Important Notices About BAYADA Benefits
BAYADA Home Health Care 401(k) Plan
Patient Protection and Affordable Care Act
Please note: the BAYADA medical plans are considered compliant with the Patient Protection and Affordable Care Act. There are no annual dollar limits, dependent children can be covered to age 26 and in-network preventive care is covered at 100%.
Summary Annual Report
BAYADA is required by the IRS to share the following Summary Annual Report (SAR) with employees. These SARs explain important financial aspects of the BAYADA Health & Welfare Plan.
Please keep a copy of the SAR for your records, and contact the BAYADA Benefits office with any questions. We are glad to help.
Medicare Part D Coverage Notice
BAYADA is required by Medicare to provide the following notice regarding prescription drug plans to plan participants who may be enrolled in that program or eligible for Medicare coverage. Your BAYADA health insurance plan may or may not cover as much as the standard Medicare prescription drug coverage pays.
As a result, you may wish to explore your options with Medicare Part D Prescription Coverage during Medicare open enrollment, which runs each year between October 15 and December 7. (Coverage becomes effective on the following January 1.) Medicare-eligible employees who are enrolled in a “non-creditable coverage” prescription plan who do not enroll during open enrollment may be subject to a penalty if they enroll at a later date.
If you wish to enroll in Medicare Part D (prescription) coverage, you may do so by either visiting www.medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227). TTY users may call 877-486-2048.
Please retain a copy of this Medicare notice for your records, and contact the BAYADA Benefits office with any questions. We are glad to help.
Download the Certificate of Creditable Coverage for the Option A: Core, Option B: Buy-Up, Option F: HMSA PPO Plan, and Option G: Kaiser Permanente HMO Plan
Download the Certificate of Non-Creditable Coverage for the Option C: High Deductible Health Plan, Option D: Minimum Coverage and Option E: Enhanced Minimum Coverage Plans
Summary Plan Descriptions
BAYADA is required by the IRS to share the following Health & Welfare Summary Plan Descriptions (SPD) to employees. These SPDs explain important features of the BAYADA health insurance plans including, summaries of covered services and supplies, claims procedures, appeals processes, and more.
Please keep a copy of the appropriate SPD for your records, and contact the BAYADA Benefits office with any questions. We are glad to help.
Special enrollment: Loss of other coverage (excluding Medicaid or a state children’s health insurance program)
If you decline enrollment for yourself or for an eligible dependent (including your spouse) while other health insurance or group health plan coverage is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage (or if the Company stops contributing toward your or your dependents’ other coverage). However, you must request enrollment within 30 days after the other coverage ends (or after the employer stops contributing toward the other coverage).
Special enrollment: Loss of coverage for Medicaid or a state children’s health insurance program
If you decline enrollment for yourself or for an eligible dependent (including your spouse) while Medicaid coverage or coverage under a state children’s health insurance program is in effect, you may be able to enroll yourself and your dependents in this plan if you or your dependents lose eligibility for that other coverage. However, you must request enrollment within 60 days after the coverage ends under Medicaid or a state children’s health insurance program (CHIP).
Special enrollment: New dependent by marriage, birth, adoption, or placement for adoption
If you have a new dependent as a result of marriage, birth, adoption, or placement for adoption, you may be able to enroll yourself and your new dependents. However, you must request enrollment within 30 days of the marriage, birth, adoption, or placement for adoption. If you request a change due to a special enrollment event within the applicable timeframe, coverage will be effective the date of marriage, birth, adoption, or placement for adoption.
Special Enrollment: Eligibility for Medicaid or a state children’s health insurance program
If you or your dependents (including your spouse) become eligible for a state premium assistance subsidy from Medicaid or through a state children’s health insurance program (CHIP) with respect to coverage under this plan, you may be able to enroll yourself and your dependents in this plan. However, you must request enrollment within 60 days of the determination of eligibility for such assistance.
Special Enrollment: Enrollment in a qualified health plan through a health insurance marketplace
If you become eligible for a Special Enrollment Period to enroll in a Qualified Health Plan through a Health Insurance Marketplace, or if you seek to enroll in a Qualified Health Plan through a Health Insurance Marketplace during the Marketplace's annual open enrollment period, you may be able to enroll yourself and your dependents in that plan. However, you must request to cancel coverage in a BAYADA plan within 30 days of the new coverage effective date.
Special Enrollment: reduction in hours of service
If you experience a change in employment status whereby you are expected to average less than 30 hours of service per week, you may be able to cancel your enrollment in a BAYADA plan.
Newborns’ and Mothers’ Health Protection Act
Group health plans and health insurance carriers 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 cesarean section. However, Federal law generally does not prohibit the mother's or newborn's attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and carriers may not, under Federal law, require that a provider obtain authorization from the plan or the carrier for prescribing a length of stay not in excess of 48 hours (or 96 hours).
Women’s Health and Cancer Rights Act
If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women's Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for:
- all stages of reconstruction of the breast on which the mastectomy was performed;
- surgery and reconstruction of the other breast to produce a symmetrical appearance;
- prostheses; and
- treatment of physical complications of the mastectomy, including lymphedema.
These benefits will be provided subject to the same deductibles and coinsurance applicable to other benefits. If you have any questions, please call the Benefits Office. Women's Health and Cancer Rights Act of 1998
Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA)
USERRA protects the job rights of individuals who voluntarily or involuntarily leave employment positions to undertake military service or certain types of service in the National Disaster Medical System. USERRA also prohibits employers from discriminating against past and present members of the uniformed services and applicants to the uniformed services.
If you leave your job to perform military service, you have the right to elect to continue your existing employer-based health plan coverage for you and your dependents for up to 24 months while in the military. Even if you don't elect to continue coverage during your military service, you have the right to be reinstated in your employer's health plan when you are reemployed, generally without any waiting period or exclusions (e.g., pre-existing condition exclusions) except for service-connected illnesses or injuries. For assistance in filing a complaint, or for any other information on USERRA, contact VETS at 1-866-4-USA-DOL (1-866-487-2365) or www.dol.gov/vets.
Medicaid and CHIP
Medicaid and the Children’s Health Insurance Program (CHIP) offer free or low-cost health coverage to children and families
If you or your children are eligible for Medicaid or CHIP and you are eligible for health coverage from BAYADA, 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 are not eligible for Medicaid or CHIP, you will not 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 (1-877-543-7669) or www.insurekidsnow.gov to find out how to apply. If you qualify, you can ask the 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 at BAYADA, BAYADA must allow you to enroll in our plan if you are not already enrolled. This is called a “special enrollment” opportunity. You must request coverage within 60 days of being determined eligible for premium assistance.