average of 80 hours a month, you can choose from two medical plans that include dental coverage. If you work less than 80 hours a month you are not eligible for health benefits through BAYADA.

Option F: HMSA PPO plan

A PPO (Preferred Provider Organization) provides care through a group (network) of preferred doctors, hospitals, labs, and other health care providers who have agreed to charge less for their services. So, when you need care, you’ll save money by seeing an in-network provider.

How it works

For most in-network routine care (such as doctors’ office visits), you pay only a small fee, or copayment. For other services (such as tests, lab work outside of annual preventive care, and others), you have to meet a deductible before the plan pays the balance on your behalf.

Once you meet your deductible, you will pay part of the cost of covered services and the plan pays the rest. The part you’re responsible for is called coinsurance.

The plan helps to protect you from extremely high medical costs through an out-of-pocket maximum. That’s a limit on what you have to pay in any plan year. If you reach the out-of-pocket maximum, the plan pays 100% of covered expenses for the rest of the plan year.

This plan/includes dental and prescription drug benefits.

Option G: Kaiser Permanente HMO plan

A Health Maintenance Organization (HMO) provides health care to people who agree to visit the health providers and hospitals that belong to the HMO when they need care. This means that, except for life-threatening emergencies, you must see your primary care physician and use Kaiser facilities. Otherwise, the plan won’t cover your care.

How it works

You choose a Primary Care Physician (PCP) who will provide most of your routine care and refer you to specialists, as needed.

You pay a copayment for most routine doctor visits. For tests, diagnostic procedures, and other medical expenses, you will pay part of the cost of covered services and the plan pays the rest. The part you’re responsible for is called coinsurance.

The plan protects you from extremely high medical costs through an out-of-pocket maximum. That’s a limit on what you have to pay in any plan year. If you reach the out-of-pocket maximum, the plan pays 100% of covered expenses for the rest of the plan year.

This plan includes dental and prescription drug benefits.

How the plans compare

HMSA PPO
Administered by HMSA
In-Network
Preventive care Plan pays 100%
Primary care
physician office visit
$17 copayment
Specialist office visit $40 copayment
Annual deductible $300 single coverage/$900 family coverage
Coinsurance Plan pays 80% after deductible
Annual out-of-pocket maximum $3,000 single coverage/$9,000 family coverage
Hospitalization 20% coinsurance for facility stay
$20 copayment/physician visit
20% copayment for surgeon (if needed)
For more details Download the Summary of Benefits and Coverage
Kaiser Permanente HMO
Administered by Kaiser Permanente
In-Network
Preventive care Plan pays 100%
Primary care
physician office visit
$20 copayment
Specialist office visit $40 copayment
Annual deductible None
Coinsurance None
Annual out-of-pocket maximum $2,500 single coverage/$7,500 family coverage
Hospitalization None
For more details Download the Summary of Benefits and Coverage
HMSA PPO Kaiser Permanente HMO
Administered by HMSA Administered by Kaiser Permanente
In-Network
Preventive care Plan pays 100% Plan pays 100%
Primary care
physician office visit
$17 copayment $20 copayment
Specialist office visit $40 copayment
Annual deductible $300 single coverage/$900 family coverage None
Coinsurance Plan pays 80% after deductible None
Annual out-of-pocket maximum $3,000 single coverage/$9,000 family coverage $2,500 single coverage/$7,500 family coverage
Hospitalization 20% coinsurance for facility stay
$20 copayment/physician visit
20% copayment for surgeon (if needed)
None
For more details Download the Summary of Benefits and Coverage Download the Summary of Benefits and Coverage

Cost of coverage

For cost information, go to the Benefits home page of the portal (office staff), or call the Benefits office at 877-291-3000.