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.

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The choices you make upon eligibility or during Open Enrollment remain in effect through the end of the plan year: December 31, 2025. 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 2025

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.

Hawaii Prescription Drug Comparison Chart

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 Payment Card – use at point of service. Submit online or paper claim forms. You have until 03/31/2025 to submit expenses incurred prior to 01/01/2025.
What happens if there is money left at the end of the plan year?	The FSA will have a carryover feature allowing up to $640 of your unused healthcare FSA balance to be carried into the 2025 plan year. Any funds over the $640 rollover will be forfeited if not used on claims incurred prior to 01/01/25. You have until 03/31/2025 to submit expenses incurred prior to 01/01/2025.	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 03/31/2025 for expenses incurred prior to 01/01/2024. Any funds not used by 03/31/2025 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

Hawaii Dental Comparison Chart

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 Plan Design – What You Pay

Hawaii Vision Comparison Chart

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 worked 1,000 hours in the prior calendar year at BAYADA.

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. Will vary by role
Waiting Period	90 days of service or 1 year of employment + 1000 hours worked.
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?

Voluntary Life Insurance is available to all BAYADA employees including licensed and non-licensed caregivers who work an average of 30 hours per week.

*Not applicable to Part-Time Office Employees

Plan Information
Voluntary life insurance can be purchased through MetLife in increments of $10,000 up to *$300,000. See Workday for your specific benefit coverage.

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

If you previously waived coverage or were enrolled in coverage from $0 – $90,000, you will be subject to Evidence of Insurability if you elect an amount greater than $100,000.

If you were previously enrolled in coverage for $100,000, then you will not be subject to Evidence of Insurability if you elect an amount greater than $100,000.

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 $798 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, Connecticut, Massachusetts, Hawaii, Colorado or Oregon, you may qualify for state-mandated short-term disability insurance or other paid leave programs.

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. Additional information regarding the plan payout will be updated here once the state of NJ releases the 2025 payout benefit amount in 4th Quarter 2024.

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 first 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 office 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.

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 [email protected], or by calling 833-993-2958.

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)

Learn about online enrollment.

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