Documents and Forms | Johns Hopkins Hospital

Summary of Benefits and Coverage (SBC)

SMM for Johns Hopkins EHP Plans + Short-Term Disability SPD

Johns Hopkins PPO Plan SBCs:

Johns Hopkins DPC Plan SBCs:M

Summary of Material Modifications (SMM)

Dental and vision

Life insurance and disability

Disability Income Insurance Certificate – Amendment

Retirement plan documents

Compliance notices

HIPAA Notice of Privacy Practices:

Plan Year 2023-2024 Summary Annual Report

DC Paid Family Leave Law Notice (English | Spanish)

Forms

Gestational Surrogacy Reimbursement Request and Affidavit

Medical

These documents provide detailed information about the plans provided under the Employment Retirement Income Security Act of 1974. They contain the plan administrator’s identity, requirements for eligibility and participation in the plan, circumstances that may result in disqualification or denial of benefits, and the identity of insurers.

Summary Plan Description (SPDs)

Summary of Benefits and Coverage (SBC)

SMM for Johns Hopkins EHP Plans + Short-Term Disability SPD

Johns Hopkins PPO Plan SBCs:

Johns Hopkins DPC Plan SBCs:

Summary of Material Modifications (SMM)

Dental and vision

Life insurance and disability

Basic Life and AD&D Insurance Certificate:

Disability Income Insurance Certificate – Amendment

Retirement plan documents

Compliance notices

HIPAA Notice of Privacy Practices:

Plan Year 2023-2024 Summary Annual Report

DC Paid Family Leave Law Notice (English | Spanish)

Forms

Gestational Surrogacy Reimbursement Request and Affidavit

Medical

These documents provide detailed information about the plans provided under the Employment Retirement Income Security Act of 1974. They contain the plan administrator’s identity, requirements for eligibility and participation in the plan, circumstances that may result in disqualification or denial of benefits, and the identity of insurers.

Summary Plan Description (SPDs)

Summary of Benefits and Coverage (SBC)

SMM for Johns Hopkins EHP Plans + Short-Term Disability SPD

Johns Hopkins PPO Plan SBCs:

Johns Hopkins DPC Plan SBCs:

Summary of Material Modifications (SMM)

Dental and vision

Life insurance and disability

Disability Income Insurance Certificate – Amendment

Retirement plan documents

Notice of New Jersey Temporary Disability Benefits

Compliance notices

HIPAA Notice of Privacy Practices:

Plan Year 2023-2024 Summary Annual Report

DC Paid Family Leave Law Notice (English | Spanish)

Forms

Gestational Surrogacy Reimbursement Request and Affidavit

Medical

These documents provide detailed information about the plans provided under the Employment Retirement Income Security Act of 1974. They contain the plan administrator’s identity, requirements for eligibility and participation in the plan, circumstances that may result in disqualification or denial of benefits, and the identity of insurers.

Summary Plan Description (SPDs)

Summary of Benefits and Coverage (SBC)

SMM for Johns Hopkins EHP Plans + Short-Term Disability SPD

Johns Hopkins PPO Plan SBCs:

Johns Hopkins DPC Plan SBCs:

Summary of Material Modifications (SMM)

Dental and vision

Life insurance and disability

Disability Income Insurance Certificate – Amendment

Retirement plan documents

Compliance notices

HIPAA Notice of Privacy Practices:

DC Paid Family Leave Law Notice (English | Spanish)

Forms

Gestational Surrogacy Reimbursement Request and Affidavit

Medical

These documents provide detailed information about the plans provided under the Employment Retirement Income Security Act of 1974. They contain the plan administrator’s identity, requirements for eligibility and participation in the plan, circumstances that may result in disqualification or denial of benefits, and the identity of insurers.

Summary Plan Description (SPDs)

Summary of Benefits and Coverage (SBC)

SMM for Johns Hopkins EHP Plans + Short-Term Disability SPD

Johns Hopkins PPO Plan SBCs:

Johns Hopkins DPC Plan SBCs:

Summary of Material Modifications (SMM)

Dental and vision

Life insurance and disability

Disability Income Insurance Certificate – Amendment

Retirement plan documents

Compliance notices

HIPAA Notice of Privacy Practices:

DC Paid Family Leave Law Notice (English | Spanish)

Forms

Gestational Surrogacy Reimbursement Request and Affidavit

Medical

These documents provide detailed information about the plans provided under the Employment Retirement Income Security Act of 1974. They contain the plan administrator’s identity, requirements for eligibility and participation in the plan, circumstances that may result in disqualification or denial of benefits, and the identity of insurers.

Summary Plan Description (SPDs)

Summary of Benefits and Coverage (SBC)

SMM for Johns Hopkins EHP Plans + Short-Term Disability SPD

Johns Hopkins PPO Plan SBCs:

Johns Hopkins DPC Plan SBCs:

Summary of Material Modifications (SMM)

Dental and vision

Life insurance and disability

401(k) Summary Plan Description

Disability Income Insurance Certificate – Amendment

Retirement plan documents

401(k) Fee Disclosure

Compliance notices

HIPAA Notice of Privacy Practices:

DC Paid Family Leave Law Notice (English | Spanish)

Forms

Gestational Surrogacy Reimbursement Request and Affidavit

Medical

These documents provide detailed information about the plans provided under the Employment Retirement Income Security Act of 1974. They contain the plan administrator’s identity, requirements for eligibility and participation in the plan, circumstances that may result in disqualification or denial of benefits, and the identity of insurers.

Summary Plan Description (SPDs)

Summary of Benefits and Coverage (SBC)

SMM for Johns Hopkins EHP Plans + Short-Term Disability SPD

Johns Hopkins PPO Plan SBCs:

Johns Hopkins DPC Plan SBCs:

Summary of Material Modifications (SMM)

Dental and vision

Life insurance and disability

Disability Income Insurance Certificate – Amendment

Retirement plan documents

Compliance notices

HIPAA Notice of Privacy Practices:

Gestational Surrogacy Reimbursement Request and Affidavit

DC Paid Family Leave Law Notice (English | Spanish)

Forms

Medical

These documents provide detailed information about the plans provided under the Employment Retirement Income Security Act of 1974. They contain the plan administrator’s identity, requirements for eligibility and participation in the plan, circumstances that may result in disqualification or denial of benefits, and the identity of insurers.

Summary Plan Description (SPDs)

Summary of Benefits and Coverage (SBC)

SMM for Johns Hopkins EHP Plans + Short-Term Disability SPD

Johns Hopkins PPO Plan SBCs:

Johns Hopkins DPC Plan SBCs:

Summary of Material Modifications (SMM)

Dental and vision

Life insurance and disability

401(k) Summary Plan Description

Disability Income Insurance Certificate – Amendment

Retirement plan documents

401(k) Fee Disclosure

Compliance notices

HIPAA Notice of Privacy Practices:

DC Paid Family Leave Law Notice (English | Spanish)

Forms

Gestational Surrogacy Reimbursement Request and Affidavit

Medical

These documents provide detailed information about the plans provided under the Employment Retirement Income Security Act of 1974. They contain the plan administrator’s identity, requirements for eligibility and participation in the plan, circumstances that may result in disqualification or denial of benefits, and the identity of insurers.

Summary Plan Description (SPDs)

Summary of Benefits and Coverage (SBC)

SMM for Johns Hopkins EHP Plans + Short-Term Disability SPD

Johns Hopkins PPO Plan SBCs:

Johns Hopkins DPC Plan SBCs:

Kaiser HMO SBC

Summary of Material Modifications (SMM)

Dental and vision

Life insurance and disability

Disability Income Insurance Certificate – Amendment

Retirement plan documents

Compliance notices

HIPAA Notice of Privacy Practices:

Plan Year 2023 Summary Annual Report (Health Benefits)

Plan Year 2022 Summary Annual Report (Life Insurance and Long-Term Disability)

DC Paid Family Leave Law Notice (English | Spanish)

Forms

Gestational Surrogacy Reimbursement Request and Affidavit

Bike Parking Agreement

Carpool Subsidy Application

Parking Declination Subsidy – Bike or Walk

Medical

These documents provide detailed information about the plans provided under the Employment Retirement Income Security Act of 1974. They contain the plan administrator’s identity, requirements for eligibility and participation in the plan, circumstances that may result in disqualification or denial of benefits, and the identity of insurers.

Summary Plan Description (SPDs)

Allegiance Flexible Spending Account SPD

Summary of Benefits and Coverage (SBC)

Allegiance Dental Summary Plan Description (SPD)

Johns Hopkins PPO Plan SBCs:

Dental and vision

Life insurance and disability

Disability Income Insurance Certificate (Physicians)

Disability Income Insurance Certificate – Amendment

Disability Income Insurance Certificate (Physicians) – Amendment

Short-Term Disability Summary Plan Description

Retirement plan documents

457(b) Retirement Plan Highlights (Physicians only)

Compliance notices

HIPAA Notice of Privacy Practices:

DC Paid Family Leave Law Notice (English | Spanish)

Forms