Summary Plan Description

of Benefit P lansfor Non-Represented Employees

• Pension & 403 (b) Plans• Medical & Dental Plans• Flexible Spending Accounts• Short Term Disabiltiy Insurance• Basic Life Insurance• Supplemental Life Insurance• Accidental Death and Dismemberment Insurance• Dependent Life Insurance• Long Term Disability Insurance January 2013

Johns Hopkins Health System CorporationThe Johns Hopkins Hospital

Pension

This is a summary

You are cautioned that this summary does not reflect any future amendments that may be made to the Plan from time to time, and may not reflect all exceptions to the general provisions covered in this summary. Any conflicts between the statements in this summary and the terms of the Plan will be resolved by reference to the full Plan document.

of the Johns Hopkins Health System Corporation Retirement Plan (the “JHHSC Retirement Plan” or the “Plan”) as it applies to employees (and their beneficiaries) of The Johns Hopkins Health System Corporation (the “Health System”) and certain of its participating affiliates. This summary describes the terms of the Plan, as amended through December 31, 2010.

If material changes are made to the Plan, you will receive a written summary description of such changes, which will supersede or supplement this summary. You should attach any written summaries of material changes to this document so that you will always have a current summary of the Plan.

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JHHSC RETIREMENT PLAN - TABLE OF CONTENTS

PLANNING YOUR RETIREMENT .............................................................................................

Page

1 The Time for Planning is Now ............................................................................................ 1 What Makes Up Retirement Income................................................................................... 1 Your Social Security Benefit .............................................................................................. 1 Your Pension from the JHHSC Retirement Plan ................................................................ 1 Helping You Save for Retirement....................................................................................... 1 It All Works Together ......................................................................................................... 2

DEFINITIONS ................................................................................................................................ 2 RETIREMENT PLAN PARTICIPATION..................................................................................... 6

What Your Retirement Plan Can Do .................................................................................. 6 Prior Participants Take Note ............................................................................................... 6 Who is Eligible for the Plan ................................................................................................ 7 Eligibility Example ............................................................................................................. 8

NORMAL RETIREMENT ............................................................................................................. 9 Your Normal Retirement Date ............................................................................................ 9 Normal Retirement Date Example ...................................................................................... 9 Your Normal Retirement Benefit ........................................................................................ 9

EARLY RETIREMENT ................................................................................................................. 9 What is Considered Early Retirement ................................................................................. 9 Early Retirement Date Example ....................................................................................... 10 Your Benefit if You Retire Early ...................................................................................... 10

DEFERRED RETIREMENT........................................................................................................ 11 Deferred Retirement Benefits ........................................................................................... 11

DETERMINING YOUR RETIREMENT BENEFIT ................................................................... 11 How Your Pension is Determined .................................................................................... 11 Final Average Compensation ............................................................................................ 12 Final Average Compensation Example ............................................................................ 12 Benefit Service .................................................................................................................. 12 Social Security Limit ........................................................................................................ 13

EMPLOYER MATCHING ACCOUNT ...................................................................................... 13 Matching Credits ............................................................................................................... 13 Matching Credit Example ................................................................................................. 13 Interest Credits .................................................................................................................. 13 Important ........................................................................................................................... 14 Retirement Formula .......................................................................................................... 14 Minimum Benefit .............................................................................................................. 14

SPECIAL BENEFIT CALCULATION RULES .......................................................................... 15 Certain Bayview Participants ............................................................................................ 15 Former JHHP Plan Participants ........................................................................................ 16 Former Homewood Plan Participants ............................................................................... 16 Early Retirement Example ................................................................................................ 16

IF YOU LEAVE THE HEALTH SYSTEM ................................................................................. 17 Vested Benefits ................................................................................................................. 17

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When Benefits are Payable ............................................................................................... 18 Breaks in Service .............................................................................................................. 18

DISABILITY AND SURVIVOR BENEFITS ............................................................................. 19 Disability Retirement ........................................................................................................ 19 Your Benefit if You are Disabled ..................................................................................... 19 Survivor Benefits for Your Beneficiary ............................................................................ 20 Special Payments .............................................................................................................. 22

HOW BENEFITS ARE PAID ...................................................................................................... 22 Applying for a Pension ..................................................................................................... 22 Payment Methods.............................................................................................................. 22

PAYING TAXES ON YOUR BENEFIT ..................................................................................... 24 ADMINISTRATIVE INFORMATION ....................................................................................... 25

Plan Insurance ................................................................................................................... 25 Assignment of Your Pension ............................................................................................ 26 Future of the Plan .............................................................................................................. 27

YOUR LEGAL RIGHTS .............................................................................................................. 27 Your Rights Under ERISA ............................................................................................... 27

ENFORCING YOUR RIGHTS .................................................................................................... 28 Claims Procedure .............................................................................................................. 28 Appealing a Denied Claim ................................................................................................ 28 Your Legal Rights ............................................................................................................. 29 Questions........................................................................................................................... 29

IMPORTANT INFORMATION ABOUT THE RETIREMENT PLAN ..................................... 29 Plan Name and Number .................................................................................................... 29 Plan Sponsor ..................................................................................................................... 30 Employer Identification Number ...................................................................................... 30 Plan Year ........................................................................................................................... 30 Plan Type .......................................................................................................................... 30 Plan Administrator ............................................................................................................ 30 Agent for Service .............................................................................................................. 30 Plan Trustee ...................................................................................................................... 30 Plan Administration .......................................................................................................... 30 Plan Financing .................................................................................................................. 30

PLANNING YOUR RETIREMENT

The Time for Planning is Now

A secure retirement may be something you don’t often think about. Perhaps you’re focused on today’s financial worries and not those that seem far off in the future.

Well, stop a moment and think about the amount of money you may need to retire. How much will that be? And where will all that money come from? These are important questions for both younger people and those approaching retirement.

A good rule of thumb is this – if you plan to maintain your standard of living after you retire, you’ll need to “shoot for” replacing approximately 70% to 80% of your pre-retirement income. Does this sound like a lot of money? Well, it is. And studies show that many people are counting too heavily on the wrong sources for income after they stop working.

What Makes Up Retirement Income

Most think that Social Security and a pension will be enough to keep them comfortable and secure. These are two sources of retirement income, but a third and very important source is your savings. If you think about it, your pension, Social Security and savings each plays a part in supporting you in retirement. And your savings can play a big role in making your retirement years comfortable.

Your Social Security Benefit

Your monthly benefit from Social Security is based on your earnings record. You can find out what that benefit will be by contacting the Social Security Administration at (800) 772-1213 or at its website on the Internet at http://www.ssa.gov

Your Pension from the JHHSC Retirement Plan

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The JHHSC Retirement Plan provides a pension benefit, completely paid by the Health System, that can give you income in your retirement, provided you meet certain requirements explained in this booklet.

Helping You Save for Retirement

In addition to the JHHSC Retirement Plan, the Health System maintains The Johns Hopkins Health System Corporation 403(b) Plan (the “403(b) Plan”) that helps you add to your personal retirement savings. To increase your savings even further, the Health System added (through December 31, 2008) matching credits to your benefit under the JHHSC Retirement Plan, based on the amount that you contribute to the 403(b) Plan. When you retire, you may elect to receive the balance of your employer matching account (which includes the sum of your matching credits and applicable interest credits) in a single sum payment. You will find more information about your employer matching

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account later in this booklet. Beginning January 1, 2009, matching contributions will be made directly to the 403(b) Plan rather than to the JHHSC Retirement Plan. The Pension Office has full details on the 403(b) Plan.

It All Works Together By understanding how each of these sources works now, before you retire, you’ll be better prepared in planning for a secure future.

DEFINITIONS

Throughout this document, certain terms appear in italics. These terms have special meanings for purposes of the Plan. Each of the italicized terms is defined below.

“Compensation” generally means your W-2 earnings for the calendar year. Your compensation is used to determine your final average compensation which is used to calculate your benefit under the Plan. See page 12 for more information on what is, and is not, included in your compensation for Plan purposes.

“Deferred retirement” refers to your status under the Plan if you choose to remain employed with a participating employer or an affiliate after your normal retirement date. See page 11 for more information on deferred retirement.

“Deferred retirement date” is the first day of the month on or next following the date you retire, if you had chosen to continue working with a participating employer or an affiliate beyond your normal retirement date. See page 11 for more information on your deferred retirement date.

“Defined benefit pension plan” is a type of retirement plan that provides a set monthly benefit at your retirement. The Plan (which includes both your traditional pension benefit and your employer matching account) is a defined benefit pension plan. Since the participating employers fund 100% of the benefits under the Plan, it is the participating employers (and not you) that assume the investment risk for the Plan.

“Disability retirement” refers to your status under the Plan if you become disabled while actively employed by a participating employer. Your benefit under the Plan will be coordinated with any Social Security disability benefits that you receive. See pages 19-20 for more information on disability retirement.

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“Early retirement date” is the first day of the month on or next following the date on which you retire after meeting certain service requirements. If you have an early retirement date, you will be eligible to begin receiving benefits before your normal retirement date. See pages 10-11 for more information on your early retirement date.

“Employer matching account” means the account under the JHHSC Retirement Plan where matching credits, based on your 403(b) Plan salary reduction contributions made between January 1, 2003 and December 31, 2008, and interest credits are accumulated. When you retire, you may elect to receive the balance of your employer matching account as a lump sum or as an annuity.

“Final average compensation” is one of the components used to calculate your benefit under the Plan. In general, final average compensation is your average annual compensation for the highest 3 consecutive calendar years of your employment within the last 10 consecutive calendar years of employment with a participating employer or an affiliate. See page 12 for a discussion of final average compensation, as well as an example of the final average compensation calculation.

“Hour of service” means any hour that you work and are paid (or for which you were entitled to be paid) by a participating employer or an affiliate. Your hours of service are used to determine your years of eligibility service, years of vesting service and years of benefit service. See pages 7-8 for more information on hours of service.

“Interest credit” refers to an amount that is credited to your employer matching account under the Plan representing guaranteed investment earnings. The rate used to determine interest credits is based on the rate of return on United States treasury obligations (T-bills) and is calculated in accordance with IRS regulations. See pages 13-14 for more information on interest credits.

“Joint and 50% survivor annuity” is a form of payment under the Plan where you would receive a reduced monthly benefit for your lifetime, and, after your death, your surviving beneficiary would receive 50% of the monthly benefit you were receiving for his or her lifetime. The joint and 50% survivor annuity is the normal form of payment for married participants under this Plan, which means that if you are married, your benefit (including the portion of your benefit based on matching credits) will be paid in this

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form unless you elect otherwise (with your spouse’s consent). See page 23 for more information on the joint and 50% survivor annuity.

“Joint and 100% survivor annuity” is an optional form of payment under the Plan where you would receive a reduced monthly benefit for your lifetime, and, after your death, your surviving beneficiary would receive the same monthly benefit for his or her lifetime. The monthly benefit that you would receive would be smaller than the monthly benefit you would have received under the joint and 50% survivor annuity due to the greater monthly benefit payable to your surviving beneficiary. See page 23 for more information on the joint and 100% survivor annuity.

“Matching credit” refers to the amount that is credited to your employer matching account under the Plan, based on the amount you contributed to the 403(b) Plan between January 1, 2003 and December 31, 2008. See page 13 for more information on matching credits.

“Normal retirement date” is the first day of the month on or next following your 65th birthday. If you retire on your normal retirement date, you will receive a normal retirement benefit under the Plan. See page 9 for more information on your normal retirement date and your normal retirement benefit.

“Participating employer” means the Health System and certain of its affiliates that are covered by this Plan. The participating employers are currently the Health System, The Johns Hopkins Hospital (the “Hospital”), The Johns Hopkins Bayview Medical Center, Inc. (“Bayview”), The Johns Hopkins Medical Service Corporation (which does business under the name Johns Hopkins Community Physicians (“JHCP”)). Participants and beneficiaries may, upon written request to the Plan Administrator, obtain information as to whether a particular employer participates in the Plan.

“Required beginning date” is April 1 of the calendar year following the later of the calendar year in which you reach age 70½ or the calendar year in which you terminate employment.

“Single life annuity” is a form of payment under the Plan where you would receive a monthly benefit for your lifetime. The single life annuity is the normal form of payment for single participants under this Plan. If you are married, you may elect to receive your benefit as a single life annuity, but you must first obtain the

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written consent of your spouse. See pages 23 for more information on the single life annuity.

“Social Security benefit” is one of the components used to calculate the benefit under the JHHSC Retirement Plan for certain Bayview participants. Your Social Security benefit is the estimated annual benefit payable to you by Social Security at age 65, determined utilizing a method established by the Plan Administrator. Rather than having the Plan use an estimated amount for you, you have the right to submit to the Plan Administrator your actual Social Security benefits payable at age 65. If you do so, the Plan’s formula for certain Bayview participants will use your actual Social Security benefit instead of an estimate. See pages 14-16 for an explanation of how your Social Security benefit affects the benefit formula for certain Bayview participants.

“Social Security limit” is applied to your final average compensation in determining your benefit under the Plan. The Social Security limit is the average of the Social Security wage bases for the 35 years ending with the year in which you are entitled to unreduced Social Security benefits. The wage base is the amount of earnings which are subject to FICA tax for Social Security (applicable to old age, survivors and disability insurance benefits). See page 13 for more information on the Social Security limit.

“10 year certain annuity” is an optional form of payment under the Plan where you would receive a reduced monthly benefit for your lifetime. If you die before receiving 10 years of monthly payments, the remaining guaranteed payments would be made to your beneficiary. If you are married, you must obtain the written consent of your spouse to elect this form of payment. See page 23 for more information on the 10 year certain annuity.

“Year of benefit service” means a year in which you complete at least 1,000 hours of service as an eligible employee with a participating employer. See page 13 for more information on years of benefit service.

“Year of eligibility service” means a year in which you complete at least 1,000 hours of service with a participating employer or an affiliate in order to become a participant in the Plan. See pages 7-9 for more information on years of eligibility service, as well as an example of how a year of eligibility service is calculated.

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“Year of vesting service” means a year in which you complete at least 1,000 hours of service with a participating employer or an affiliate. Once you have completed 5 years of vesting service (3 years of vesting service if you have an employer matching account), you have a vested (or nonforfeitable) right to receive benefits under the Plan. See pages 17-18 for more information on vesting and years of vesting service.

RETIREMENT PLAN PARTICIPATION

What Your Retirement Plan Can Do

One way to build your future financial security is through the JHHSC Retirement Plan. Your JHHSC Retirement Plan is a type of plan that’s known as a “defined benefit pension plan.” It provides a set monthly payment at retirement. This monthly benefit is your pension, and it’s calculated by a formula using your compensation and years of service. Your benefit will generally increase with every year you continue to work for a participating employer.

In addition to a set monthly benefit, the JHHSC Retirement Plan provided you with an opportunity to accumulate employer-provided matching credits, based on your contributions to your 403(b) Plan account made between January 1, 2003 and December 31, 2008. Although matching credits are no longer recorded in your employer matching account, interest credits are still added on a daily basis. When you retire or leave employment, you may elect to receive the balance of your employer matching account in a single sum payment (if your spouse consents) or as an annuity. If the balance is paid as a single sum, you may be able to defer taxation on the payment by rolling it over into another employer’s retirement or savings plan or to a traditional IRA. Matching credits or contributions are now made directly to your 403(b) Plan account.

When you retire, you will receive your pension, along with benefits from Social Security. Your personal savings (including any money you’ve saved through the 403(b) Plan, any matching contributions to your 403(b) Plan account, and your employer matching account under the JHHSC Retirement Plan) will be an additional source of income. These three sources can help provide the income you’ll need to retire.

Prior Participants Take Note

If you terminated your employment with a participating employer before January 1, 2006, the rules of the JHHSC Retirement Plan may be different for you. Please contact the Pension Office if you have questions regarding your periods of service prior to January 1, 2006.

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Who is Eligible for the Plan You are eligible to participate in the Plan if you meet the following requirements:

• you are a non-bargaining employee of a participating employer;

• you are not classified by the participating employer as a physician intern or fellow;

• you are not excluded from participation in the Plan by the terms of a personal employment contract with the participating employer;

• you are not an independent contractor; and

• you are not deemed to be a leased employee who provides services pursuant to an agreement with a leasing organization.

Once you satisfy the above requirements, you will be an “eligible employee,” and you will participate in the JHHSC Retirement Plan on the first day of the month after you complete a “year of eligibility service.”

You will earn a “year of eligibility service” if you complete at least 1,000 hours of service with a participating employer or an affiliate during your first year of employment (beginning on your date of hire) or in any calendar year beginning after your date of hire. You may also earn a ½ year of eligibility service if you complete at least 500 (but less than 1,000) hours of service during your first year of employment or any subsequent calendar year.

An “hour of service” is any hour that you work and are paid (or for which you are entitled to be paid) by a participating employer or an affiliate. You may earn hours of service during periods that you are not at work but are still paid, such as vacations, holidays, sick time, disability, approved leave of absence, layoff or jury duty. You will not earn hours of service for hours which you are paid by the Health System, directly or indirectly, for the sole purpose of complying with workers’ compensation, unemployment compensation or disability insurance laws. You also may earn hours of service during certain unpaid leaves of absences. (See pages 18-20 for a discussion of service credit during a leave of absence.)

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If you were employed by John Hopkins Bayview Physicians, P.A. (“JHBP”) and you transferred to a position of employment covered by the Plan on or after June 1, 1999, your employment with JHBP will count in determining whether you have completed a year of eligibility service under this Plan.

If you were employed by The Suburban Hospital Healthcare System (“SHHS”) and you transferred to a position of employment covered by the Plan on or after July 1, 2009, your employment with SHHS will count in determining whether you have completed a year of eligibility service under this Plan.

Prior to November 1, 1998, employees of The Johns Hopkins Home Care Group, Inc., Johns Hopkins Home Health Services, Inc., Johns Hopkins Pediatrics-At-Home, Inc., and Johns Hopkins Pharmaquip, Inc. (the “Home Care Employees”) who met the above eligibility requirements were eligible to participate in the Plan. However, effective October 31, 1998, the benefits of Home Care Employees were “frozen.” All Plan benefits for Home Care Employees are fully vested. This means that Home Care Employees are entitled to a benefit at retirement or termination of employment, but the benefit is calculated based on years of benefit service and compensation (see pages 11-13) earned as of October 31, 1998 and the terms of the Plan in effect on that date. Also, Home Care Employees did not receive matching credits under the Plan.

Eligibility Example Assume that Bill, a non-bargaining employee of the Hospital (a participating employer), was hired on April 9, 2010. Bill is not classified by the Hospital as a resident, physician intern or fellow, he is not excluded from participation in the JHHSC Retirement Plan by the terms of a personal employment contract, and he is not deemed to be an independent contractor or a leased employee. In his first year of employment (April 9, 2010 through April 8, 2011), Bill completes at least 1,000 hours of service with the Hospital. Therefore, Bill becomes a participant in the JHHSC Retirement Plan on May 1, 2011 (assuming he is still employed by the Hospital or another participating employer on that date.)

If Bill does not complete at least 1,000 hours of service in his first year of employment (April 9, 2010 through April 8, 2011), he cannot become a participant on May 1, 2011. Instead, Bill will become a participant in the Plan on the January 1st following any calendar year in which he completes at least 1,000 hours of service. So, for example, if Bill does not complete at least 1,000 hours of service with the Hospital by April 8, 2011, but he does

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complete at least 1,000 hours of service with the Hospital during calendar year 2011, he will become a participant in the Plan on January 1, 2012 (assuming he is still employed by the Hospital or another participating employer on that date).

If Bill completes at least 500 but less than 1,000 hours of service with the Hospital by April 8, 2011, and also completes at least 500 hours of service with the Hospital during calendar year 2011, he will become a participant in the Plan on January 1, 2012 (assuming he is still employed by the Hospital or another participating employer on that date).

NORMAL RETIREMENT

Your Normal Retirement Date

You are eligible for a normal retirement benefit if you retire on your “normal retirement date,” which is the first day of the month on or next following your 65th birthday. However, you may remain employed past this date. If you choose to remain employed past your 65th birthday, this is called “deferred retirement” and is described on page 11.

Normal Retirement Date Example

Assume that Linda, a Bayview employee and a participant in this Plan, was born on May 11, 1956. Linda will attain age 65 on May 11, 2021. Linda’s normal retirement date under the Plan is June 1, 2021.

Your Normal Retirement Benefit

Your normal retirement benefit is calculated using a formula that provides you with an annual benefit, payable in 12 monthly payments, beginning on your normal retirement date. The formula is based on your compensation, years of benefit service (to a maximum of 40 years), and the Social Security limit, plus the balance of your employer matching account. A description of the formula appears later under the section “Determining Your Retirement Benefit.”

EARLY RETIREMENT

What is Considered Early Retirement

You are eligible to retire on the first day of the month on or next following your 55th birthday, provided you have completed at least 5 years of vesting service (3 years of vesting service if you have an employer matching account). You may retire early at any time from this date to your normal retirement date. If you do retire early, the date on which you retire is called your “early retirement date.”

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Early Retirement Date Example

Using the above example, Linda will attain age 55 on May 11, 2011. If Linda decides to retire on August 22, 2011, her early retirement date will be September 1, 2011 (assuming she has at least 5 years of vesting service (or 3 years of vesting service if she has an employer matching account) when she retires).

Your Benefit if You Retire Early

Your early retirement benefit is calculated just like your normal retirement benefit. (See “Determining Your Retirement Benefit”). When you retire early, you may choose to postpone the start of your pension until you reach your normal retirement date, or you may choose to receive your benefit at your early retirement date or on the first day of any month between your early retirement date and your normal retirement date. See page 17 for an example of an early retirement benefit calculation.

If you postpone the start of your pension until your normal retirement date, you will receive the full amount of your benefit, based on your compensation and years of benefit service at your early retirement date, the Social Security limit at your normal retirement date and the balance of your employer matching account at the time you receive your benefit.

If you choose to begin receiving your benefit before your normal retirement date (and you have not attained age 62 with 35 years of vesting service, as described below) your benefit, other than the balance of your employer matching account, will be permanently reduced (as shown in the chart below), since you will receive it over a longer period of time. The reduction is ½% per month (6% per year) for each of the first 60 months and 5/12% per month (5% per year) for each of the next 60 months that you start benefit payments early – before your normal retirement date. The chart below shows the percentage of your full (age 65) benefit (other than the balance of your employer matching account) that you would receive if your benefit begins before your normal retirement date:

AGE BENEFITS COMMENCE

PERCENTAGE OF YOUR FULL BENEFIT THAT YOU WOULD RECEIVE

65 100% 64 94% 63 88% 62 82% 61 76% 60 70% 59 65%

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58 60% 57 55% 56 50% 55 45%

If you choose to begin receiving your benefit before your normal

retirement date, but after attaining age 62 and

completing at least 35 years of vesting service, your benefit will not be reduced. In other words, you will receive the same monthly amount that you would have received if you had postponed the start of your pension until age 65.

The balance of your employer matching account will not be reduced if you receive payment prior to your normal retirement date. You will receive a payment equal to the current balance.

DEFERRED RETIREMENT

Deferred Retirement Benefits

You may continue working after your normal retirement date, in which case your benefit will not begin until the first day of the month on or next following the day you actually retire. This date is called your “deferred retirement date.”

Generally, your deferred retirement benefit is calculated just like your normal retirement benefit (See “Determining Your Retirement Benefit.”)

DETERMINING YOUR RETIREMENT BENEFIT

How Your Pension is Determined

In general, there are four factors used in the pension formula:

• your final average compensation;

• your years of benefit service;

• the Social Security limit; and

• your employer matching account.

Each of these factors is discussed below.

In most cases, your benefit under the JHHSC Retirement Plan will be determined using the retirement formula described on page 14. However, special benefit calculation rules apply to certain participants. A discussion of the special benefit calculation rules appears on pages 15-17.

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Final Average Compensation

“Final average compensation” is your average annual compensation for the highest 3 consecutive calendar years of employment during your last 10 consecutive calendar years of employment with a participating employer or an affiliate.

For purposes of calculating your final average compensation, “compensation” for any calendar year generally consists of your W-2 earnings for such year. W-2 earnings for any calendar year typically include base pay, bonuses, disability pay, overtime, shift differential and any salary reduction contributions to tax-deferred annuities and benefit plans. Contributions to or benefits paid from a retirement plan, deferred compensation plan, welfare benefit plan or fringe benefit plan are not included in compensation. Your compensation taken into account under the Plan is subject to a limit established by federal tax law. For 2011, the annual limit on compensation for purposes of the Plan is $245,000.

Final Average Compensation Example

Suppose your annual compensation from a participating employer during your last 10 years of employment looks like this:

2001 $29,300 2002 $30,500 2003 $32,000 2004 $33,400 2005 $35,000 2006 $36,700 2007 $38,100 2008 $40,000 2009 $41,100 2010 $43,200

Of these 10 final years of employment, the highest-paid 3 consecutive years would be:

2008 $40,000 2009 $41,100 2010 $43,200 Total $124,300

Your final average compensation would be $41,433.33 ($124,300/3).

Benefit Service You are credited with a full “year of benefit service” for each calendar year in which you complete at least 1,000 hours of

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service as an eligible employee of a participating employer. If you complete at least 500 (but less than 1,000) hours of service as an eligible employee in a calendar year, you are credited with a ½ year of benefit service. The maximum number of years of benefit service used to determine your retirement benefit is 40.

Note: If you previously participated in this Plan and took a single sum payment of your benefit, your prior years of benefit service will not be counted again. This provision does not apply to a single sum payment of the balance of your employer matching account.

Social Security Limit The “Social Security limit” is the average of Social Security wage bases for the 35 years ending with the year in which you are entitled to unreduced Social Security benefits. The wage base is the amount of earnings which are subject to tax for Social Security or FICA (applicable to old age, survivors and disability insurance benefits). It’s expected to go up every year. In 2011, the Social Security wage base is $106,800. For 2011, the 35-year average for an individual who was born in 1946 is $64,464. The Pension Office can supply you with more information regarding Social Security limits.

EMPLOYER MATCHING ACCOUNT

Matching Credits If you are a participant in the JHHSC Retirement Plan and you contributed to your account under the 403(b) Plan between January 1, 2003 and December 31, 2008, you received matching credits in your employer matching account under the JHHSC Retirement Plan. The matching credits equaled 50% of your 403(b) Plan contributions for a payroll period, to the extent your 403(b) Plan contributions did not exceed 2% of your compensation for the payroll period.

Matching Credit Example Assume that Stephanie, a Hospital employee, is a participant in the JHHSC Retirement Plan. During the first payroll period of 2007, Stephanie earned $1,500 and elected to contribute $75 (5%) to her account in the 403(b) Plan. A matching credit of $15 was added to her employer matching account under the JHHSC Retirement Plan (she contributed at least 2% of compensation ($30) to her 403(b) Plan account, and 50% of that amount is $15).

Interest Credits Interest credits are added to your employer matching account under the JHHSC Retirement Plan on a daily basis. The rate used to determine interest credits may change each calendar quarter. The rate for any calendar quarter is the monthly average

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discount rate on 6-month Treasury bills plus 150 basis points determined for the second calendar month preceding the calendar quarter. For example, the interest rate for the last calendar quarter of 2010 (October – December 2010) is 1.69%, which is equal to the monthly average discount rate on 6-month Treasury bills for August 2010 (0.19%), plus 150 basis points. For purposes of determining interest credits on a daily basis, the rate will be calculated using an interest compounding method.

Although you will not receive any further matching credits in the JHHSC Retirement Plan after December 31, 2008, your employer matching account will continue to accrue interest credits until your benefit commencement date – the date as of which you receive the balance of your employer matching account in a single sum, or you begin to receive the balance as an annuity.

Important Please note that your employer matching account under the JHHSC Retirement Plan is different from your account under the 403(b) Plan, because your employer matching account under the JHHSC Retirement Plan does not share in the actual earnings of the trust fund that holds the JHHSC Retirement Plan’s assets. Your employer matching account under the JHHSC Retirement Plan is guaranteed to earn interest at the rate described above, even if the JHHSC Retirement Plan’s actual investment return is lower or higher. The value of your employer matching account, therefore, will always increase as you continue to work.

Retirement Formula Your annual retirement benefit will be calculated as follows:

RETIREMENT FORMULA

Step 1 1% of your final average compensation PLUS

Step 2 ½% of your final average compensation above the Social Security limit

TIMES Step 3 your years of benefit service (up to 40)

PLUS Step 4 The annuity equivalent of the balance of your

employer matching account.

Minimum Benefit Regardless of the result under the retirement formula, your

benefit (expressed as an annual amount payable at your normal retirement date for your lifetime only) cannot be less than $480

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times your years of benefit service (up to a maximum of 5 years of benefit service), plus the annuity equivalent of the balance of your employer matching account. Remember, if you start receiving your benefit before your normal retirement date, it may be reduced below the minimum amount to reflect early commencement (but the balance of your employer matching account will not be reduced).

USING THE RETIREMENT FORMULA

To make it easier to understand how this formula works, let’s look at the following example:

Assume that Sue, an employee with 20 years of benefit service, has final average compensation of $70,000 when she retires at age 65 in 2011. The Social Security limit applicable to Sue is $64,464. Sue’s pension is being paid as a “single life annuity.” This means that she will get an annuity paid for the remainder of her life, with no benefits payable after her death. Here’s how to determine Sue’s pension from the Plan.

Step 1 $70,000.00 (Sue’s final average compensation) x .01 (one percent) $ 700.00 Step 2 $ 5536.00 (Sue’s final average compensation above the Social Security limit) x .005 (one-half of one percent) $ 27.68 Step 3 $ 727.68 (the sum of steps 1 and 2) x 20 (Sue’s years of benefit service) $ 14,553.60 (Sue’s annual pension at age 65) Step 4 Sue’s employer matching account balance is $4,500 on the date she retires. In addition to her

pension benefit (described in steps 1-3), Sue may elect to receive a single sum payment of her employer matching account, which means that she would receive a distribution of $4,500. Alternatively, Sue could elect to have her employer matching account converted into an annuity (using factors determined by the Plan’s actuary).

SPECIAL BENEFIT CALCULATION RULES

Certain Bayview Participants

If you participated in the JHHSC Retirement Plan prior to January 1, 2003 as a Bayview employee, and you were actively employed by a participating employer (or on an authorized leave of absence) on December 31, 2002, you may be entitled to receive a benefit under the old Bayview pension formula. You will receive a benefit from the JHHSC Retirement Plan determined under the benefit formula described on page 14 unless the annual benefit determined under the following formula would be greater.

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BAYVIEW PENSION FORMULA

Step 1 1-2/3% of your final average compensation TIMES

your years of benefit service MINUS

Step 2 1-2/3% of your Social Security benefit TIMES

your years of benefit service (up to 30 years) Note that, the compensation used to determine your final

average compensation under the Bayview pension formula is based on your total W-2 earnings and not just base salary or wages.

Former JHHP Plan Participants

If you were a participant in the Johns Hopkins Health Plan, Inc. Employee Retirement Plan (the “JHHP Plan”) on December 31, 1991, the benefit you earned through June 30, 1992 will be calculated using the retirement formula of the JHHP Plan. The benefit you earn after June 30, 1992 will be calculated using the JHHSC Retirement Plan benefit formula described on page 14. Please contact the Pension Office for more information.

Former Homewood Plan Participants

If you were a participant in the Homewood Hospital Center, Inc. Pension Plan (the “Homewood Plan”) on December 31, 1991, your benefit will generally be calculated using the JHHSC Retirement Plan benefit formula described on page 14. However, your benefit cannot be less than the sum of (1) the benefit you earned through June 30, 1989 using the retirement formula of the Homewood Plan, plus (2) the benefit you earned after June 30, 1989 using the JHHSC Retirement Plan benefit formula (including your employer matching account). Contact the Pension Office for more information.

Early Retirement Example As explained under “Early Retirement,” your pension benefit (other than your employer matching account) will be permanently reduced if you retire and take your benefit early, because the benefit is paid over a longer period of time.

Let’s look at Sue’s pension benefit (excluding her employer matching account) – $14,553.60 per year paid over her lifetime beginning at her normal retirement date (age 65). What would that benefit have been if Sue had retired at age 62, 60 or 55?

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Retirement Age Benefit Reduction Sue’s Annual

Benefit* 62 18% $11,933.95 60 30% $10,187.52 55 55% $6,549.12

*This example shows the effect of the benefit reduction, but does

not take into account the fact that if Sue retired earlier, she may have fewer years of benefit service and/or lower final average compensation. Due to these factors, her actual benefit would be less.

IF YOU LEAVE THE HEALTH SYSTEM

Vested Benefits If you terminate employment with the Health System (and its affiliates) for any reason other than retirement, death or disability, you will still be entitled to a benefit under the Plan if you are “vested.” You will have a vested (or nonforfeitable) right to a benefit if, as of the date you terminate employment, you have completed at least 5 years of vesting service (3 years of vesting service if you have an employer matching account). As a general rule, if you leave your employment with the Health System (and its affiliates) prior to completing 5 years of vesting service (or 3 years of vesting service if you have an employer matching account), no benefit will be paid to you under the Plan. (However, if you are still employed by the Health System (or an affiliate) when you reach your normal retirement date, you will be fully vested at that time, even if you do not yet have the requisite years of vesting service.)

You are credited with a full “year of vesting service” for each calendar year in which you complete at least 1,000 hours of service. If you complete at least 500 (but less than 1,000) hours of service in a calendar year, you are credited with ½ year of vesting service.

If you were employed by John Hopkins Bayview Physicians, P.A. (“JHBP”) and you transferred to a position of employment covered by the Plan on or after June 1, 1999, your employment with JHBP will count in determining your years of vesting service under this Plan.

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If you were employed by The Suburban Hospital Healthcare System (“SHHS”) and you transferred to a position of employment covered by the Plan on or after July 1, 2009, your employment with SHHS will count in determining your years of vesting service under this Plan.

When Benefits are Payable You will normally begin receiving your benefit at age 65, although you may choose to begin receiving it at an earlier or later date, subject to the following rules.

You may elect to receive your vested employer matching account as soon as administratively possible after your termination of employment, or at a later date that you choose, but not later than your required beginning date.

You may elect to receive the remainder of your pension benefit under the JHHSC Retirement Plan (other than your employer matching account) as of the first day of the month that is on or next following your 55th birthday, or at a later date that you choose, but not later than your required beginning date. If you elect to receive your pension benefit prior to age 65, it will be permanently reduced because it will be paid out over a longer period. The reduction is ½% per month (6% per year) for each of the first 60 months and 5/12% per month (5% per year) for each of the next 60 months that you start your benefit payments early – before your normal retirement date. (See the chart on page 17 for an illustration).

If the single sum value of your pension benefit under the JHHSC Retirement Plan (other than the employer matching account) is not more than $25,000, you may elect to receive your pension benefit as soon as administratively possible after your termination of employment, or at a later date that you choose, but not later your required beginning date. If you elect to receive your pension benefit at or after age 55, but prior to age 65, it will be permanently reduced as described in the preceding paragraph. If you elect to receive your pension benefit prior to age 55, it will be permanently reduced so that you will receive the actuarial equivalent of the benefit payable at age 65. The actuarial equivalent reduction is generally greater than ½% per month.

Breaks in Service If you complete fewer than 500 hours of service during a calendar year you will have a “break in service.” Normally, this happens when you stop working for the Health System (and its affiliates).

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Break-in-service rules are important if you return to work at the Health System (or an affiliate).

• If you were vested when you left and you return to work, then your years of vesting service (including years counted for eligibility for early retirement) will be reinstated; your years of benefit service will be reinstated as long as you did not receive a single sum payment of your benefit (other than your employer matching account) when you left. Your employer matching account will continue to accrue interest credits after you leave employment until your balance is paid or begins to be paid.

• If you were not

vested when you left and you return to work in less than 5 years (i.e., have less than 5 consecutive one-year breaks in service), then your years of service for all purposes under the Plan and your employer matching account will be reinstated once you return to work. If you return to work after five or more years, then you lose your years of service and you lose the balance of your employer matching account prior to your break in service for all purposes under the Plan.

You will not

DISABILITY AND SURVIVOR BENEFITS

have a break in service during any paid or unpaid authorized leave of absence (provided you return to work at the end of your leave period). You will earn hours of service during these leaves for all purposes under the Plan. To the extent required by federal law, an absence for service in the armed forces will also be counted as service for all purposes under the Plan.

Disability Retirement If you have at least 10 years of vesting service and you become “disabled,” you are eligible for a “disability retirement” benefit under the Plan. You are “disabled” for purposes of the Plan if you incur a disability while in the active service of the Health System (or another participating employer) for which you are eligible for and receiving Social Security disability benefits.

Your Benefit if You are Disabled

Your disability retirement benefit is calculated using the standard retirement formula. Unlike early retirement, there is no reduction in your disability retirement benefit for payments that

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start before age 65. Your years of benefit service and final average compensation as of the date of your disability retirement and your employer matching account as of your benefit starting date will be used to calculate your benefit. The benefit will begin as of the date your Social Security disability benefit begins.

To continue receiving your benefit prior to age 65, you may be required to submit evidence from time to time of your continued disability.

Survivor Benefits for Your Beneficiary

The availability and amount of a survivor benefit, payable upon your death, depends on several factors, including whether or not you are vested, whether or not you are married, whether or not you have an employer matching account and whether or not you are receiving benefit payments under the Plan when you die. Note: Your beneficiary may be eligible for one or more special one-time payments (see “Special Payments” below).

You may designate any person or persons to receive benefits after your death. If you are married, you may designate a beneficiary other than your spouse only with your spouse’s written consent. You may change your beneficiary designation at any time by completing a new beneficiary designation form and filing it with the Pension Office.

If you are not vested when you die, no

survivor benefits are payable (unless you made voluntary contributions to the Plan prior to July 1, 1992 – see the “Special Payments” section, below).

If you die after you are vested and you have not yet begun to receive your benefit, the following conditions apply:

• Your beneficiary will receive a single sum payment of your employer matching account balance as soon as administratively possible after your death. If your surviving beneficiary is your spouse, your spouse will receive a single sum payment (or an actuarially equivalent annuity) of your employer matching account balance which may be paid (or begin to be paid in the case of an annuity) in any month following your death (but no later than the end of the year in which you would have reached age 70 ½).

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• If you die before age 55, your beneficiary may elect to receive a single sum payment or a survivor’s benefit equal to one-half of the reduced amount that you would have received had you retired at age 55 with a joint and 50% survivor annuity form of payment (but based only on the benefit you had earned at the date of your death or earlier termination of employment, and excluding your employer matching account). Your beneficiary must begin to receive the single sum payment or monthly survivor benefit by the end of the year following the year of your death (e.g., if you die on November 15, 2011, your beneficiary must begin to receive the survivor benefit by December 2012). However, if your surviving beneficiary is your spouse, your spouse may begin to receive the survivor benefit in any month following your death (but no later than the end of the year in which you would have reached age 70 ½). If payment of the survivor benefit begins prior to your 65th birthday, your beneficiary’s benefit payment will be reduced, since it will be payable over a longer period.

• If you die at or after age 55, your beneficiary may elect to receive a single sum payment or a survivor’s benefit equal to the reduced amount that you would have received had you retired on the date of your death with a joint and 100% survivor annuity form of payment (but based only on the benefit you had earned at the date of your death or earlier termination of employment, and excluding your employer matching account). The survivor benefit commencement and reduction rules described in the preceding paragraph will apply.

Whether you are single or married, if you are receiving benefit payments when you die, your surviving spouse or beneficiary will receive whatever survivor benefits (if any) are payable under the form of benefit payment you had elected to receive.

Note: If you elect a single life annuity or if you receive all the guaranteed payments under a 10 year certain annuity, no payments will be made after your death (unless your beneficiary qualifies for a Special Payment (see below)).

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Special Payments One or more of the following special benefits may become payable to your beneficiary upon your death. These benefits would be in addition to your beneficiary’s survivor benefit described above.

If you die (i) after your 55th birthday, (ii) while actively employed by the Health System (or a participating employer) and (iii) before you start to receive benefit payments, your beneficiary will receive a single sum payment equal to 12 times the monthly amount (excluding your employer matching account) you would have received had you retired on your date of death. This Special Payment is in addition to any preretirement survivor annuity to which you may be entitled.

If you die after you have started to receive monthly benefit payments, your beneficiary will receive a single sum payment equal to 12 times the monthly amount you were receiving (excluding your employer matching account). This Special Payment is in addition to any preretirement survivor annuity to which you may be entitled.

To the extent that a portion of your benefit is attributable to voluntary contributions that you made to the Plan prior to July 1, 1992, your beneficiary may elect to receive your contributions plus interest in a single sum. Contact the Pension Office for more information on voluntary contributions.

HOW BENEFITS ARE PAID

Applying for a Pension You must apply for your pension on the forms provided by the Pension Office. When you apply, you’ll receive details about the financial effect of each payment method, so you can choose the one that is best for you. You can request more information about the options before you make your choice.

You must make your choice in writing before payments begin. After payments start, you cannot change your election.

Payment Methods You may elect that your benefit be paid in one of the following ways:

• Single Sum – You can receive the value of your employer matching account balance in a single sum payment. You also can receive the remainder of your benefit under the Plan in a single sum payment if the single sum value of your benefit (excluding your employer matching account) does not exceed $25,000.

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• Single Life Annuity – You will receive a lifetime monthly pension. When you die, no further payments will be made.

Note: An unmarried participant who does not designate a specific optional form in which to receive benefits will receive benefits in this form (even with respect to his or her employer matching account).

• Joint and Survivor Annuity – You will receive reduced monthly benefit payments during your life so that after your death, benefit payments continue to another person for the remainder of his or her life. The amount of the continued monthly payments will be equal to 100%, 75% or 50% of your reduced monthly payment (whichever you elect before your pension begins).

Note: A married participant who does not designate a specific optional form in which to receive benefits will receive benefits in the form of a joint and 50% survivor annuity with his or her spouse as the survivor annuitant (even with respect to his or her employer matching account).

• 10 Year Certain Annuity – You will receive reduced payments during your life in order to guarantee payments for a total of 10 years (120 monthly payments). If you die before receiving all 120 payments, the remaining guaranteed payments will be made to your beneficiary. If your beneficiary dies before all the payments are made, any remaining guaranteed payments will be made to the beneficiary’s estate, unless you have designated another beneficiary to receive those payments. If you die after receiving at least 120 monthly payments, no death benefits will be payable to your beneficiary.

• Cash Refund Option – You will receive reduced monthly benefit payments during your life so that after your death, if you die prior to receiving the full value of your benefit under the Plan (determined as of the date you began to receive payments), the remaining value of your benefit will be paid in a single sum to your beneficiary.

• Level Income Option – If you begin to receive benefits under the JHHSC Retirement Plan on or after July 1, 2004, but before you start receiving your old-age Social Security benefits, you may elect the level income option. Under this option, you will receive an increased amount of benefit

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from the Plan until your Social Security benefits begin, and a correspondingly lower amount of benefit from the Plan after your Social Security benefits begin. The goal of the level income option is to provide you with a steady monthly income both before and after you begin to receive Social Security benefits. This option also is available to your beneficiary under a joint and survivor option.

If you are married, you must have written consent from your spouse in order to receive benefits in any form other than a joint and survivor annuity with your spouse as the survivor annuitant.

PAYING TAXES ON YOUR BENEFIT

Generally speaking, if you choose an annuity form of benefit with monthly payments, each payment will be fully taxable as ordinary income for Federal income tax purposes in the year in which you receive it (special rules and adjustments may apply if you made voluntary contributions to the Plan prior to July 1, 1992). You will be asked to make an election about income tax withholding.

If any portion of your benefit under the JHHSC Retirement Plan is paid in a single sum, that portion will be fully taxable as ordinary income for Federal income tax purposes when you receive it, unless you roll it over to a traditional IRA or another employer’s eligible retirement plan. If you receive a single sum payment before age 59½, your payout (if not rolled over) may be subject to an additional 10% penalty tax. However, the penalty tax may not apply if you receive the single sum payment:

• upon your retirement at age 55 or later;

• upon disability or death; or

• as a result of a qualified domestic relations order (see page 27 for a discussion of qualified domestic relations orders).

If you elect to receive a portion of your benefit in a single sum payment, government regulations require that 20% of the payment be withheld automatically for Federal income tax, unless you directly roll over the amount to a traditional IRA or another employer’s eligible retirement plan. The withheld amount will be applied toward your Federal income taxes for the year in which you receive the payment.

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You must provide your written election to the Pension Office to have your single sum payment rolled over directly to a traditional IRA (or another eligible retirement plan that accepts rollovers) to avoid 20% withholding. You will not pay Federal income taxes until you take the money out of the IRA or other plan, at which time you will pay ordinary Federal income tax (and, if applicable, the additional 10% penalty tax for premature distributions) on the money you receive. If you die and you have a surviving spouse who will receive a single sum payment of all or a portion of your benefit, he or she may roll it over to an IRA or another employer’s eligible retirement plan. If you die and your designated beneficiary is someone other than your spouse, he or she may directly

roll over a single sum payment of all or a portion of your benefit to an IRA.

You (and your beneficiary) also may roll over your single sum payment to a Roth IRA. Such rollovers are subject to federal income tax when made. You are solely responsible for the income tax withholding and reporting to a Roth IRA, although you may enter into a voluntary tax withholding agreement with the Health System prior to the distribution.

Because tax laws are complex and subject to change, this information is intended only as a general guideline based on our understanding of the Federal income tax law in effect at the beginning of 2011. State and local tax laws may also apply. For your own protection, you should consult a tax specialist before you receive any Plan money that is subject to taxation. All Plan benefits will be paid to you (or your beneficiary) minus any income tax withholding that may be required by Federal, state or local laws.

ADMINISTRATIVE INFORMATION

Plan Insurance Your benefits under the Plan are insured by the Pension Benefit Guaranty Corporation (PBGC), a federal insurance agency. If the Plan terminates (ends) without enough money to pay all benefits, the PBGC will step in to pay pension benefits. Most people receive all of the pension benefits they would have received under the Plan, but some people may lose certain benefits.

The PBGC guarantee generally covers: (1) normal and early retirement benefits; (2) disability benefits if you become disabled before the Plan terminates; and (3) certain benefits for your survivors.

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The PBGC guarantee generally does not cover: (1) benefits greater than the maximum guaranteed amount set forth by law for the year in which the Plan terminates; (2) some or all of the benefit increases and new benefits based on Plan provisions that have been in place for fewer than 5 years at the time the Plan terminates; (3) benefits that are not vested because you have not worked long enough for the Health System; (4) benefits for which you have not met all of the requirements at the time the Plan terminates; (5) certain early retirement payments (such as supplemental benefits that stop when you become eligible for Social Security) that result in an early retirement monthly benefit greater than your monthly benefit at the Plan’s normal retirement age; and (6) non-pension benefits, such as health insurance, life insurance, certain death benefits, vacation pay, and severance pay.

Even if certain of your benefits are not guaranteed, you still may receive some of those benefits from the PBGC depending on how much money your Plan has and how much the PBGC collects from employers.

For more information about the PBGC and the benefits it guarantees, ask your Plan Administrator or contact the PBGC’s Technical Assistance Division, Pension Benefit Guaranty Corporation, 1200 K Street N.W., Suite 930, Washington, D.C. 20005-4026 or call (202) 326-4000 (not a toll-free number). TTY/TDD users may call the federal relay service toll-free at 1-800-877-8339 and ask to be connected to 202-326-4000. Additional information about the PBGC’s pension insurance program is available through the PBGC’s website on the Internet at http://www.pbgc.gov

Assignment of Your Pension

.

Your pension is not subject to the claims of your creditors or the creditors of your spouse or other beneficiaries. However, federal law permits payment of all or a portion of your benefit to another person, provided such payment is made in order to comply with a “qualified domestic relations order” relating to child support, alimony or marital property rights payments. The Plan Administrator will contact you in the event it receives a domestic relations order that could affect your Plan benefits.

The Plan has procedures for determining whether a domestic relations order must be honored (that is, whether your pension legally must be paid to a third party). You may obtain copies of these procedures, as well as other information relevant to processing qualified domestic relations orders, without charge, from the Pension Office.

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Future of the Plan The Health System expects to continue the Plan, but has the right to change or terminate it at any time. No decision to change or end the Plan will deprive you of your vested benefits earned up to the date of change or termination, but projected benefits (benefits that would have been earned had the Plan not been changed or terminated) will not be protected. If the Plan is terminated, all employees will become fully vested in their accrued (not projected) pension to the extent funded. You’ll be told how the change affects your benefits, if at all.

YOUR LEGAL RIGHTS

Your Rights Under ERISA As a participant in the Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all plan participants shall be entitled to:

• Examine (without charge) at the Plan Administrator’s office and at other specified locations, all documents governing the Plan and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor and available at the Public Discourse Room of the Employee Benefits Security Administration.

• Obtain, upon written request to the Plan Administrator, copies of all documents governing the operation of the Plan and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The Plan Administrator may make a reasonable charge for copies.

• Obtain, upon written request to the Plan Administrator, a copy of the Plan’s procedures for determining whether a domestic relations order received by the Plan is a “qualified” order. The Plan must provide this information free of charge.

• Receive a summary of the Plan’s annual funding notice. The Plan Administrator is required by law to furnish each participant with a copy of this notice.

• Receive a pension benefit statement at least once every three years telling you whether you have a right to receive a pension at normal retirement age (age 65), and if so, what your benefits under the Plan would be at normal retirement if you stop working now. If you do not have a right to a pension, the statement will tell you how many more years you have to work to get this right. You may request this

28

statement not more than once every twelve (12) months. The Plan must provide this statement free of charge.

In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your Plan, called “fiduciaries” of the Plan, have a duty to do so prudently and in the interest of you and other Plan participants and beneficiaries. No one, including your employer, or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining retirement income or exercising your rights under ERISA.

ENFORCING YOUR RIGHTS

Claims Procedure If your claim for a pension benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules.

Appealing a Denied Claim If your claim for benefits from the Plan is denied in any way, the Plan Administrator will notify you in writing within 90 days of receipt of the claim. The notice will tell you:

• why the claim was denied;

• the Plan provisions on which the denial is based;

• what other material is needed to correct your claim and why it is needed; and

• how you can get your claim reviewed again.

If you disagree with what the notice says, you may file a written request for reconsideration, no later than 60 days after receiving the notice, with the Plan Administrator.

The Plan Administrator will review your appeal within 60 days, unless special circumstances require an extension. In that case, the Plan Administrator may take up to 120 days, if you are notified of the delay before the end of the first 60-day period. If you don’t hear from the Plan Administrator in the first 60 days, you may assume your appeal has been denied. If the Plan Administrator notifies you that an extension is needed, and you don’t get a final decision within 120 days, you may also assume your appeal has been denied. While your appeal is pending, you have the right to review Plan documents and to submit issues and

29

comments in writing. You may have a lawyer or other representative present your case.

Your Legal Rights Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request materials from the Plan and do not receive them within 30 days, you may file suit in a federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Plan Administrator.

If you have a claim for benefits which is denied or ignored, in whole or in part, you may file suit in a state or Federal court. In addition, if you disagree with the Plan’s decision or lack thereof concerning the qualified status of a domestic relations order, you may file suit in Federal court. If it should happen that Plan fiduciaries misuse the Plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a Federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example, if it finds your claim is frivolous.

Questions If you have any questions about your Plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Plan Administrator, you should contact the nearest office of the Employee Benefits Security Administration (EBSA), U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, EBSA, U.S. Department of Labor, 200 Constitution Avenue, NW, Washington, DC 20210. You may obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration at 1-800-998-7542. You may also seek assistance with the Plan by calling EBSA toll-free at 1-866-444-EBSA or by directing electronic inquiries to EBSA’s website at www.askebsa.dol.gov

IMPORTANT INFORMATION ABOUT THE RETIREMENT PLAN

Plan Name and Number Johns Hopkins Health System Corporation Retirement Plan (No. 333)

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Plan Sponsor Johns Hopkins Health System Corporation 600 North Wolfe Street Baltimore, MD 21287

Employer Identification Number

52-1465301

Plan Year July 1 to June 30

Plan Type Defined benefit pension plan

Plan Administrator Administrative Committee Johns Hopkins Health System Corporation

c/o Vice President of Human Resources, Johns Hopkins Health System Corporation 600 North Wolfe Street Baltimore, MD 21287 (410) 614-3494

Agent for Service Vice President of Human Resources, Johns Hopkins Health System Corporation 600 North Wolfe Street Baltimore, MD 21287

Service of legal process may also be made upon the plan trustee.

Plan Trustee State Street Bank & Trust Company State Street Financial Center One Lincoln Street Boston, MA 02111

Plan Administration The Johns Hopkins Health System Corporation sponsors the Plan and has appointed the Plan Administrator to administer it. The Plan Administrator resolves any questions that arise about the Plan, administers the Plan in a uniform way and sets the rules for operating the Plan.

Plan Financing The Health System pays the full cost of any benefits that you earn under the Plan (except to the extent that participants made voluntary contributions to the Plan prior to July 1, 1992). Each year, the amount of the Health System’s contributions is determined with the advice of the Plan’s actuaries.

403(b) Plans

This is a summary of the Johns Hopkins Health System Corporation 403(b) Plan (the

“Plan”) as it applies to employees (and their beneficiaries) of the Johns Hopkins Health System

Corporation (the “Health System”) and certain of its participating affiliates. This summary

describes the terms of the Plan, as amended through December 31, 2010.

You are cautioned that this summary does not reflect any future amendments that may be

made to the Plan from time to time, and may not reflect all exceptions to the general provisions

covered in this summary. Any conflicts between the statements in this summary and the terms of

the Plan will be resolved by reference to the full Plan document.

If material changes are made to the Plan, you will receive a written summary description

of such changes, which will supersede or supplement this summary. You should attach any

written summaries of material changes to this document so that you will always have a current

summary of the Plan.

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JOHN HOPKINS HEALTH SYSTEM CORPORATION 403(b) PLAN

TABLE OF CONTENTS

Page

INTRODUCTION .......................................................................................................................... 1

DEFINITIONS ................................................................................................................................ 1

ELIGIBILITY TO PARTICIPATE ................................................................................................ 3

Who is Eligible for the Plan ................................................................................................ 3

MAKING CONTRIBUTIONS UNDER THE PLAN .................................................................... 3

Voluntary Pretax and Roth Contributions........................................................................... 3

Age-Based Catch-Up Contributions ................................................................................... 4

Service-Based Catch-Up Contributions .............................................................................. 4

Rollover Contributions........................................................................................................ 5

Matching Contributions ...................................................................................................... 5

Suspension of Matching Contributions ............................................................................... 5

Limits on Contributions ...................................................................................................... 6

INVESTING YOUR ACCOUNT................................................................................................... 6

Investment Elections ........................................................................................................... 7

Changing Your Investments ............................................................................................... 7

Transaction Fees and Expenses .......................................................................................... 7

Participant Investment Directions ....................................................................................... 7

VESTING ....................................................................................................................................... 8

RECEIVING YOUR BENEFITS ................................................................................................... 9

Form of Payment................................................................................................................. 9

Payment Upon Death ........................................................................................................ 11

IN-SERVICE CASH WITHDRAWALS ..................................................................................... 11

Age 59½ ............................................................................................................................ 11

Rollover Contributions...................................................................................................... 11

Automatic Enrollment Contributions ................................................................................ 12

Hardship ............................................................................................................................ 12

PAYING TAXES ON YOUR BENEFIT AND ROLLOVER RIGHTS ..................................... 13

LOANS ......................................................................................................................................... 14

Amount that may be Borrowed ......................................................................................... 14

Interest Rate ...................................................................................................................... 15

Term of Loan .................................................................................................................... 15

Repaying a Loan ............................................................................................................... 15

QUALIFIED DOMESTIC RELATIONS ORDERS .................................................................... 15

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ADMINISTRATIVE INFORMATION ....................................................................................... 16

Future of the Plan .............................................................................................................. 16

Plan Expenses ................................................................................................................... 16

Plan is Not an Employment Contract................................................................................ 16

Benefits are Not Insured ................................................................................................... 16

YOUR LEGAL RIGHTS .............................................................................................................. 16

Your Rights Under ERISA ............................................................................................... 16

ENFORCING YOUR RIGHTS .................................................................................................... 17

Claims Procedure .............................................................................................................. 17

Appealing a Denied Claim ................................................................................................ 17

Your Legal Rights ............................................................................................................. 18

Questions........................................................................................................................... 18

IMPORTANT INFORMATION ABOUT THE PLAN ............................................................... 19

Plan Name and Number .................................................................................................... 19

Plan Sponsor ..................................................................................................................... 19

Employer Identification Number ...................................................................................... 19

Plan Year ........................................................................................................................... 19

Plan Type .......................................................................................................................... 19

Plan Administrator ............................................................................................................ 19

Agent for Service .............................................................................................................. 19

Plan Custodian .................................................................................................................. 19

Plan Administration .......................................................................................................... 20

INTRODUCTION

Johns Hopkins Health System Corporation has established the

Johns Hopkins Health System Corporation 403(b) Plan (the

“Plan”) to provide eligible employees with an opportunity to save

and invest for retirement. Under the Plan, you may contribute a

portion of your compensation on a pretax and/or after-tax Roth

basis, and receive employer matching contributions based on the

amount of those contributions after completing a year of service.

Any contributions that you make to the Plan are completely

voluntary. You decide whether or not to contribute to the Plan

and how much to contribute. However, if you are an eligible

employee whose employment with the Johns Hopkins Health

System Corporation or an affiliate began on or after January 1,

2009, you will be automatically enrolled in the Plan, unless you

affirmatively elect otherwise.

This booklet is a summary of the Plan, as amended through

December 31, 2010. It is not the Plan document. In case of any

conflict between the information in this summary plan description

and the terms of the Plan document, the terms of the Plan

document will control. The Plan document contains a complete

description of the terms and conditions of the Plan and legally

governs the operation of the Plan. If you have any questions

about the Plan or your eligibility, you may call the Pension Office

at (410) 614-3494. If you have further questions, or if you wish

to examine a copy of the Plan document and the trust agreement

for the Plan, please contact the plan administrator.

DEFINITIONS Throughout this document, certain terms appear in italics. These

terms have special meanings for purposes of the Plan. Each of

the italicized terms is defined below.

“Beneficiary(ies)” means the individual, institution, trustee or

estate designated by you to receive your benefits at your death.

As part of your enrollment process, you will be asked to complete

a beneficiary designation form.

“Compensation” means the amount paid to you that must be

reported as wages on your Form W-2, plus compensation that is

not currently includable in your gross income because it is

contributed through a salary reduction agreement to a plan that

meets the requirements of Section 125, 132(f), 401(k), 402(e)(3),

402(h), 403(b) or 457(b) of the Internal Revenue Code.

Compensation taken into account under the Plan cannot exceed

the limits of Section 401(a)(17) of the Internal Revenue Code

($245,000 for 2011). This limit is adjusted by the Internal

Revenue Service from time to time for increases in cost-of-living.

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“Fund Sponsor” means an insurance, variable annuity or investment company that makes investment options available to participants under this Plan.

“Funding Vehicles” means the annuity contracts or custodial accounts offered as investment alternatives under this Plan and specifically approved by the Health System for use under this Plan.

“Health System” means the Johns Hopkins Health System Corporation.

“JHHSC Retirement Plan” means the Johns Hopkins Health System Corporation Retirement Plan, which is a defined benefit pension plan sponsored by the Health System. For more information about the JHHSC Retirement Plan, please refer to the summary plan description for the JHHSC Retirement Plan.

“Plan” means The Johns Hopkins Health System Corporation 403(b) Plan as described in this summary and as set forth in the Johns Hopkins Health System Corporation 403(b) Plan document, as it may be amended from time to time.

“Plan Administrator” means the person or entity responsible for the administration of the Plan. See the Section entitled “Important Information About the Plan” for information about the plan administrator.

“Plan Year” means the period of twelve consecutive months commencing on January 1 and ending on the following December 31.

“Roth Contribution” means any contributions made to the Plan that are includible in your gross income at the time deferred. As indicated in your salary reduction agreement, these contributions are irrevocably designated as Roth contributions. Roth contributions may be distributed tax-free (along with any associated investment earnings) if certain requirements are met. See the Section entitled “Paying Taxes on Your Benefit and Rollover Rights” for more information on distributions of Roth contributions.

“Third Party Administrator” means the professional service provider retained by the plan administrator to assist in the administration of the Plan. Currently, the third party administrator for the Plan is Lincoln National Life Insurance Company. You may contact Lincoln by visiting its website, lincolnalliance.com, or by calling (800) 234-3500. You may also contact Lincoln’s on-site representative.

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ELIGIBILITY TO PARTICIPATE

Who is Eligible for the

Plan

You are eligible to participate in the Plan if you are an employee

of the Health System or one of the following Health System

affiliates:

The John Hopkins Hospital

John Hopkins Bayview Medical Center, Inc.

However, you are not eligible to participate in the Plan if you are

covered by a collective bargaining agreement (unless the

agreement specifically provides for participation in the Plan), or

if you are a leased employee or independent contractor.

Once you are eligible, you may begin to make voluntary pretax

and Roth contributions to the Plan by completing and submitting

a salary reduction agreement (and any other necessary enrollment

forms) to the third party administrator.

Automatic Enrollment If you are an eligible employee who was hired on or after January

1, 2009 and you do not elect to voluntarily participate in the Plan

within 30 days of receiving notice of Plan eligibility, you will be

automatically enrolled in the Plan unless you affirmatively elect

otherwise during the 30 day period.

Automatic enrollment means that your compensation will be

reduced automatically, and the amount by which your

compensation is reduced will be contributed on your behalf to

your account under the Plan.

MAKING CONTRIBUTIONS UNDER THE PLAN

Voluntary Pretax and

Roth Contributions

You may voluntarily elect to participate in the Plan by completing a salary reduction agreement. On the agreement, you elect the amount of your compensation that you wish to contribute to the Plan on a pretax basis and/or as a Roth contribution. You may elect a whole number percentage (e.g., 15%) or a flat dollar amount (e.g., $200) of your compensation to be contributed each pay period. After your salary reduction agreement is completed and submitted, your compensation will be reduced by the amount you have elected, and the same amount will be contributed to your account under the Plan.

If you were automatically enrolled in the Plan, you will be deemed to have authorized the Health System or your participating employer to contribute 2% of your compensation to the Plan on a pretax basis. Unless you affirmatively elect otherwise, the contribution amount will automatically increase by

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1% of compensation each year up to a maximum of 10% of compensation. You may elect to change your contribution rate at any time by completing a salary reduction agreement.

Unlike pretax contributions, Roth contributions are subject to federal income tax when made to the Plan, but the Roth contributions and any associated investment earnings are distributed tax-free if the requirements of a “qualified distribution” are met. See “Receiving Your Benefits” and “In-Service Cash Withdrawals,” below, for more information.

You may terminate your salary reduction agreement at any time. Your ability to modify the agreement may be subject to reasonable restrictions established by the plan administrator. The salary reduction agreement is legally binding and irrevocable with respect to compensation paid while the agreement is in effect.

The amount of voluntary pretax and Roth contributions that you can make to the Plan is subject to certain limits imposed by law. See the Section entitled “Limits on Contributions,” below, for more information on contribution limits.

Age-Based

Catch-Up Contributions

If you are eligible to contribute to the Plan, you will attain at least age 50 by the end of the plan year, and you have reached the contribution limits imposed by the Plan or by law, you may make an age-based “catch-up contribution” of $5,500 (for 2011) on a pretax or Roth basis. Catch-up contribution limits are adjusted annually for inflation.

The plan administrator will determine whether a voluntary pretax or Roth contribution is an age-based catch-up contribution, based on Internal Revenue Service regulations and other guidance.

Service-Based Catch-Up

Contributions

If you are eligible to contribute to the Plan and you have completed at least 15 years of service with the Health System and its affiliates, you may make an additional service-based catch-up contribution on a pretax or Roth basis. Your service-based catch-up contribution for any year cannot exceed the least of:

$3,000

$15,000 minus the total of your service-based catch-up contributions for previous years; or

$5,000 multiplied by your years of service with the Health System and its affiliates, minus the total of your voluntary pretax and Roth contributions (including any catch-up contributions) made in all previous years to the Plan or any other plan maintained by the Health System.

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If you make both service-based and age-based catch-up contributions to the Plan, the contributions will first be treated as service-based contributions and then as age-based contributions. This treatment reduces the amount of service-based catch-up contributions you can make in future years.

Rollover Contributions You may transfer (or “roll over”) to the Plan amounts from another employer’s plan (including Roth contributions held in another employer’s plan) or an individual retirement account (IRA), subject to certain restrictions that may be imposed by the fund sponsor.

Matching Contributions Between January 1, 2009 and July 1, 2009, if you made voluntary pretax and/or Roth contributions to the Plan, and you had completed one year of service with the Health System (as defined below under “Vesting”), you received employer matching contributions in your match account under the Plan. Your matching contributions equaled 50% of your voluntary pretax and Roth contributions to the Plan for each payroll period, to the extent your voluntary pretax and Roth contributions did not exceed 2% of your compensation for the payroll period (see “Suspension of Matching Contributions” below).

Prior to January 1, 2009, if you made voluntary pretax and Roth contributions to the Plan, and you were a participant in the JHHSC Retirement Plan, you received “matching credits” in your employer matching account under the JHHSC Retirement Plan. Your employer matching account will continue to receive interest credits after January 1, 2009 under the terms of the JHHSC Retirement Plan. See the JHHSC Retirement Plan summary plan description for more information.

Example: Assume that Stephanie, an employee of The Johns Hopkins Hospital, is a participant in this Plan and has completed at least one year of service (as defined below under “Vesting”). During the first payroll period of 2009, Stephanie earns $1,500 in compensation and elects to contribute $75 (5%) as a voluntary pretax contribution to her account under the Plan. A matching contribution of $15 will be added to match account under the Plan (she makes a voluntary pretax contribution of at least 2% of her compensation ($30) to her account under the Plan, and 50% of that amount is $15).

Suspension of Matching

Contributions

The Health System will not provide employer matching contributions for payroll periods that end on or after July 1, 2009. You may continue to make voluntary pretax and Roth contributions to the Plan after July 1, 2009. The Health System’s Board of Trustees will revisit this issue on a periodic basis. If the Board reinstates the Plan’s employer matching contribution feature, you will receive additional information at that time.

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Limits on Contributions Your voluntary pretax and Roth contributions to the Plan and all

other defined contribution plans in which you may have

participated during the year are limited to a certain dollar amount

set forth in the Internal Revenue Code. The current dollar limit

for 2011 is $16,500.

If you have completed at least 15 years of service with your

current organization, you may make a service-based “catch-up

contribution” under the Plan (see the section entitled “Catch-Up

Contributions,” above). Service-based catch-up contributions do

not count for purposes of the dollar limit described above.

There is also a limit on the total contributions that can be added to

your account under the Plan for any plan year. In 2011, the

contributions to your account (not including catch-up

contributions) under the Plan cannot exceed the lesser of $49,000

or 100% of your annual compensation. The IRS may adjust this

limit from time to time.

If you will reach age 50 or older by the end of the plan year, and

your contributions will be limited by the Plan or by law, you may

make an age-based catch-up contribution under the Plan (see the

section entitled “Catch-Up Contributions,” above). Age-based

catch-up contributions do not count for purposes of either of the

limits described in this Section.

For more information on the limits applicable to the Plan, contact

the Pension Office at (410) 614-3494.

INVESTING YOUR ACCOUNT

The Plan features a wide range of investment alternatives with

different objectives, risk and potential for gain. The availability

of these alternatives allows you to create an investment program

that is right for you.

Before deciding to invest in any investment fund, you should read

the prospectus for that fund. Except in the case of a fixed annuity

investment option, there is no guarantee that the stated investment

goals of any of the investment fund will be realized. You can

obtain detailed information (including a prospectus) about each of

the investment funds by contacting the third party administrator.

The plan administrator has the right to add or remove investment

funds under the Plan. You will be notified in advance of any

such change.

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Investment Elections When you enroll in the Plan and elect to make voluntary pretax

and/or Roth contributions, you choose how your contributions

and employer matching contributions are to be invested. You

may direct that your contributions be invested among any or all of

the investment funds offered under the Plan, in increments of 1%.

Your election of how contributions added to your account are to

be invested will remain in effect until changed by you.

If you are automatically enrolled in the Plan, the contributions

added to your account will be initially invested in the default

investment fund selected by the Health System. You may change

the investment allocation of these contributions at any time by

contacting the third party administrator.

Changing Your

Investments

You may change your investment election as of any business day.

Any such change will apply, as you direct, (1) only to existing

money in your Plan account, (2) only to future contributions to

your Plan account, or (3) both. In order to make an investment

change, you must contact the third party administrator.

Transaction Fees and

Expenses

There is an annual fee of $50 if you invest all or a portion of your

Plan account in the self-directed brokerage account option. Also,

certain transactional fees may apply based on the investments you

select within the self-directed brokerage account option. Unless

otherwise indicated in a fund’s prospectus or by the third party

administrator, there are no other transaction fees or expenses that

reduce your Plan account balance associated with the purchase or

sale of investment options offered under the Plan.

Participant Investment

Directions

The Plan is intended to comply with Section 404(c) of the

Employee Retirement Income Security Act of 1974 (“ERISA”)

and accompanying regulations. This means that the Plan permits

participants to direct the investment of their Plan accounts. As

long as the Plan complies with the requirements of Section

404(c), you will have responsibility for deciding how your Plan

account is invested and the parties that otherwise would be

responsible for making investment decisions (the “fiduciaries” of

the Plan) will not be liable for any losses that result directly from

your investment instructions.

To comply with Section 404(c), the Plan must permit participants

to choose from a broad range of investment alternatives and must

provide participants with certain information about the investment

alternatives and the operation of the Plan. In addition to the

information included in this summary and in your enrollment

package for the Plan, you may request the following information:

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a description of the annual operating expenses of each

investment fund which reduce the rate of return for

participants and beneficiaries, and the aggregate amount of

such expenses expressed as a percentage of average net

assets of the investment option;

copies of any prospectuses, financial statements and

reports, and of any other materials relating to the

investment funds to the extent that such information is

provided to the Plan;

a list of the assets comprising the portfolio of each

investment fund which constitute Plan assets within the

meaning of ERISA, and the value of each such asset;

information concerning the value of shares or units in each

investment fund, as well as the past and current investment

performance of such investment fund, determined, net of

expenses, on a reasonable and consistent basis; and

information concerning the value of shares or units in

investment funds held in your Plan account.

The plan administrator is the named fiduciary responsible for

providing this information. To request any of this information,

contact the Pension Office at (410) 614-3494 or the third party

administrator.

The Plan’s default investment fund is intended to meet the

requirements of a “qualified default investment alternative” under

U.S. Department of Labor regulations. You will receive an

annual notice explaining the default fund’s investment objectives,

risk and return characteristics and fees and expenses. If you

would like to receive more information about the Plan’s default

investment fund, contact the Pension Office at (410) 614-3494 or

the third party administrator.

VESTING

You always have a 100% vested (that is, nonforfeitable) interest

in all of your contributions to the Plan. Any employer matching

contributions that are made to the Plan based on your voluntary

pretax and Roth contributions to this Plan will become vested in

accordance with the following schedule.

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Years of Service Nonforfeitable Interest

1 0%

2 25%

3 50%

4 75%

5 100%

A “year of service” means each year of your employment (from

the date of your hire or reemployment) that you are credited with

at least 1,000 hours of service, as determined under the terms of

the Plan.

An “hour of service” means any hour that you work and are paid

(or for which you are entitled to be paid) by the Health System or

a participating employer.

RECEIVING YOUR BENEFITS

Your Plan account will be payable upon your termination of employment with the Health System and its affiliates for any reason. Payment must begin no later than April 1 following the later of the calendar year in which you attain age 70½ or the calendar year in which you terminate employment (your “required beginning date”). Failure to begin receiving benefit payments by your required beginning date may subject you to federal tax penalties.

Form of Payment You may choose from among several payment options for receiving your Plan account when you retire. These optional forms of payment include a single sum payment and your choice of annuity options (as described below). Your form of payment may depend on the funding vehicle in which you have elected to invest your contributions to the Plan, and may be subject to legal restrictions. You should contact your fund sponsor for more details on choosing a form of payment.

Single sum payment. You may elect to receive the value of your Plan account in a single sum payment.

Single life annuity. You may elect to convert the value of your Plan account into an equivalent annuity (using actuarial factors) that will pay you a monthly benefit for as long as you live. This form of payment will provide you with the greatest amount of monthly income because it is paid over your life only.

10

Joint and survivor annuity. You may elect to convert the value of your Plan account into an equivalent annuity (using actuarial factors) that will pay you a reduced monthly benefit for as long as you live. After your death, your beneficiary will receive, at your election, 50%, 75% or 100% of the amount you received in monthly installments for your beneficiary’s life. If you are married when you begin to receive payment of your Plan account and you elect an annuity option, your Plan account must be paid as a joint and survivor annuity with your spouse as your beneficiary, unless you elect otherwise and your spouse consents to your election.

Single life annuity with 120 guaranteed monthly payments. You may elect to convert the value of your Plan account into an equivalent annuity (using actuarial factors) that will pay you a reduced monthly benefit for as long as you live. If, as of the date of your death, you have received less than 120 monthly payments, your beneficiary will receive the remaining monthly payments, provided that you and your beneficiary will not receive a total of more than 120 monthly payments.

Single life annuity with cash value option. You may elect to convert the value of your Plan account into an equivalent annuity (using actuarial factors) that will pay you a reduced monthly benefit for as long as you live. If, as of the date of your death, you have received less than the value of your Plan account (as of the date payments began), the excess of such value over the value of the monthly payments you received will be paid as a single sum payment to your beneficiary.

Note that a participant may only take a distribution from his or her Roth contribution account if such distribution would constitute a “qualified distribution.” A qualified distribution is a distribution that is made at least five taxable years after your first Roth contribution to the Plan and after you attain age 59½, your death or the date you become disabled.

Periodic installment payments. You may elect to receive the value of your Plan account in a series of monthly, quarterly, semi-annual, or annual installment payments. The third party administrator will help you set up the amount and frequency of the installment payments. These payments will continue until the vested portion of your Plan account has been fully distributed. Note that if you elect this form of payment option, you may, in accordance with procedures established by the Plan Administrator, modify the amount and/or frequency of future installment payments, including an election to receive any remaining portion of your vested Plan account in a single sum payment.

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Payment Upon Death If you die before beginning to receive payment of your Plan

account or while receiving installment payments, the value of

your Plan account will be paid to your beneficiary in a form

described above that he or she elects (subject to any restrictions

applied by a fund sponsor and subject to applicable law). If you

are married when you die, your spouse will be your beneficiary,

unless you have elected otherwise and your spouse has consented

to your election. If you die after beginning to receive payment of

your Plan account, your Plan account will be paid in accordance

with the form of payment you have elected.

IN-SERVICE CASH WITHDRAWALS

In certain circumstances, you are permitted to make withdrawals from your Plan account while you are still employed by the Health System or a Health System affiliate. A withdrawal from your Plan account while you are still actively employed may have special tax consequences. (See the section entitled “Paying Taxes on Your Benefit and Rollover Rights,” below.) You may request a withdrawal from your Plan account by contacting the third party administrator.

Age 59½ Once you reach age 59½, you may make a withdrawal from your Plan account, not more than once per plan year, up to the total vested portion of your Plan account. Your withdrawal cannot include any Roth contributions (or associated investment earnings) unless it would satisfy the requirements of a qualified distribution (as defined on page 10). You may make this withdrawal in the form of a single sum or a series of monthly, quarterly, or semi-annual installment payments. Installment payments, if elected, will continue until the earlier of:

(1) your severance from employment;

(2) your death; or

(3) your election to alter the amount and/or frequency of future installment payments. Note that you may not make such an election more than once per plan year.

Rollover Contributions At any time, but not more than once per plan year, you may withdraw from your Plan account any amount that you previously rolled over to the Plan (and any earnings on that amount). Your withdrawal cannot include any Roth contributions (or associated investment earnings) unless it would satisfy the requirements of a qualified distribution (as defined on page 10).

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Automatic Enrollment

Contributions

If you were automatically enrolled in the Plan, you may withdraw your automatic contributions to the Plan within 90 days following your first salary reduction contribution. The amount distributed cannot be rolled over and will be subject to federal income tax, but no early withdrawal penalties. Any employer matching contributions associated with the automatic contributions that you withdrew will be forfeited.

Hardship If permitted under the funding vehicle in which you have invested your contributions, you may withdraw from your Plan account in the event of a financial hardship. All pretax contributions and rollover contributions in your Plan account are eligible for hardship withdrawal. Roth contributions, employer matching contributions and investment earnings on your voluntary pretax contributions are not available for hardship withdrawal. To qualify for a hardship withdrawal, you must show and the plan administrator must determine that you have an immediate and heavy financial need and the withdrawal is necessary to satisfy that need.

An “immediate and heavy financial need” means one (or more) of the following:

certain medical expenses for you, your spouse, your dependents or your primary designated beneficiary under the Plan;

the purchase (excluding mortgage payments) of your principal residence;

payment of tuition and related educational fees for the next twelve months of post-secondary education for you, your spouse, your dependents or your primary designated beneficiary under the Plan;

payments necessary to prevent eviction from your principal residence or foreclosure on your mortgage;

burial or funeral expenses for your spouse, your parents, your dependents or your primary designated beneficiary under the Plan; or

expenses for the repair of casualty damages to your

principal residence that would qualify for a casualty

deduction under the Internal Revenue Code.

A withdrawal is necessary to satisfy an immediate and heavy

financial need if the need cannot be relieved through

reimbursement or compensation by insurance, by reasonable

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liquidation of your assets, by stopping Plan contributions, or by

other distributions or non-taxable loans.

PAYING TAXES ON YOUR BENEFIT AND ROLLOVER RIGHTS

Generally speaking, if you choose an annuity form of benefit with

monthly payments, each payment will be fully taxable as ordinary

income for federal income tax purposes in the year in which you

receive it. You will be asked to make an election about income

tax withholding.

If you receive your Plan account as a single sum payment, the

payment will be fully taxable as ordinary income for federal

income tax purposes when you receive it, unless you roll it over

to a traditional IRA or another employer’s eligible retirement

plan. Amounts received as a hardship withdrawal are not eligible

for rollover. If you receive a single sum payment before age 59½,

your payout (if not rolled over) may be subject to an additional

10% penalty tax. However, the penalty tax may not apply if you

receive the single sum payment:

upon your retirement at age 55 or later;

upon disability or death; or

as a result of a qualified domestic relations order (see the

Section entitled “Qualified Domestic Relations Orders,”

below).

If you elect to receive your Plan account in a single sum payment,

federal law requires that 20% of the payment be withheld

automatically for federal income tax, unless you directly roll over

the amount to a traditional IRA or another employer’s eligible

retirement plan. The withheld amount will be applied toward

your federal income taxes for the year in which you receive the

payment.

You must provide your written election to the third party

administrator to have your single sum payment rolled over

directly to a traditional IRA (or another eligible retirement plan

that accepts rollovers) to avoid 20% withholding. You will not

pay federal income taxes until you take the money out of the

traditional IRA or other plan, at which time you will pay ordinary

federal income tax (and, if applicable, the additional 10% penalty

tax for premature distributions) on the money you receive. If you

die and you have a surviving spouse who will receive a single

sum payment of all or a portion of your benefit, he or she may roll

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it over to an IRA or another employer’s eligible retirement plan.

If you die and your designated beneficiary is someone other than

your spouse, he or she may directly roll over your benefit under

the Plan to an IRA.

If your Roth contributions have been invested in the Plan (or

another similar arrangement) for at least five years and you are at

least age 59 ½ on the date of distribution, the amount deferred as

Roth contributions (along with any associated investment

earnings) will be distributed to you tax-free.

You (and your beneficiary) also may roll over your Plan account

to a Roth IRA. Such rollovers are subject to federal income tax

when made, except for the portion of the rollover that is

attributable to Roth contributions. You are solely responsible for

the income tax withholding and reporting on rollovers to a Roth

IRA, although you may enter into a voluntary tax withholding

agreement with the Health System prior to the distribution.

Because tax laws are complex and subject to change, this

information is intended only as a general guideline based on our

understanding of the federal income tax law in effect at the end of

2010. State and local tax laws may also apply. For your own

protection, you should consult a tax specialist before you receive

any Plan money that is subject to taxation. All Plan benefits will

be paid to you (or your beneficiary) minus any income tax

withholding that may be required by federal, state or local laws.

LOANS

If permitted under the funding vehicle in which you have invested

your contributions, you may borrow from your Plan account. To

request a loan, or to obtain more information about borrowing

from the Plan, contact the third party administrator. The third

party administrator may charge a loan origination fee in

connection with a Plan loan.

Amount that may be

Borrowed

The maximum amount that you can borrow from the Plan is the

lesser of (1) $50,000 (reduced by your highest outstanding loan

balance over the past 12 months) or (2) 50% of the value of your

Plan account (excluding Roth contributions and any associated

investment earnings). The minimum amount of any loan from

your Plan account is $1,000. You may have only one Plan loan

outstanding at a time. Roth contributions and any associated

investment earning are not available for loans.

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Interest Rate The rate of interest on loans from the Plan will be a reasonable

rate determined by the plan administrator (or the fund sponsor)

from time to time to be commensurate with the prevailing interest

rate charged on similar commercial loans. The rate of interest

will remain fixed for the life of the loan.

Term of Loan You must select the term of your loan (up to 60 months) at the

time you apply for the loan. You may repay the entire

outstanding balance of your loan at any time, without penalty.

Repaying a Loan Generally, your loan will be repaid in installments through

automatic payroll deductions, which you must authorize at the

time you apply for the loan. If you stop making required loan

repayments (for example, because you leave the Health System

before your loan is repaid), your outstanding loan balance,

including accrued interest, will become due and payable

immediately. If you do not repay this amount within the time

requested, the amount owed will be deducted from your Plan

account before the Plan makes any distribution to you. The

amount of this deduction will be treated as a taxable distribution

to you for the year in which the deduction is made.

QUALIFIED DOMESTIC RELATIONS ORDERS

Your Plan account is intended only for you or your beneficiary.

It generally cannot be assigned, attached or seized by any

creditors except with respect to Plan loans or a federal income tax

levy.

If your spouse, former spouse, child or other dependent obtains a

court order ordering the Plan to pay some or all of your Plan

account to him or her pursuant to a divorce, child support action

or other kind of domestic relations proceeding, the Plan can

honor the terms of the order (and pay all or part of your Plan

account to that person) only if the order is a “qualified domestic

relations order” as defined by law.

The Plan has procedures for determining whether a domestic

relations order must be honored (that is, whether all of part of

your Plan account legally must be paid to a third party). You

may obtain copies of these procedures, as well as other

information relevant to processing qualified domestic relations

orders, without charge, from the plan administrator.

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ADMINISTRATIVE INFORMATION

Future of the Plan The Health System expects to continue the Plan, but has the right to change or terminate it at any time. No decision to change or end the Plan will deprive you of your vested benefits earned up to the date of change or termination, but projected benefits (benefits that would have been earned had the Plan not been changed or terminated) will not be protected. You will be told how the change affects your benefits, if at all.

Plan Expenses All reasonable expenses necessary to operate and administer the Plan will be paid by the Plan unless paid by the Health System. The Plan Administrator may determine that administrative expenses paid by the Plan will be deducted from participants’ accounts or allocated among participants’ accounts on either a proportionate or flat fee basis. In addition, the Plan Administrator may charge your account for the expense associated with a specific optional feature that you elect, such as loans and reviews of qualified domestic relations orders.

Plan is Not an

Employment Contract

The Plan should at no time be considered a contract of employment between you and the Health System or a Health System affiliate. It does not guarantee you the right to continue your employment, nor does it limit the Health System’s (or the affiliate’s) right to discharge you or any other employee with or without cause.

Benefits are Not Insured The Pension Benefit Guaranty Corporation (PBGC), a federal agency, was established to guarantee benefits under certain types of retirement plans. The PBGC does not, however, insure benefits under a “defined contribution plan” such as this one.

YOUR LEGAL RIGHTS

Your Rights Under ERISA As a participant in the Plan, you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all Plan participants shall be entitled to:

Examine (without charge) at the plan administrator’s office

and at other specified locations, all documents governing

the Plan, including insurance contracts, and a copy of the

latest annual report (Form 5500 Series) filed by the Plan

with the U.S. Department of Labor and available at the

Public Disclosure Room of the Employee Benefits Security

Administration

Obtain, upon written request to the plan administrator,

copies of all documents governing the operation of the

Plan, including insurance contracts, and copies of the latest

17

annual report (Form 5500 Series) and updated summary

plan description. The plan administrator may make a

reasonable charge for copies.

Receive a summary of the Plan’s annual financial report.

The plan administrator is required by law to furnish each

participant with a copy of this summary annual report.

Receive a pension benefit statement at least once every

calendar quarter. Your statement will provide the total

value of your Plan account, including any contributions

made during the quarter and investment earnings or losses.

The plan administrator is required to provide you with an

explanation of any limitations or restrictions on your right

under the Plan to direct the investment of your account.

In addition to creating rights for Plan participants, ERISA

imposes duties upon the people who are responsible for the

operation of the employee benefit plan. The people who operate

your Plan, called “fiduciaries” of the Plan, have a duty to do so

prudently and in the interest of you and other Plan participants

and beneficiaries. No one, including your employer, or any other

person, may fire you or otherwise discriminate against you in any

way to prevent you from obtaining retirement income or

exercising your rights under ERISA.

ENFORCING YOUR RIGHTS

Claims Procedure If your claim for benefits is denied or ignored, in whole or in part,

you have a right to know why this was done, to obtain copies of

documents relating to the decision without charge, and to appeal

any denial, all within certain time schedules.

Appealing a Denied Claim If your claim for benefits from the Plan is denied in any way, the

plan administrator will notify you in writing within 90 days of

receipt of the claim. The notice will tell you:

the specific reason(s) why the claim was denied;

the Plan provisions on which the denial is based;

what other material is needed to correct your claim and why it is needed; and

how you can get your claim reviewed again.

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If you disagree with what the notice says, you may file a written

request for reconsideration, no later than 60 days after receiving

the notice, with the plan administrator.

The plan administrator will review your appeal within 60 days,

unless special circumstances require an extension. In that case,

the plan administrator may take up to 120 days, if you are

notified of the delay before the end of the first 60-day period. If

you do not hear from the plan administrator in the first 60 days,

you may assume your appeal has been denied. If the plan

administrator notifies you that an extension is needed, and you do

not get a final decision within 120 days, you may also assume

your appeal has been denied. While your appeal is pending, you

have the right to review Plan documents and to submit issues and

comments in writing. You may have a lawyer or other

representative present your case.

Your Legal Rights Under ERISA, there are steps you can take to enforce the above

rights. For instance, if you request materials from the Plan and

do not receive them within 30 days, you may file suit in a federal

court. In such a case, the court may require the plan

administrator to provide the materials and pay you up to $110 a

day until you receive the materials, unless the materials were not

sent because of reasons beyond the control of the plan

administrator.

If you have a claim for benefits which is denied or ignored, in

whole or in part, you may file suit in a state or Federal court. In

addition, if you disagree with the Plan’s decision or lack thereof

concerning the qualified status of a domestic relations order, you

may file suit in Federal court. If it should happen that Plan

fiduciaries misuse the Plan’s money, or if you are discriminated

against for asserting your rights, you may seek assistance from

the U.S. Department of Labor, or you may file suit in a Federal

court. The court will decide who should pay court costs and legal

fees. If you are successful, the court may order the person you

have sued to pay these costs and fees. If you lose, the court may

order you to pay these costs and fees, for example, if it finds your

claim is frivolous.

Questions If you have any questions about your Plan, you should contact the

plan administrator. If you have any questions about this

statement or about your rights under ERISA, or if you need

assistance in obtaining documents from the plan administrator,

you should contact the nearest office of the Employee Benefits

Security Administration (EBSA), U.S. Department of Labor,

listed in your telephone directory or the Division of Technical

Assistance and Inquiries, EBSA, U.S. Department of Labor, 200

19

Constitution Avenue, NW, Washington, DC 20210. You may

obtain certain publications about your rights and responsibilities

under ERISA by calling the publications hotline of the Employee

Benefits Security Administration at 1-800-998-7542. You may

also seek assistance with the Plan by calling EBSA toll-free at

1-866-444-EBSA or by directing electronic inquiries to EBSA’s

website at www.askebsa.dol.gov.

IMPORTANT INFORMATION ABOUT THE PLAN

Plan Name and Number Johns Hopkins Health System Corporation

403(b) Plan (No. 001)

Plan Sponsor Johns Hopkins Health System Corporation

600 North Wolfe Street

Baltimore, MD 21287

Employer Identification Number

52-1465301

Plan Year January 1 to December 31

Plan Type Defined Contribution 403(b) Plan

Plan Administrator Administrative Committee

Johns Hopkins Health System Corporation

c/o Vice President of Human Resources,

Johns Hopkins Health System Corporation

600 North Wolfe Street

Baltimore, MD 21287

(410) 614-3494

Agent for Service Vice President of Human Resources,

Johns Hopkins Health System Corporation

600 North Wolfe Street

Baltimore, MD 21287

Service of legal process may also be made upon the Plan trustee.

Plan Custodian Wilmington Trust Company

1100 North Market Street

Wilmington, Delaware 19890

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Plan Administration The Johns Hopkins Health System Corporation sponsors the Plan

and has appointed the plan administrator to administer it. The

plan administrator resolves any questions that arise about the

Plan, administers the Plan in a uniform way and sets the rules for

operating the Plan. The plan administrator has delegated most of

the day-to-day administration of the Plan to the Plan’s

recordkeeper, which is:

Lincoln National Life Insurance Company

1300 Clinton Street

Ft. Wayne, IN 46802

(800) 234-3500

lincolnalliance.com

Medical & Dental Plans

Flexible Spending Accounts

Short Term Disability Insurance

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JHHSC/JHH EHP Medical Plan Coverage Period: 01/01/2013 – 12/31/2013 Summary of Benefits and Coverage: What this Plan Covers & What it Costs Coverage for: Individual | Plan Type: PPO

Questions: Call 410-955-6208 or visit us at www.hopkinsmedicine.org/jhhr. All benefits are determined under the Summary Plan Description. If you aren’t clear about any of the bolded terms used in this form, see the Glossary. You can view the Glossary at www.dol.gov/ebsa/healthreform or call 1-800-261-2393 to request a copy.

This is only a summary. If you want more detail about your coverage and costs, you can get the complete terms in the Summary Plan Description at www.hopkinsmedicine.org/jhhr or by calling 410-955-6208.

Important Questions Answers Why this Matters:

What is the overall deductible?

$0 at JHHSC institutions, $100 In-Network for inpatient services, $750 Out-of-Network; n/a to prescription drugs; excl. charges above allowed amount

You must pay all the costs up to the deductible amount before this plan begins to pay for covered services you use. Check your Summary Plan Description to see when the deductible starts over (usually, but not always, January 1st). See the chart starting on page 2 for how much you pay for covered services after you meet the deductible.

Are there other deductibles for specific services?

Yes, $1,000 for gastric bypass surgery and $1000 for infertility treatment. There are no other specific deductibles.

You must pay all of the costs for these services up to the specific deductible amount before this plan begins to pay for these services.

Is there an expense out–of–pocket limit?

Yes. $2,000 In-Network, $3,500 Out-of-Network

The out-of-pocket limit is the most you could pay during a plan year for your share of the cost of covered services. This limit helps you plan for health care expenses.

What is not included in the out–of–pocket limit?

Deductible, co-pays, penalties, prescription drug expenses, charges above allowed amount or plan maximums, premiums, and services plan does not cover

Even though you pay these expenses, they don’t count toward the out-of-pocket limit.

Is there an overall annual limit on what the plan pays?

No The chart starting on page 2 describes any limits on what the plan will pay for specific covered services, such as office visits.

Does this plan use a network of providers?

Yes. See www.ehp.org or call 1-800-261-2393 for a list of network providers

If you use an in-network doctor or other health care provider, this plan will pay some or all of the costs of covered services. Be aware, your in-network doctor or hospital may use an out-of-network provider for some services. Plans use the term in-network, preferred, or participating for providers in their network. See the chart starting on page 2 for how this plan pays different kinds of providers.

Do I need a referral to see a specialist? No You can see the specialist you choose without permission from this plan.

Are there services this plan doesn’t cover? Yes Some of the services this plan doesn’t cover are listed on page 4. See your Summary Plan

Description for additional information about excluded services.

 

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• Co-payments are fixed dollar amounts (for example, $15) you pay for covered health care, usually when you receive the service. • Co-insurance is your share of the costs of a covered service, calculated as a percent of the allowed amount for the service. For example, if

the plan’s allowed amount for an overnight hospital stay is $1,000, your co-insurance payment of 20% would be $200. This may change if you haven’t met your deductible.

• The amount the plan pays for covered services is based on the allowed amount. If an out-of-network provider charges more than the allowed amount, you may have to pay the difference. For example, if an out-of-network hospital charges $1,500 for an overnight stay and the allowed amount is $1,000, you may have to pay the $500 difference. (This is called balance billing.)

• This plan may encourage you to use In-Network providers by charging you lower deductibles, co-payments and co-insurance amounts.  

 

Your cost if you use an Common Medical Event Services You May Need In-network

Provider Out-of-network

Provider Limitations & Exceptions

Primary care visit to treat an injury or illness $15 co-pay/visit 30% coinsurance No deductible In-Network Specialist visit $40 co-pay/visit 30% coinsurance No deductible In-Network

Other practitioner office visit

$15 co-pay for chiropractic visit $40 co-pay for acupuncture visit

30% coinsurance Limited to specific visit purposes; $1,500 separate annual maximum

If you visit a health care provider’s office or clinic

Preventive care/screening/immunization No charge 30% coinsurance No deductible In-Network

Diagnostic test (x-ray, blood work) $10 co-pay x-ray, no charge blood work

30% coinsurance No deductible In-Network If you have a test

Imaging (CT/PET scans, MRIs) $50 co-pay/test 30% coinsurance No deductible In-Network

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Your cost if you use an Common Medical Event Services You May Need In-network

Provider Out-of-network

Provider Limitations & Exceptions

Generic drugs

$10 co-pay 30 days $20 co-pay 90 days by mail $30 co-pay 90 days at retail

Not covered

Preferred brand drugs

$30 co-pay 30 days $60 co-pay 90 days by mail $90 co-pay 90 days at retail

Not covered

If you need drugs to treat your illness or condition More information about prescription drug coverage is available at www.ehp.org

Non-preferred brand drugs

$50 co-pay 30 days $100 co-pay 90 days by mail $150 co-pay 90 days at retail

Not covered

Preauthorization may be required for some drugs, generic and brand, or not covered.

Specialty medications limited to 30 day supply at retail.

Facility fee (e.g., ambulatory surgery center) No charge 30% coinsurance No deductible In-Network Not covered unless preauthorized If you have

outpatient surgery Physician/surgeon fees No charge 30% coinsurance No deductible In-Network

Not covered unless preauthorized

Emergency room services $150 co-pay, waived if admitted

$150 co-pay, waived if admitted

No deductible Not covered unless emergency medical situation

Emergency medical transportation No charge No charge No deductible

If you need immediate medical attention

Urgent care $40 co-pay 30% coinsurance No deductible In-Network

If you have a hospital stay Facility fee (e.g., hospital room)

$150 co-pay at JHHSC institutions; otherwise $300 co-pay then 10% coinsurance

30% coinsurance plus $500 co-pay

Deductible applies Not covered unless preauthorized

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Your cost if you use an Common Medical Event Services You May Need In-network

Provider Out-of-network

Provider Limitations & Exceptions

Physician fee (non-surgical)

No charge at JHHSC institutions; otherwise 10% coinsurance

30% coinsurance Deductible applies

Mental/Behavioral health outpatient services $15 co-pay 30% coinsurance No deductible In-Network

Mental/Behavioral health inpatient services

$150 co-pay at JHHSC institutions; otherwise $300 co-pay then 10% coinsurance

30% coinsurance plus $500 co-pay

Deductible applies Not covered unless preauthorized

Substance use disorder outpatient services $15 co-pay 30% coinsurance No deductible In-Network

If you have mental health, behavioral health, or substance abuse needs

Substance use disorder inpatient services Same as mental/ behavioral health

Same as mental/ behavioral health Same as mental/ behavioral health

Prenatal and postnatal care No charge 30% coinsurance No deductible In-Network

If you are pregnant Delivery and all inpatient services

$150 co-pay at JHHSC institutions; otherwise $300 co-pay then 10% coinsurance

30% coinsurance plus $500 co-pay

Stays longer than 48 hours (normal delivery) or 96 hours (caesarean) not covered unless preauthorized. Deductible applies.

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Your cost if you use an Common Medical Event Services You May Need In-network

Provider Out-of-network

Provider Limitations & Exceptions

Home health care No charge 30% coinsurance No deductible In-Network Limit 40 days/year Not covered unless preauthorized

Rehabilitation services (physical, occupational, speech therapy) $10 co-pay 30% coinsurance

No deductible In-Network Speech therapy not covered unless preauthorized, limit 30 visits/year PT/OT limit 60 visits/year, pre authorization required after 12th visit or not covered

Habilitation services Not covered Not covered None

Skilled nursing care No charge 30% coinsurance Limit 120 days/year; Not covered unless preauthorized

Durable medical equipment No charge 30% coinsurance Not covered unless preauthorized

If you need help recovering or have other special health needs

Hospice service No charge 30% coinsurance Not covered unless preauthorized

Eye exam $10 co-pay $35 benefit Only covered once every 12 months Must elect coverage for child

Glasses $10 co-pay $145 benefit $140 benefit Only covered once every 12 months

Must elect coverage for child

If your child needs dental or eye care

Dental check-up Not covered Not covered None

Excluded Services & Other Covered Services:

Services Your Plan Does NOT Cover (This isn’t a complete list. Check your Summary Plan Description for other excluded services.)

• Cosmetic surgery, except to correct eligible accidental injury or illness or congenital defect • Dental care (Adult) • Habilitation services

• Long-term care • Private-duty nursing • Routine foot care

• Treatment that requires pre-authorization, if it is not obtained

• Emergency room visits for non-emergency medical situations

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Other Covered Services (This isn’t a complete list. Check your Summary Plan Description for other covered services and your costs for these services.)

• Acupuncture, for anesthesia, pain management and therapeutic purposes only, $1500 annual maximum

• Bariatric surgery, at JHHSC institutions only, 100% after $1,000 deductible

• Chiropractic care for initial exam, x-rays and spinal manipulation only, $1500 annual maximum.

• Hearing aids, for children under 19; replacements only once every three years

• Infertility treatment at JHHSC institutions only, 100% after $1,000 deductible; $30,000 and three IVF attempts lifetime limit

• Non-emergency care when travelling outside the U.S.

• Routine eye care (Adult) • Weight loss programs (employee only)

Your Rights to Continue Coverage:

If you lose coverage under the plan, then, depending upon the circumstances, Federal and State laws may provide protections that allow you to keep health coverage. Any such rights may be limited in duration and will require you to pay a premium, which may be significantly higher than the premium you pay while covered under the plan. Other limitations on your rights to continue coverage may also apply.

For more information on your rights to continue coverage, contact the plan at 1-800-261-2393. You may also contact your state insurance department, the U.S. Department of Labor, Employee Benefits Security Administration at 1-866-444-3272 or www.dol.gov/ebsa, or the U.S. Department of Health and Human Services at 1-877-267-2323 x61565 or www.cciio.cms.gov.

Your Grievance and Appeals Rights:

If you have a complaint or are dissatisfied with a denial of coverage for claims under your plan, you may be able to appeal or file a grievance. For questions about your rights, this notice, or assistance, you can contact: Employer Health Programs, 1-800-261-2393 or www.ehp.org, or the Department of Labor, Employee Benefits Security Administration, at 1-866-444-EBSA (3272) or www.dol.gov/ebsa/healthreform.

Additionally, a consumer assistance program can help you file your appeal. Contact:

Maryland Office of the Attorney General, Health Education and Advocacy Unit, 200 St. Paul Place, 16th Floor, Baltimore, MD 21202, (877) 261-8807  

––––––––––––––––––––––To see examples of how this plan might cover costs for a sample medical situation, see the next page.––––––––––––––––––––––

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Having a baby (normal delivery)

Managing type 2 diabetes (routine maintenance of

a well-controlled condition)

About these Coverage Examples: These examples show how this plan might cover medical care in given situations. Use these examples to see, in general, how much financial protection a sample patient might get if they are covered under different plans.

Amount owed to providers: $7,540 Plan pays $6,424 Patient pays $1,116

Sample care costs: Hospital charges (mother) $2,700 Routine obstetric care $2,100 Hospital charges (baby) $900 Anesthesia $900 Laboratory tests $500 Prescriptions $200 Radiology $200 Vaccines, other preventive $40 Total $7,540

Patient pays: Deductibles $200 Co-pays $540 Co-insurance $376 Limits or exclusions $0 Total $1,116

Amount owed to providers: $4,100 Plan pays $3,685 Patient pays $415

Sample care costs: Prescriptions $1,500 Medical Equipment and Supplies $1,300 Office Visits and Procedures $730 Education $290 Laboratory tests $140 Vaccines, other preventive $140 Total $4,100

Patient pays: Deductibles $0 Co-pays $415 Co-insurance $0 Limits or exclusions $0 Total $415

This is not a cost estimator.

Don’t use these examples to estimate your actual costs under this plan. The actual care you receive will be different from these examples, and the cost of that care will also be different.

See the next page for important information about these examples.  

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Questions: Call 410-955-6208 or visit us at www.hopkinsmedicine.org/jhhr. All benefits are determined under the Summary Plan Description. If you aren’t clear about any of the bolded terms used in this form, see the Glossary. You can view the Glossary at www.dol.gov/ebsa/healthreform or call 1-800-261-2393 to request a copy.  

Questions and answers about the Coverage Examples: What are some of the assumptions behind the Coverage Examples?

• Costs don’t include premiums. • Sample care costs are based on national

averages supplied by the U.S. Department of Health and Human Services, and aren’t specific to a particular geographic area or health plan.

• The patient’s condition was not an excluded or preexisting condition.

• All services and treatments started and ended in the same coverage period.

• There are no other medical expenses for any member covered under this plan.

• Out-of-pocket expenses are based only on treating the condition in the example.

• The patient received all care from in-network providers. If the patient had received care from out-of-network providers, costs would have been higher.

What does a Coverage Example show? For each treatment situation, the Coverage Example helps you see how deductibles, co-payments, and co-insurance can add up. It also helps you see what expenses might be left up to you to pay because the service or treatment isn’t covered or payment is limited.

Does the Coverage Example predict my own care needs?

No. Treatments shown are just examples. The care you would receive for this condition could be different based on your doctor’s advice, your age, how serious your condition is, and many other factors.

Does the Coverage Example predict my future expenses?

No. Coverage Examples are not cost estimators. You can’t use the examples to estimate costs for an actual condition. They are for comparative purposes only. Your own costs will be different depending on the care you receive, the prices your providers charge, and the reimbursement your health plan allows.

Can I use Coverage Examples to compare plans?

Yes. When you look at the Summary of Benefits and Coverage for other plans, you’ll find the same Coverage Examples. When you compare plans, check the “Patient Pays” box in each example. The smaller that number, the more coverage the plan provides.

Are there other costs I should consider when comparing plans?

Yes. An important cost is the premium you pay. Generally, the lower your premium, the more you’ll pay in out-of-pocket costs, such as co-payments, deductibles, and co-insurance. You should also consider contributions to accounts such as health savings accounts (HSAs), flexible spending arrangements (FSAs) or health reimbursement accounts (HRAs) that help you pay out-of-pocket expenses.

Important Telephone Numbers

Claims or Coverage Questions

Johns Hopkins EHP

HR Service Center

(410) 424-4450 or

(410) 955-6208

www.ehp.org

Care Management Program (Preauthorization of services)

Johns Hopkins EHP (410) 424-4450

COBRA Questions Johns Hopkins EHP (410) 424-4450

Flexible Spending Accounts EHP

Ceridian Benefit Services

(410) 424-4450

www.ehp.org

(800) 992-2437

Short Term Disability Benefits

HR Service Center, Phipps 455

Employer Health Programs

(410) 955-6208

(410) 762-5312

Claim Forms HR Service Center, Phipps 455 (410) 955-6208

www.ehp.org

Confidential Help With Personal Problems

Faculty and Staff Assistance Program

(410) 955-1220

Credit Union Services Credit Union (410) 955-6116

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Table Of Contents

General Information About Your Benefits .......................................................................................... 1 

Who Is Eligible ...................................................................................................................................... 2 Employee Coverage ........................................................................................................................... 2 Dependent Coverage .......................................................................................................................... 2 Domestic Partner Coverage .............................................................................................................. 3 

When Coverage Begins ......................................................................................................................... 5 Changing Your Coverage ...................................................................................................................... 5 Special Enrollment Rights For EHP Medical and Dental Coverage ..................................................... 7 Certificates Of Coverage ....................................................................................................................... 8 Coverage Costs ...................................................................................................................................... 8 

The Johns Hopkins EHP Medical Plan ................................................................................................ 9 

Network Providers ................................................................................................................................. 9 Primary Care Physicians ....................................................................................................................... 9 Three Ways to Receive Care ............................................................................................................... 10 

Option 1 – EHP Network Providers ................................................................................................ 10 Hopkins Affiliated Facilities ............................................................................................................ 11 Option 2 – Out-of-Network Providers ............................................................................................. 11 

Payment Terms You Should Know ..................................................................................................... 11 Care Management Program ................................................................................................................. 13 Chronic Care Management Program ................................................................................................... 14 Health Coach Program ........................................................................................................................ 15 EHP Customer Service ........................................................................................................................ 16 

What’s Covered by the Johns Hopkins EHP Medical Plan .............................................................. 17 

Medical Benefits At-A-Glance ............................................................................................................ 17 Covered Services and Supplies ........................................................................................................... 23 

In General ........................................................................................................................................ 23 Prescription Drug Benefits .............................................................................................................. 27 Smoking Cessation ........................................................................................................................... 30 Emergency Services ......................................................................................................................... 31 Out-Of-Area Care and Coverage for Students ................................................................................ 32 Ambulance Services ......................................................................................................................... 33 Vision Benefits ................................................................................................................................. 33 Maternity Benefits ............................................................................................................................ 35 Infertility Treatment Benefits ........................................................................................................... 36 Medical and Modified Foods ........................................................................................................... 37 Women’s Health and Cancer Rights Act.......................................................................................... 38 Home Health Care Benefits ............................................................................................................. 38 Skilled Nursing/Rehabilitation Facility Benefits ............................................................................. 39 Hospice Care Benefits ...................................................................................................................... 40 

ii

Transplants ...................................................................................................................................... 41 Mental Health and Substance Abuse Treatment ................................................................................. 42 

What’s Not Covered by The EHP Medical Plan ................................................................................ 44 

Johns Hopkins EHP Dental Plans ....................................................................................................... 49 

Dental Benefits At-A-Glance .............................................................................................................. 50 What the EHP Dental Plans Cover ...................................................................................................... 52 

Preventive and Diagnostic Services ................................................................................................. 52 Basic Services .................................................................................................................................. 52 Major Services ................................................................................................................................. 52 Orthodontia ...................................................................................................................................... 53 

Pre-Treatment Review ......................................................................................................................... 53 Use Network Dentists and Save .......................................................................................................... 54 Alternate Treatment ............................................................................................................................. 54 What The EHP Dental Plans Do Not Cover........................................................................................ 54 Election of No Dental Benefits ........................................................................................................... 56 

Flexible Spending Accounts ................................................................................................................. 57 

When You Can Contribute to an FSA ................................................................................................. 57 How to Use the FSAs .......................................................................................................................... 58 

Use It or Lose It ............................................................................................................................... 59 Eligible Health Care Expenses ........................................................................................................ 59 

Health Care FSA Worksheets.............................................................................................................. 60 Filing a Claim for Reimbursement From the Health Care FSA .......................................................... 62 Using the Dependent Care FSA .......................................................................................................... 63 

Eligible Dependent Care Expenses .................................................................................................. 63 Eligible Day Care Providers............................................................................................................ 64 

When You May Use the Dependent Care FSA ................................................................................... 64 The Dependent Care Tax Credit .......................................................................................................... 64 Filing a Claim for the Dependent Care FSA ....................................................................................... 67 

Short Term Disability Benefits ............................................................................................................ 68 

Payment of Benefits ............................................................................................................................ 68 Partial Disability .................................................................................................................................. 69 What’s Not Covered By Short Term Disability Benefits .................................................................... 70 When Short Term Disability Benefits End .......................................................................................... 71 Mid Term Disability Benefits.............................................................................................................. 71 

Administrative Information About Your Johns Hopkins EHP Benefits ......................................... 72 

Filing A Claim With Employer Health Programs ............................................................................... 72 What Happens When You Have Duplicate Coverage ......................................................................... 73 Coverage by Affiliated EHP Plans and the EHP Medical Plan .......................................................... 74 Employees Whose Worksite Is Outside The United States ................................................................ 75 

iii

When the EHP Medical Plan and Short Term Disability Plan May Recover Payment ...................... 75 When Benefit Plan Coverage Ends ..................................................................................................... 77 COBRA Continuation Coverage ......................................................................................................... 78 

Length of COBRA Coverage ............................................................................................................ 78 Electing COBRA Coverage .............................................................................................................. 81 When COBRA Coverage Ends ......................................................................................................... 82 

Benefit Coverage During FMLA Leaves of Absence ......................................................................... 82 Benefit Coverage During Other (Non-FMLA) Leaves of Absence .................................................... 83 When You Become Covered By Medicare ......................................................................................... 83 Medicare and End Stage Renal Disease .............................................................................................. 84 Plan Information .................................................................................................................................. 84 Claims And Appeals ............................................................................................................................ 86 

Filing a Claim .................................................................................................................................. 87 Claims and Appeals Procedures ...................................................................................................... 89 If Your Claim is Denied ................................................................................................................... 90 First Level Appeal ............................................................................................................................ 90 Final Appeal ..................................................................................................................................... 93 

External Review .................................................................................................................................. 95 Protected Health Information .............................................................................................................. 98 Your Rights Under ERISA .................................................................................................................. 98 JHHSC/JHH’s Rights ........................................................................................................................ 100 For More Information ........................................................................................................................ 100 

GENERAL INFORMATION

1

General Information About Your Benefits Benefits For You And Your Family Health care benefits are probably the benefits employees believe are the most important, and with good reason. The cost of health care can take a major bite out of a household budget. The Johns Hopkins Health System Corporation/The Johns Hopkins Hospital (JHHSC/JHH) offers you and your family health care benefits under the EHP Medical and Dental Plans to help you pay for medical, vision and dental care when you need it. Health Care and Dependent Care Flexible Spending Accounts (FSAs) are available to help you save on your out-of-pocket health care and dependent day care expenses. Short Term and Mid Term Disability benefits also offer necessary income protection should you become ill or injured and are unable to work for an extended length of time. These benefits are provided under the Johns Hopkins Health System Corporation/The Johns Hopkins Hospital Employee Benefits Plan for Non-Represented Employees and are described in this Summary Plan Description (SPD). Please read it carefully. The benefits described in this SPD are for eligible non-represented employees of the Johns Hopkins Health System Corporation and the Johns Hopkins Hospital. (Benefits for employees of the members of the Johns Hopkins Home Care Group are set forth in a separate SPD). Benefits are administered through Johns Hopkins Employer Health Programs, Inc. Long Term Disability, Life and Accidental Death and Dismemberment insurance benefits are described in a separate summary plan description. This January 2013 version of the SPD replaces the prior version of the SPD which was dated January 2011. This January 2013 version applies to all claims incurred on or after January 1, 2013. IMPORTANT NOTE – Federal law requires that you also be provided with a “Summary of Benefits and Coverage” that briefly summarizes the benefits provided by your EHP Medical Plan in a limited number of pages. Your entitlement to benefits is determined only by this Summary Plan Description and not by the Summary of Benefits and Coverage. For information about your benefits, you should refer to this Summary Plan Description and should not rely on the Summary of Benefits and Coverage.

GENERAL INFORMATION

2

Who Is Eligible Employee Coverage Employees are generally eligible for the benefits described in this SPD as follows: Benefit Plan: Full-Time

Employee (30+ Hours/Week)

Part-Time Employee

(20-29 Hours/Week)

Weekend Option Nurse

EHP Medical Plan (includes vision and prescription drugs)

Yes Yes Yes

EHP Dental Plans Yes Yes Yes Salary Protection Short Term Disability (11

Weeks) Optional Mid Term Disability Optional Long Term

Disability

Yes Yes Yes

Yes Yes Yes

No No Yes

Flexible Spending Accounts Health Care Account Dependent Care Account

Yes Yes

Yes Yes

Yes Yes

Dependent Coverage Eligible dependents may also be covered under the EHP Medical and Dental Plans. Eligible dependents are: Your legal spouse. You must submit proof that you are married (such as a copy of your marriage

license/certificate or income tax return) the first time you enroll your spouse You may not cover your former spouse after the divorce has become final.

Your children, through the end of the month in which they turn age 26. You must submit a copy of your child’s birth certificate the first time you enroll your child. To be eligible, a child must be your natural child, a stepchild who resides with you, a foster child, a child legally adopted or placed with you for adoption, or a child for whom you are the legal guardian. A stepchild who does not reside with you is not eligible.

Same sex domestic partners and their children, but only if they meet the requirements set forth below under Domestic Partner Coverage; and

Your physically or mentally disabled dependent child of any age, provided the physical or mental disability began while the child was eligible as described above.

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To be considered disabled, a child must be entitled to Supplemental Security Income (SSI) benefits on account of disability. However, if the child has not applied for SSI, you can instead demonstrate to the Plan Administrator’s satisfaction that the child meets the SSI disability criteria for adults -- the inability to engage in any substantial gainful activity as a result of any medically determinable physical or mental impairment(s) which can be expected to result in death, or has already lasted, or can be expected to last, for a continuous period of not less than 12 months. A dependent in active military service is not eligible for coverage. If your spouse also works for JHHSC/JHH, you cannot be covered as both an employee and a dependent. Likewise, if your eligible child also works for JHHSC/JHH, he or she cannot be covered as both an employee and a dependent. Please note that your eligible children may only be covered by one parent’s plan. If you have any questions about coverage, please contact the HR Service Center, Phipps 455, at 410-955-6208. Domestic Partner Coverage Coverage under the EHP Medical and Dental Plans is also available under certain circumstances for same sex domestic partners and their children, in accordance with the JHHSC/JHH Policy Regarding Employee Benefits for Domestic Partners (Same Sex). Starting in 2014, coverage will only be provided for same sex domestic partners and their children if the employee is a legal resident of a state that does not allow same sex marriage. If the employee is a legal resident of Maryland, the District of Columbia, or any other state that does allow same sex marriage, then starting in 2014 same sex domestic partner coverage will not be provided. In 2014 and thereafter, if an employee with same sex domestic partner coverage (because the employee lives in a state that does not allow same sex marriage) changes legal residency to Maryland, the District of Columbia or another state that does allow same sex marriage, the employee will lose coverage for his or her same sex partner (and the partner’s children) at the end of the month in which the employee changes legal residency. A domestic partner (and the partner’s children) who loses coverage under the two preceding paragraphs cannot continue coverage under COBRA. The rules in this Summary Plan Description for coverage of same sex domestic partners only apply for employees who are eligible for domestic partner coverage. A same sex domestic partner is eligible for coverage only while he or she satisfies the requirements for benefits under the Domestic Partner Policy. A child of a same sex domestic partner is only eligible for

GENERAL INFORMATION

4

coverage while the domestic partner is actually covered under the EHP Medical or Dental Plans and only if the child would be eligible for coverage as explained above if he or she were an employee’s child. The Internal Revenue Code has different tax rules for domestic partner coverage. Under current law, the tax rules for domestic partner coverage also apply to coverage of legally married same sex spouses. Because of the different tax rules, contributions for domestic partner or same sex spouse coverage usually must be made with after tax dollars. Also, an employee with domestic partner or same sex spouse coverage will have additional taxable income shown on Form W-2, equal to the fair market value of the domestic partner or same sex spouse coverage minus the after tax contribution. However, the Code’s different tax rules do not apply if a domestic partner or same sex spouse (and the partner/spouse’s children, if any), qualifies as the employee’s dependent for federal health plan tax purposes. Contact the HR Service Center for information about how to show that a domestic partner or same sex spouse (and the partner/spouse’s children) qualifies as a dependent for federal health plan tax purposes. Expenses of a domestic partner or same sex spouse (or the partner/spouse’s child) cannot be reimbursed under the Health Care Flexible Spending Account, unless the partner/spouse (or the child), qualifies as the employee’s dependent for federal health plan tax purposes. Expenses of a domestic partner or same sex spouse’s child cannot be reimbursed under the Dependent Care Spending Account, unless the partner/spouse’s child qualifies as the employee’s dependent for federal health plan tax purposes and meets other requirements set forth later in this SPD under Using the Dependent Care FSA. Coverage for a domestic partner or same sex spouse (or the partner/spouse’s children) can only be added or dropped during annual open enrollment. The Special Enrollment and family status change rules do not apply to domestic partners/same sex spouses and their children, even if they are dependents for federal health plan tax purposes. Of course, coverage will automatically end immediately if a domestic partner/same sex spouse or the partner/spouse’s children are no longer eligible for coverage under the Plans or the Domestic Partner Policy. Same sex domestic partners, same sex spouses and the partner/spouse’s children are not eligible for COBRA coverage. However, if a partner/spouse’s child also qualifies as your child as explained above under Dependent Coverage, then the child is eligible for COBRA coverage. Qualified Medical Child Support Order (QMCSO) You may enroll children who are not otherwise eligible as described above in the EHP Medical or Dental Plans if called for by a Qualified Medical Child Support Order (QMCSO). A QMCSO is a court order setting responsibility for health care expenses for non-custodial children. If you are served with a QMCSO, please send the court order to the HR Service Center as soon as possible. Coverage

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5

will only be provided if the Plan Administrator determines that the QMCSO meets applicable legal requirements. When Coverage Begins Coverage under the EHP Medical and Dental Plans and Short Term Disability begins the first day of the month following your date of hire, if you are eligible and you complete the online enrollment process within 30 days from your first day of work. To be eligible, you must be a full-time employee who is regularly scheduled to work at least 30 hours per week, or a part-time employee who is regularly scheduled to work at least 20 hours per week. You are also eligible if you are classified by your employer as a weekend option nurse. You are not eligible if you are classified by your employer as a temporary employee or if you are included in a unit of employees covered by a collective bargaining agreement that does not expressly provide for participation in the Plans. If you do not complete the online enrollment process within 30 days from your first day of work, you will not have coverage until the next annual open enrollment unless you have a family status change or qualify for Special Enrollment as explained below. In order for coverage to be effective, you must be actively at work on the first day of coverage performing your usual duties during your usual working hours. If you are absent from work due to a Paid Time Off (PTO) day, vacation day, holiday, jury duty or other similar reasons, you will still be considered actively at work and coverage will be effective. Coverage for your dependents will begin at the same time as your own if you have enrolled them in accordance with your Guide to Benefits booklet. If you have a new baby, adopt a child, or have a child placed with you for adoption, and you enroll this dependent within 30 days, your child’s coverage becomes effective on the date of the birth or adoption. If you marry and you enroll your spouse within 30 days after your marriage, your spouse’s coverage becomes effective on the first day of the month following the date you complete the online enrollment process. Changing Your Coverage During the annual open enrollment period, you may change your EHP Medical or Dental Plans coverage, or change your contributions to a Health Care or Dependent Care Flexible Spending Account. Outside of the annual open enrollment period, you may start or stop coverage, add new dependents, or drop a dependent from your coverage only if you have a qualifying family status change or a Special Enrollment situation (see Special Enrollment Rights discussed below). In the case of a Flexible Spending Account, you may also increase or decrease your contributions if you have a qualifying family status change, subject to the minimum and maximum limitations described later in this SPD under Flexible Spending Accounts. Examples of IRS-qualified changes in family status include:

GENERAL INFORMATION

6

Marriage, legal separation, annulment or divorce;

Birth, death or adoption of a dependent;

Placement for adoption of a dependent;

A change in employment status (for example: you or your dependent terminate employment or start a new job);

A change from full-time to part-time employment (or vice versa) by you or your dependent;

A change in your or your dependent’s employment status due to an unpaid leave of absence;

Your dependent becomes eligible or is no longer eligible for coverage under the Plan;

Your spouse elects to add or drop coverage during open enrollment under your spouse’s plan;

You are required to cover your child due to a QMCSO;

You or your dependent gain or lose eligibility for Medicare or Medicaid (you may change the current election for the affected person only); and

Any other event that the Plan Administrator determines to qualify as a family status change under the Internal Revenue Code.

Current federal law does not recognize same sex marriages. Therefore, if you add or drop coverage because of a same sex spouse, special tax rules will apply. Contact the HR Service Center if you want more information. Any employee, spouse or dependent child whose coverage under any other group health plan suddenly or unexpectedly ends may possibly be permitted coverage under the EHP Medical or Dental Plans without waiting until the next open enrollment. Please notify the HR Service Center about your situation to see if coverage is available. Any change in your benefit coverage must correspond directly to the change in family status. If you change your coverage via the online enrollment process and submit a copy of proof of the family status change (such as a marriage or birth certificate or adoption papers) within 30 days after the status change, the new coverage will become effective on the first of the month following the date you complete the online enrollment process. If you do not change your coverage via the online enrollment process within 30 days after the status change, you must wait until the next annual open enrollment

GENERAL INFORMATION

7

before the new coverage can become effective. Please keep the HR Service Center informed of any changes in family status by contacting us in Phipps Room 455. Special Enrollment Rights For EHP Medical and Dental Coverage Losing other coverage If you did not enroll for coverage under the EHP Medical or Dental Plans because you had coverage through another source (such as a spouse’s employer or COBRA), and you subsequently lose that other coverage, you may enroll for EHP Medical or Dental Plan coverage. You must request this special enrollment by completing the online enrollment process within 30 days of losing your other coverage. If requested on time, coverage under the EHP Medical or Dental Plans will become effective on the first of the month following the date you complete the online enrollment process. Special enrollment does not apply if you lost coverage under the other plan because you did not make required contributions or if you lost coverage for cause (such as making a fraudulent claim). New Children Children whom you acquire through birth, adoption, or placement for adoption may be granted special enrollment, as long as you enroll them for coverage via the online enrollment process within 30 days following the date you acquired the child. If enrolled on time, coverage will become effective on the date of the birth, adoption or placement for adoption. If you do not have coverage for yourself, your spouse or any of your other children, you may also enroll yourself, your spouse or any of your other children when you enroll your new child. Medicaid and Children’s Health Insurance Program If you or your child have health insurance coverage under Medicaid or a Children’s Health Insurance Program (“CHIP”) and you or your child lose eligibility for that coverage, you may enroll for EHP Medical Plan coverage. You must request this special enrollment via the online enrollment process within 60 days of losing your Medicaid or CHIP coverage. If enrolled on time, coverage will become effective on the first day of the month following the date you complete the online enrollment process. If you or your child become eligible to receive assistance from Medicaid or CHIP to pay your required contributions for coverage under the EHP Medical Plan, you may enroll for EHP Medical Plan coverage. You must request this special enrollment via the online enrollment process within 60 days of becoming eligible for the assistance. If enrolled on time, coverage under the EHP Medical Plan will become effective on the first day of the month following the date you complete the online enrollment process.

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Certificates Of Coverage If you or a covered dependent lose coverage under the EHP Medical Plan (including COBRA coverage), be sure to notify the HR Service Center and request a certificate of coverage. The certificate of coverage is available at no cost to you. The certificate will state the length of time you (or your covered dependent) had uninterrupted coverage under the EHP Medical Plan. The certificate of coverage may allow you to reduce any pre-existing condition limits that apply to future medical coverage. Please note that certificates are not automatically provided for dependents until the HR Service Center is aware that the dependent has lost coverage (for example, when a child no longer qualifies for coverage because of age). You may request a certificate of coverage for up to 24 months from the date your coverage ended. Coverage Costs JHHSC/JHH pays the majority of the cost of your coverage under the EHP Medical and Dental Plans. JHHSC/JHH also offers you “Wellness Rewards” under the Healthy@Hopkins Program, which you can use to help cover the cost of those benefits that require employee contributions, including the EHP Medical and Dental Plans. Required employee contributions are deducted from your paycheck on a pre-tax basis. Because your contributions are deducted before taxes, you reduce your taxable income and save on federal and state income taxes, and Social Security taxes. Special rules may apply for state taxes if you live in Pennsylvania or New Jersey. For the exact contributions required by the EHP Medical and Dental Plans, please refer to your Guide to Benefits booklet or contact the HR Service Center. JHHSC/JHH pays the full cost of your Short Term Disability benefits.

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The Johns Hopkins EHP Medical Plan Previously, there were two Johns Hopkins EHP Medical Plans for you to choose from: the Basic Plan and the Premium Plan. Starting in 2013, there is only one EHP Medical Plan with three levels of benefits as explained below. The EHP Medical Plan described in this SPD is designed to provide you and your family with quality health care services in the most cost effective settings. The EHP Medical Plan offers you the security of a wide range of health care benefits, including coverage for inpatient and outpatient hospital care, medical and surgical services, prescription drugs, vision care and mental health and substance abuse services. The EHP Medical Plan also offers vital preventive care benefits, such as coverage for routine physicals; well-woman care, including Pap tests and mammograms; and well-child care, including immunizations and check-ups. Network Providers The EHP Medical Plan gives you access to The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Howard County General Hospital, Suburban Hospital, Sibley Memorial Hospital, All Children’s Hospital, and a Network of local and regional community hospitals. There are two parts to the Network:

You can go to providers that participate in the Johns Hopkins Employer Health Programs (EHP) Network.

For services received outside the State of Maryland, you can go to providers that participate in the MultiPlan PHCS Healthy Directions Network. For services received inside the State of Maryland, MultiPlan Network providers are only considered to be in-Network providers if they also participate in the Johns Hopkins EHP Network.

Any reference to Network providers in this SPD also means MultiPlan PHCS Healthy Directions Network providers, but only for services received outside the State of Maryland.

You should ask your provider if they are in the EHP Network before you receive services in Maryland, or if they are in the MultiPlan PHCS Healthy Directions Network before you receive services outside of Maryland. For a complete listing of EHP Network providers, please see the provider directory available at www.ehp.org, or call 410-424-4450 or 800-261-2393. For a complete listing of MultiPlan PHCS Healthy Directions Network providers, please see the provider directory available at www.multiplan.com or call 866-980-7427. Primary Care Physicians You are encouraged (but not required) to select a Primary Care Physician (PCP) to coordinate your

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medical care. However, you never need a referral from a PCP. (Certain services require preauthorization, as explained later in this SPD). Having an established PCP ensures that preventive services are addressed and allows you the opportunity for a relationship with your PCP and to feel comfortable with your choice of provider. You can designate or change your PCP by calling an EHP Customer Service Representative at 1-800-261-2393 or 410-424-4450, or go to www.ehp.org and sign in to HealthLink@Hopkins to send a secure email to EHP. Your PCP change will become effective the first day of the month following the date you request the change. Your PCP is responsible for helping to keep you well, providing routine treatment, or referring you to an EHP Network specialist when necessary. There are no claims to file — the EHP Network provider receives payment directly from the Plan. You may select a pediatrician as the PCP for your children. Go online for the Johns Hopkins EHP provider search for PCPs, available on the EHP Web site at www.ehp.org. You and your dependents may select any listed PCP who is available. Three Ways to Receive Care The EHP Medical Plan offers three ways to receive care. The Plan incorporates the cost-efficiencies that result from using the EHP Network of highly qualified health care professionals and facilities. You can also use Out-of-Network providers, although lower benefits are provided. The Plan offers you the reassurance of being treated by any doctor you choose, in a location convenient to you. Option 1 – EHP Network Providers The Plan pays benefits under Option 1 if you go to a provider in the Johns Hopkins EHP Network. You do not have to select a Primary Care Physician and you never need a referral. Certain services require preauthorization, as explained later in this SPD. There are no claims to file — EHP Network providers receive payment directly from the Plan. Some services are only available thru EHP Network providers, as described later in this SPD under Covered Services and Supplies. Most outpatient services are covered at 100% under Option 1, subject to a copay for certain services. Most inpatient services are covered at 90% under Option 1, after meeting an annual inpatient deductible of $100 per person/$200 per family and a $300 copay per admission. You pay the remaining 10%.until you reach an annual out-of-pocket maximum of $2,000 per person/$4,000 per family. After you reach the out-of-pocket maximum, benefits for covered services are paid at 100% of the charge for the remainder of that calendar year, subject to a $300 copay per admission.

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Hopkins Affiliated Facilities Option 1 provides higher benefits for inpatient services if you go to a Hopkins Affiliated Facility, which includes Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Howard County General Hospital, Suburban Hospital, Sibley Memorial Hospital and All Children’s Hospital. All Hopkins Affiliated Facilities are part of the Johns Hopkins EHP Network. At a Hopkins Affiliated Facility, inpatient services are covered at 100%, there is no annual deductible and the copay per admission is only $150. Because inpatient services are covered at 100% to begin with, there is no need for an out-of-pocket maximum. Option 2 – Out-of-Network Providers The Plan pays benefits under Option 2 if you go to a provider outside of the Johns Hopkins EHP Network. You must first meet an annual deductible of $750 per person/$1,500 per family. After the deductible and any applicable copay, the Plan pays 70% of the Reasonable and Customary Charge (see Payment Terms You Should Know discussed below), and you pay the remaining 30%, until you reach an annual out-of-pocket maximum of $3,500 per person/$7,000 per family. After you reach the out-of-pocket maximum, benefits for covered services are paid at 100% of the Reasonable and Customary Charge for the remainder of that calendar year. You are responsible for any copays and amounts over the Reasonable and Customary Charge, and those amounts do not count towards the deductible or the annual out-of-pocket maximum. Payment Terms You Should Know To understand how your benefits are paid, please refer to the following terms. Coinsurance: Your percentage share of the charge for certain medical expenses. If you receive

inpatient care under Option 1 from an EHP Network provider that is not a Hopkins Affiliated Facility, the Plan generally pays 90%of the charge, after the Option 1 deductible, and you pay the remaining 10%. No coinsurance applies under Option 1 for outpatient care or for inpatient care at a Hopkins Affiliated Facility. If you receive care from an Out-of-Network provider under Option 2, the Plan generally pays 70% of the Reasonable and Customary Charge (R&C), after the Option 2 deductible, and you pay the remaining 30%, plus any amounts over R&C.

Copay: The amount you pay for certain services and prescription drugs. Please refer to the

Medical Benefits At-A-Glance chart later in this SPD for specific copay amounts. You pay the copay directly to the provider at the time of service. The copay does not apply toward the out-of-pocket maximum.

Deductible:

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If you receive inpatient care under Option 1 at an EHP Network facility that is not a

Hopkins Affiliated Facility, the deductible is the amount you must pay each calendar year before the Plan begins to pay benefits for inpatient care.

If you receive inpatient or outpatient care from an Out-of-Network provider under Option 2,

the deductible is the amount you must pay each calendar year before the Plan begins to pay any benefits (other than for certain emergency care).

Expenses incurred and applied to your Option 1 deductible do not apply to your Option 2

deductible, and vice versa.

Except for gastric bypass surgery and infertility treatment, no deductible applies if you receive inpatient care under Option 1 at a Hopkins Affiliated Facility.

Expenses incurred and applied to your deductible in October, November and December of a

calendar year are also carried over and applied to the next calendar year’s deductible. Expenses incurred by two or more individuals can meet the family deductible. However, no one individual will be required to satisfy more than the individual deductible.

Out-of-Pocket Maximum: Since you are responsible for a portion of the cost of certain of your

medical expenses, the Plan includes an annual out-of-pocket maximum to protect you in the event of high medical bills. Under Option 1, after you have paid the annual out-of-pocket maximum of $2,000 per person ($4,000 per family), the Plan pays any additional covered expenses at 100% for the remainder of that calendar year. Under Option 2, after you have paid the annual out-of-pocket maximum of $3,500 per person ($7,000 per family), the Plan pays any additional covered expenses at 100% of the Reasonable and Customary Charge (R&C) for the remainder of that calendar year. If you receive care from an Out-of-Network provider under Option 2, you are still responsible for any amounts over the Reasonable and Customary Charge. Expenses incurred and applied to your Option 1 out-of-pocket maximum do not apply to your Option 2 out-of-pocket maximum, and vice versa.

The out-of-pocket maximum includes the deductible and coinsurance, but does not include copays; penalties; prescription drug copays and expenses; amounts in excess of the Reasonable and Customary Charge (R&C); amounts in excess of Plan maximums; or any charges for services which are not covered.

Providers: a provider is any hospital, skilled nursing/rehabilitation facility, individual, organization,

or agency licensed to provide professional services and acting within the scope of that license. Benefits will only be paid for covered services from providers who meet this definition. Benefits will not be paid for any services and related charges provided by a close relative of the patient (spouse, child, grandchild, brother, sister, brother-in-law, sister-in-law, parent or grandparent).

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Reasonable and Customary Charge (R&C): This is the prevailing, reasonable fee paid to

similar providers for the same services or supplies in the same geographic area. Johns Hopkins Employer Health Programs calculates what is the Reasonable and Customary Charge by using a vendor that determines the prevailing fees paid by health plans in the area where the service or supply was provided. EHP Network providers will not charge more than the Reasonable and Customary Charge, but Out-of-Network providers can charge more and you are responsible for charges above the Reasonable and Customary Charge.

Care Management Program The Johns Hopkins EHP Medical Plan has several features designed to help both you and the Plan manage health care costs, while still providing you with quality care. While part of increasing health care costs results from new technology and important medical advances, another significant cause is the way health care services are used. Some studies indicate that a high percentage of the cost for health care services may be unnecessary. For example, hospital stays can be longer than necessary. Some hospitalization may be entirely avoidable, such as when surgery could be performed at an outpatient facility with equal quality and safety. Also, surgery is sometimes performed when other treatment could be more effective. All of these instances increase costs for JHHSC/JHH and you. To help control these costs, the EHP Medical Plan features a Care Management Program. Before you can receive benefits for certain medical services and supplies under the EHP Medical Plan, you must have these services and supplies preauthorized by the Johns Hopkins EHP Care Management Program. Your EHP Network doctor will initiate the preauthorization process if you receive Network care under Option 1. You or your Out-of-Network doctor are required to initiate the preauthorization process if you receive Out-of-Network care under Option 2. If you do not obtain preauthorization, coverage for benefits may be reduced or denied entirely. The following services and supplies require preauthorization by the Care Management Program:

Durable medical equipment and medical supplies;

Hearing aids for dependent children;

Home health care;

Hospice care;

Hospital inpatient stays;

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Hypnosis or biofeedback training for treatment of voiding dysfunction

Infertility treatment

Mental health and substance/alcohol abuse inpatient treatment

Physical/occupational therapy after 12 visits per calendar year

Prosthetic devices and orthotics;

Skilled nursing/rehabilitation facility stays;

Speech therapy;

Surgical procedures (certain procedures only, including gastric bypass, as described on a list maintained by Johns Hopkins Employer Health Programs);

Transplant services; and

Use of certain drugs and medications (as described on a list maintained by Johns Hopkins

Employer Health Programs). The purpose of the Care Management Program is to assure you receive quality care that is medically necessary and appropriate. The Program also strives to protect you from significant, and sometimes unnecessary, health care expenses. The Care Management Program is not intended to diagnose or treat your medical conditions. Rather, the Care Management Program will coordinate the medical care services you receive across the continuum of care. There are dedicated care managers available to help you in coordinating medical care for both acute and chronic illnesses. They will work closely with you, your Primary Care Physician and your other medical providers to ensure that you have access to appropriate services. Your care manager may also suggest alternative care options and coordinate with providers to improve standards for the medical care you receive. Additionally, your care manager can help you identify non-medical resources, such as social workers or community groups, that can help you. Chronic Care Management Program The Johns Hopkins EHP Medical Plan is committed to supporting you in managing your health. If you have asthma, diabetes, cardiovascular problems or other complex conditions and meet certain criteria, the EHP Medical Plan provides an innovative Chronic Care Management Program to help you.

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Some features of the Chronic Care Management Program, depending on your health status, include:

Regular monitoring to review your diet, medications and other related health information;

Access to disease specialists and your personal nurse case manager;

Access to the EHP TeleWatch monitoring system;

Educational materials about your condition, tips on managing your symptoms, healthy eating, exercise and stress management.

The Chronic Care Management Program is free and completely voluntary. Your eligibility for benefits under the EHP Medical Plan is not affected if you participate in the Program or if you withdraw from the Program after you start. Becoming more involved in your own health can positively impact many aspects of your life. Johns Hopkins EHP encourages you to participate in the Chronic Care Management Program. Health Coach Program Another program to assist you in managing your health is the Health Coach program. This free, voluntary program encourages interest in healthier lifestyles. If you have well managed chronic conditions or are at risk for developing chronic conditions, you may benefit from this program. Risk factors may include hypertension, high cholesterol, obesity, smoking, and pre-diabetes. Health coaching provides one-on-one assistance to guide you in adopting healthy lifestyle behaviors. Program duration is 6 to 10 months and sessions are conducted by telephone each month. Primary areas of interest for enrolling in the program are weight loss, nutrition, fitness, stress management and tobacco cessation. The health coach will work with you on monthly goal setting and create an individualized action plan based on your needs. Throughout the program, various assessments are taken to evaluate your progress, health status, and program satisfaction, and modifications to your action plan are made as needed. You may self-refer into the program or be referred by your health care provider or case manager. If you are appropriate for the program you will be contacted by your assigned health coach. Your eligibility for benefits under the EHP Medical Plan is not affected if you do not participate in the program or if you withdraw from the program after you start. We encourage you to take advantage of this free program to assist you in managing your health. You may contact the program at healthcoach@jhhc.com or call 1-800-957-9760.

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EHP Customer Service An important feature of your EHP Medical Plan is the Customer Service Representatives available to assist you by answering any questions you may have about covered benefits, using your plan, filing a claim, resolving complaints, etc. If you have a question, EHP Customer Service Representatives are available Monday through Friday, from 8 a.m. to 5 p.m., at 1-800-261-2393 or 410-424-4450. A Johns Hopkins EHP Medical Plan identification card will be issued to you and each of your covered dependents. Carry your identification card with you at all times and show it to your health care provider whenever you receive medical care. Only you and your covered dependents are permitted to use the identification card. It is illegal to loan your card to persons who are not covered under the EHP Medical Plan. If you lose your identification card, call a Johns Hopkins EHP Customer Service Representative immediately to request a new card. You may also print a temporary ID card by going to www.ehp.org and signing into HealthLink@Hopkins. Your identification card includes important information and phone numbers about the procedures to follow to receive benefits.

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What’s Covered by the Johns Hopkins EHP Medical Plan Medical Benefits At-A-Glance The following chart summarizes most of the benefits and services available under the Johns Hopkins EHP Medical Plan. This chart is not a complete description of benefits. For more information, please refer to the rest of this SPD.

SERVICES PROVIDED EHP NETWORK

PROVIDERS

OUT-OF-NETWORK

PROVIDERS

HOPKINS AFFILIATED

FACILITIES CALENDAR YEAR DEDUCTIBLE

Per individual $100 (inpatient services only) $750 None Per family $200 (inpatient services only) $1,500 None COINSURANCE OUT-OF-POCKET MAXIMUM (includes deductible; excludes copays)

Per individual $2,000 $3,500 Not applicable Per family $4,000 $7,000 Not applicable PENALTY FOR FAILURE TO OBTAIN PREAUTHORIZATION

Not applicable $500 or denial of benefits Not applicable

1. TREATMENT OF

ILLNESS OR INJURY

Primary care office visit 100% after $15 copay 70% of R&C after deductible 100% after $15 copay

Specialty care office visit 100% after $40 copay 70% of R&C after deductible 100% after $40 copay

Diagnostic services and treatment 100% 70% of R&C after deductible 100% Hopkins Affiliated Facilities include Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Howard County General Hospital, Suburban Hospital, Sibley Memorial Hospital and All Children’s Hospital. EHP Network Providers and Hopkins Affiliated Facilities have agreed to accept the EHP fee schedule as full payment and will not balance bill, other than required copays, coinsurance, and deductibles. Out-of-Network providers can balance bill for charges in addition to deductibles and coinsurance. This chart is not a complete description of benefits. For more information, please refer to the rest of this SPD. Only medically necessary services and supplies are covered. “R&C” is explained under Payment Terms You Should Know, earlier in this SPD.

COVERED SERVICES AND SUPPLIES

18

SERVICES PROVIDED EHP NETWORK

PROVIDERS

OUT-OF-NETWORK

PROVIDERS

HOPKINS AFFILIATED

FACILITIES

2. PREVENTIVE SERVICES

General preventive exam (adult physical, GYN and well child care)

100% 70% of R&C after deductible 100%

Diagnostic services for exam 100% 70% of R&C after deductible 100%

Mammogram 100% 70% of R&C after deductible 100%

Screening colonoscopy 100% 70% of R&C after deductible 100%

3. IMMUNIZATIONS AND

INOCULATIONS

As recommended by Centers for Disease Control and Prevention

100% 70% of R&C after deductible 100%

4. PRESCRIPTION DRUGS In-network pharmacy only; 30-day supply; No copay for prescribed Prilosec OTC, Claritin OTC and Claritin D OTC; No copay for certain generic contraceptives

$10 copay – generic

$30 copay – brand preferred $50 copay – brand non-preferred

90-day supply for maintenance drugs

Mail order: $20 copay – generic

$60 copay – brand preferred $100 copay – brand non-preferred

In-Network pharmacy: $30 copay – generic

$90 copay – brand preferred $150 copay – brand non-preferred

Specialty medications 30-day supply, available from In-network pharmacy only

5. ALLERGY TESTS AND

PROCEDURES

Allergy tests 100% 70% of R&C after deductible 100%

Desensitization materials/serum 100% 70% of R&C after deductible 100%

6. LABORATORY

PROCEDURES

Laboratory tests 100% 70% of R&C after deductible 100% Hopkins Affiliated Facilities include Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Howard County General Hospital, Suburban Hospital, Sibley Memorial Hospital and All Children’s Hospital. EHP Network Providers and Hopkins Affiliated Facilities have agreed to accept the EHP fee schedule as full payment and will not balance bill, other than required copays, coinsurance, and deductibles. Out-of-Network providers can balance bill for charges in addition to deductibles and coinsurance. This chart is not a complete description of benefits. For more information, please refer to the rest of this SPD. Only medically necessary services and supplies are covered. “R&C” is explained under Payment Terms You Should Know, earlier in this SPD.

COVERED SERVICES AND SUPPLIES

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SERVICES PROVIDED EHP NETWORK

PROVIDERS

OUT-OF-NETWORK

PROVIDERS

HOPKINS AFFILIATED

FACILITIES

7. RADIOLOGY

PROCEDURES

CT scans, PET scans and MRIs 100% after $50 copay 70% of R&C after deductible 100% after $50 copay All other imaging studies, including x-rays and ultrasound

100% after $10 copay 70% of R&C after deductible 100% after $10 copay

8. SURGICAL

PROCEDURES

Professional services for inpatient and outpatient surgery; Care Management Program authorization may be required

90% for inpatient after deductible

100% for outpatient

70% of R&C after deductible(1)

100%

Medically necessary reconstructive and/or surgically implanted prosthetic devices

90% for inpatient after deductible

100% for outpatient

70% of R&C after deductible(1)

100%

Gastric bypass surgery; Care Management Program authorization required

Covered at Hopkins Facility Only

Covered at Hopkins Facility Only

100% after separate $1,000 deductible

9. REPRODUCTIVE

HEALTH

Physician office visits (for prenatal care only)

100% 70% of R&C after deductible 100%

Inpatient maternity care and delivery, including physician, hospitalization, lab and X-ray services

$300 copay, then 90% after deductible

($150 copay, then 100%, for admissions before 7/1/13)

$500 copay, then 70% of R&C after deductible (1)

$150 copay, then 100%

Birthing centers (licensed facility) 100% 70% of R&C after deductible (1) Not available

Voluntary sterilization 100% 70% of R&C after deductible (1) 100%

Interruption of pregnancy 100% 70% of R&C after deductible (1) 100%

In-vitro fertilization and artificial insemination; Care Management Program authorization required

Covered at Hopkins Affiliated Facility Only

Covered at Hopkins Affiliated Facility Only

100% after separate $1,000 deductible (2)

Hopkins Affiliated Facilities include Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Howard County General Hospital, Suburban Hospital, Sibley Memorial Hospital and All Children’s Hospital. EHP Network Providers and Hopkins Affiliated Facilities have agreed to accept the EHP fee schedule as full payment and will not balance bill, other than required copays, coinsurance, and deductibles. Out-of-Network providers can balance bill for charges in addition to deductibles and coinsurance. This chart is not a complete description of benefits. For more information, please refer to the rest of this SPD. Only medically necessary services and supplies are covered. “R&C” is explained under Payment Terms You Should Know, earlier in this SPD.

(1) Failure to obtain preauthorization for hospitalization will result in a $500 penalty or possible denial of benefits. (2) $30,000 lifetime maximum combined including prescription drugs, lab work and X-rays, in-vitro fertilization attempts (any implantation of oocyte)

limited to a maximum of three per lifetime within the $30,000 lifetime maximum, only covered at Hopkins Affiliated Facilities.

COVERED SERVICES AND SUPPLIES

20

SERVICES PROVIDED EHP NETWORK

PROVIDERS

OUT-OF-NETWORK

PROVIDERS

HOPKINS AFFILIATED

FACILITIES

10. URGENT CARE CENTER

Physician visit 100% after $40 copay 70% of R&C after deductible 100% after $40 copay

Diagnostic services and treatment 100% 70% of R&C after deductible 100%

11. EMERGENCY SERVICES Care in emergency room for emergency medical situations only

100% after $150 copay (waived if admitted); no deductible

100% of R&C after $150 copay (waived if admitted); no deductible

100% after $150 copay (waived if admitted)

12. AMBULANCE TRANSPORTATION

Ground or air transportation when medically necessary

100% 100% of R&C 100%

13. HOSPITAL CARE Inpatient care, including newborn nursery/NICU (semi-private, unless private room is medically necessary)

$300 copay per admission, then

90% after deductible

$500 copay per admission; then 70% of R&C after deductible (1)

$150 copay per admission,

then 100%

Other inpatient services 90% after deductible 70% of R&C after deductible 100% Inpatient physician services (excluding surgical)

90% after deductible 70% of R&C after deductible 100%

Skilled nursing/rehabilitation facility (120 days per calendar year combined maximum; Care Management Program authorization required)

100%

70% of R&C after deductible (1)

100%

Outpatient services including testing prior to outpatient surgery

100% 70% of R&C after deductible 100%

Outpatient surgery facility charges including freestanding surgical centers

100% 70% of R&C after deductible 100%

14. CHEMOTHERAPY/ RADIATION THERAPY

Physician services and materials 100% 70% of R&C after deductible 100% Hopkins Affiliated Facilities include Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Howard County General Hospital, Suburban Hospital, Sibley Memorial Hospital and All Children’s Hospital.

EHP Network Providers and Hopkins Affiliated Facilities have agreed to accept the EHP fee schedule as full payment and will not balance bill, other than required copays, coinsurance, and deductibles. Out-of-Network providers can balance bill for charges in addition to deductibles and coinsurance. This chart is not a complete description of benefits. For more information, please refer to the rest of this SPD. Only medically necessary services and supplies are covered. “R&C” is explained under Payment Terms You Should Know, earlier in this SPD.

(1) Failure to obtain preauthorization for hospitalization will result in a $500 penalty or possible denial of benefits.

COVERED SERVICES AND SUPPLIES

21

SERVICES PROVIDED EHP NETWORK

PROVIDERS

OUT-OF-NETWORK

PROVIDERS

HOPKINS AFFILIATED

FACILITIES 15. ACUPUNCTURE For anesthesia, pain control and therapeutic purposes ($1,500 calendar year combined maximum)

100% after $40 copay

70% of R&C after deductible

100% after $40 copay

16. HOME HEALTH CARE Care Management Program authorization required (40 visits per calendar year combined maximum)

100%

70% of R&C after deductible

100%

17. HOSPICE CARE Inpatient and home; Care Management Program authorization required

100% 70% of R&C after deductible (1) 100%

18. SPEECH THERAPY Care Management Program authorization required (30 visits per calendar year combined maximum)

100% after $10 copay

70% of R&C after deductible

100% after $10 copay

19. PHYSICAL/OCCUPATIONAL THERAPY

60 visits per calendar year combined maximum by licensed therapist only; Care Management Program authorization required after 12 visits

100% after $10 copay

70% of R&C after deductible

100% after $10 copay

20. CHIROPRACTIC CARE Restricted to initial exam, X-rays and spinal manipulations ($1,500 calendar year combined maximum)

100% after $15 copay

70% of R&C after deductible

100% after $15 copay

21. DURABLE MEDICAL EQUIPMENT AND SUPPLIES (Care Management Program authorization required)

Equipment and medical supplies 100% 70% of R&C after deductible 100% Custom molded orthotics 100% 70% of R&C after deductible 100% Prosthetic appliances 100% 70% of R&C after deductible Not available Hearing aids for children under 26 100% 70% of R&C after deductible Not available Hopkins Affiliated Facilities include Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Howard County General Hospital, Suburban Hospital, Sibley Memorial Hospital and All Children’s Hospital. EHP Network Providers and Hopkins Affiliated Facilities have agreed to accept the EHP fee schedule as full payment and will not balance bill, other than required copays, coinsurance, and deductibles. Out-of-Network providers can balance bill for charges in addition to deductibles and coinsurance. This chart is not a complete description of benefits. For more information, please refer to the rest of this SPD. Only medically necessary services and supplies are covered. “R&C” is explained under Payment Terms You Should Know, earlier in this SPD.

(1) Failure to obtain preauthorization for hospitalization will result in a $500 penalty or possible denial of benefits.

COVERED SERVICES AND SUPPLIES

22

SERVICES PROVIDED EHP NETWORK PROVIDERS

OUT-OF-NETWORK PROVIDERS

HOPKINS AFFILIATED FACILITIES

22. NUTRITION COUNSELING

Care Management Program authorization required after second visit per calendar year

100% after $15 copay

70% of R&C after deductible

100% after $15 copay

23. MENTAL HEALTH AND SUBSTANCE ABUSE

Inpatient care for mental health and substance/alcohol abuse

100% after $150 copay per admission

$500 copay per admission, then 70% of R&C after deductible (1)

100% after $150 copay per admission

Outpatient treatment for mental health and substance/alcohol abuse

100% after $15 copay per visit

70% of R&C after deductible

100% after $15 copay per visit

Partial hospital facility days 100% after $15 copay per day 70% of R&C after deductible (1) 100% after $15 copay per day Hopkins Affiliated Facilities include Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Howard County General Hospital, Suburban Hospital, Sibley Memorial Hospital and All Children’s Hospital.

EHP Network Providers and Hopkins Affiliated Facilities have agreed to accept the EHP fee schedule as full payment and will not balance bill, other than required copays, coinsurance, and deductibles. Out-of-Network providers can balance bill for charges in addition to deductibles and coinsurance. This chart is not a complete description of benefits. For more information, please refer to the rest of this SPD. Only medically necessary services and supplies are covered. “R&C” is explained under Payment Terms You Should Know, earlier in this SPD. (1) Failure to obtain preauthorization for hospitalization can result in a $500 penalty or possible denial of benefits.

COVERED SERVICES AND SUPPLIES

23

Covered Services and Supplies The Johns Hopkins EHP Medical Plan provides benefits for the services and supplies listed in this section. Only services and supplies that are medically necessary are covered. A medically necessary service or supply is one that the Plan Administrator determines: Diagnoses, prevents or treats a covered medical condition; Is appropriate for the symptoms, diagnosis or treatment of the covered medical condition; Is supplied or performed in accordance with current standards of medical practice within the

United States of America; Is not primarily for the convenience of the covered person, facility or provider; Is the most appropriate supply or level of service that can safely be provided; and Is recommended or approved by the attending professional provider.

In the case of an inpatient admission, medically necessary also means treatment that could not adequately be provided on an outpatient basis. In General Benefit limits, coinsurance and copay amounts are shown in the Medical Benefits At-A-Glance chart. Covered services and supplies include the following (when medically necessary and subject to any conditions or limitations described elsewhere in this SPD): Abortion; Acupuncture for anesthesia, pain control and therapeutic purposes, when provided by a licensed

acupuncturist; Adult preventive care, including evidence based items or services that have in effect a rating of A

or B in the current recommendations of the United States Preventive Services Task Force; Ambulance services; Ambulatory surgical center; Anesthetics and oxygen, and their administration; Artificial limbs and eyes;

COVERED SERVICES AND SUPPLIES

24

Birthing facilities; Blood products, if not replaced; Casts, splints; Chiropractic care for misalignment or partial dislocation of or in the vertebral column and

correction by manual or mechanical means of nerve interference; Consultation services by a specialist in the medical field for which the consultation relates. Staff

consultation required by the facility is not covered; Contraceptive devices provided for in comprehensive guidelines supported by the Health

Resources and Services Administration and approved by the Food and Drug Administration; Convalescent facility care and home health care (Care Management preauthorization required); Cosmetic/reconstructive surgery when due to: Accidental injury or illness that is or would be covered by the Plans; Correction of a congenital malformation of a child, or Treatment for morbid obesity – see “Obesity treatment” below;

Dental services if rendered as initial treatment as a result of an accident causing injury to sound

natural teeth and treatment is provided within 48 hours of the accident; Diabetic supplies (Care Management preauthorization required); Diagnostic X-rays and laboratory services; Doctors’ (including surgeons’) fees for treatment of illness or injury; Doctors’ fees and hospital charges for maternity care; Doctors’ fees for office visits; Durable medical equipment, including wheelchairs. (Care Management preauthorization required)

Durable medical equipment is medical equipment which:

Can withstand repeated use; Is primarily and customarily used to serve a medical purpose;

COVERED SERVICES AND SUPPLIES

25

Is generally not useful to a person in the absence of illness or injury; Is appropriate for use in the home; and Is not primarily for the convenience of the patient;

Emergency services; Foot care for incision and drainage of infected tissues of the foot, removal of lesions, treatment of

fractures and dislocations of bone in the foot; Foot orthotics that are: custom-molded and related to a specific medical diagnosis; or an integral part of a leg brace and the cost is included in the orthotist’s charge (Care

Management preauthorization required); Freestanding dialysis facility; Gastric bypass surgery – see “Obesity treatment” below. Hearing aids for a dependent child under age 26, up to $1400 per aid. The aids must be prescribed,

fitted, and dispensed by a licensed audiologist. Replacement aids are available only once every three years. (Care Management preauthorization required)

Home health care (Care Management preauthorization required); Hospice care (Care Management preauthorization required); Hospital charges for covered semi-private room and board and other hospital-provided services and

supplies (Care Management preauthorization required for admission); Hypnosis or biofeedback training, but only for treatment of voiding dysfunction (Care

Management preauthorization required); Immunizations for routine use in children, adolescents, and adults that have in effect a

recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention;

Laboratory tests; Mental health and substance abuse treatment (Care Management preauthorization required for

inpatient care, partial hospitalization days and intensive outpatient care);

COVERED SERVICES AND SUPPLIES

26

Midwifery services; Newborn care; Nursing services (professional) by a registered nurse or licensed practical nurse who is not a close

relative (spouse, child, grandchild, brother, sister, brother-in-law, sister-in-law, parent, or grandparent) of the patient;

Obesity treatment – non-surgical treatment for employees only, as part of the Johns Hopkins

Weight Management Program. Your employer pays 50% of the charges for your participation in the Program. The other 50% is charged to you and covered by the Plan as follows. You must first pay a $300 annual deductible. After that, the Plan covers 70% of the amount charged to you and you pay the remaining 30%. The maximum benefit payment by the Plan per calendar year is $1,000.

Obesity treatment – surgical treatment for morbid obesity when Body Mass Index (BMI) (weight in

kilograms/height in meters squared) is greater than 40, or equal to or greater than 35 with a co-morbid medical condition, including hypertension, a cardiopulmonary condition, sleep apnea, or diabetes. Care Management preauthorization required and all services must be provided at a Hopkins Affiliated Facility. You must first pay a separate $1,000 deductible per surgery.

Obesity treatment – surgical treatment for overhanging, stretching or laxity of skin, but only if

medically necessary as a result of surgical or non-surgical treatment for morbid obesity. Limited to a lifetime benefit maximum of $5,000. (Care Management preauthorization required)

Prosthetic devices and orthotics that are integral to the device (Care Management preauthorization

required); Rehabilitation services (Care Management preauthorization required); Second surgical opinions; Skilled nursing/rehabilitation facility services (Care Management preauthorization required); Surgical dressings and medical supplies; Surgical procedures (Care Management preauthorization required for certain procedures); Temporomandibular Joint Syndrome (TMJ) treatment and/or orthognathic surgery, limited to

physical therapy, surgery and ortho devices such as mouthguards and intraoral devices (excludes orthodontics and prosthetics);

COVERED SERVICES AND SUPPLIES

27

Therapies, including: Chemotherapy; Dialysis treatment; Nutrition counseling (annual visit exclusive of procedures and testing); Occupational, physical and speech therapy provided by a licensed occupational, physical, or

speech therapist, that is required because of an illness or accidental injury. Occupational, physical and speech therapy is also covered if required for the treatment of a person under age 19 with a congenital or genetic birth defect in order to enhance the person's ability to function. Congenital or genetic birth defect means a defect existing at or from birth, including a hereditary defect, and includes autism or an autism spectrum disorder, cerebral palsy, intellectual disability, Down syndrome, spina bifida, hydroencephalocele, and congenital or genetic developmental disabilities. Unless caused by a congenital or genetic birth defect, treatment of stuttering, articulation disorders, tongue thrust and lisping, and maintenance therapy are not covered. Care Management preauthorization is required except for the first 12 occupational and physical therapy visits;

Radiotherapy; Transplants (Care Management preauthorization required); Vasectomies and tubal ligations; Well-child care, including evidence-informed preventive care and screenings provided for in

comprehensive guidelines supported by the Health Resources and Services Administration; Well-woman care, including evidence-informed preventive care and screenings for women

provided for in comprehensive guidelines supported by the Health Resources and Services Administration; and

X-ray, radium, and radioisotope treatment.

Following are descriptions of other services and supplies covered by the EHP Medical Plan. Prescription Drug Benefits Benefits are paid for prescription drugs designated as such under federal law, as well as injectable insulin, diabetic supplies (needles and syringes when prescribed with insulin only), and other medicines and supplies designated by Johns Hopkins Employer Health Programs. Prescription drug benefits also cover erectile dysfunction medications, provided: The member is male; There is a documented organic cause of erectile dysfunction;

COVERED SERVICES AND SUPPLIES

28

The treating provider is an EHP Network provider; and The maximum monthly number of doses is limited to six units of all erectile dysfunction

medications combined, with refills limited to three months per prescription. EHP Network Pharmacies You must obtain prescription drugs from an EHP Network pharmacy to receive benefits under the EHP Medical Plan. Your Johns Hopkins EHP provider search at www.ehp.org has a complete list of Network pharmacies. No benefits are provided if drugs are purchased from an Out-of-Network pharmacy. An EHP Network pharmacy has an arrangement to provide prescription drugs to you at an agreed upon price. When you buy covered drugs from an EHP Network pharmacy, present your EHP Medical Plan identification card to the pharmacist. You should request and retain a paid receipt for your copay amount if you need it for income tax purposes or to submit a claim to your Health Care Flexible Spending Account. Please note: As explained below, your physician may need to obtain preauthorization before certain drugs may be dispensed. Copay You pay a $10 copay for each separate prescription or refill for a generic drug. No copay applies for generic contraceptives that are required to be covered without cost-sharing under comprehensive guidelines supported by the Health Resources and Services Administration. The copay is $30 for a brand name preferred drug and $50 for a brand name non-preferred drug, regardless of whether a generic version is available. For maintenance drugs, you may obtain a 90-day supply at a retail pharmacy for three times the normal monthly copay for that prescription. Or, you may use the EHP Medical Plan’s Mail Order program, presently offered through Caremark. Through this program, you can obtain a 90-day supply of maintenance drugs each time you order for only two times the normal monthly copay. Your copay through the Mail Order program is $20 for each separate prescription or refill of a generic drug. The Mail Order copay is $60 for brand name preferred drugs and $100 for brand name non-preferred drugs. If you have any questions about the Mail Order program, call EHP. Medication Copay Waiver Program As part of the “Healthy Savings” program, if you receive treatment for asthma or diabetes that is covered by the EHP Medical Plan, you may be eligible to have the copay waived for certain medications you take for treatment of your condition.

COVERED SERVICES AND SUPPLIES

29

Contact the Care Management Program by phone at 410-762-5213 or 800-261-2396 (extension 5213), or by email at healthyhopkins@jhhc.com. Ask for a copy of the Healthy Savings Agreement and the Frequently Asked Questions piece. They will provide you with details about the program and what you must do to have your copay waived. You may be required to report routine test results and/or discuss your progress with a personal care nurse assigned to you. If you are already enrolled in the Chronic Care Management Program, you should automatically receive a copy of the Healthy Savings Agreement from your care manager. Not all medications for treatment of asthma and diabetes are eligible for copay waiver, but many of the most widely prescribed medications are. The Frequently Asked Questions piece contains a list of the medications that are currently eligible. JHHSC/JHH may add or remove medications from the list in the future. Prior Authorization and Quantity Limits Certain medications require prior authorization before coverage is approved, to assure medical necessity, clinical appropriateness and/or cost effectiveness. Coverage of these medications is subject to specific criteria approved by physicians and pharmacists on the Johns Hopkins Health Care Pharmacy and Therapeutics Committee. Also, certain medications have specific dispensing limitations for quantity and maximum dose, and step-therapy requirements. Because of this, your EHP Medical Plan includes a Prior Authorization requirement and a Quantity Limit program for certain drugs. A current list of drugs subject to Prior Authorization and the Quantity Limit program can be found at the EHP website (www.ehp.org), on your employer’s website (www.hopkinsmedicine.org/jhhr), or by calling EHP customer service at 410-424-4450. The list is subject to change. A complete explanation of Prior Authorization and the Quantity Limit program is available at any time by going to the websites listed above, by calling EHP customer service, or from the HR Service Center (Phipps 455; 410-955-6208). If your physician determines that use of a drug that requires prior authorization is warranted, your physician must complete a Prior Authorization Request Form and fax it to EHP at the number shown on the Form. If your physician determines that coverage of a prescription drug in a greater quantity than is allowed under the Quantity Limit program is medically warranted, your physician can submit a request by also using the Prior Authorization Request Form. EHP will notify you and your physician of approval or denial of either request. If additional information regarding a denial is needed, your physician may contact EHP at the number shown on the denial notice. You may appeal the denial in accordance with the appeal rules for pre-service claims set forth below in this Summary Plan Description. What’s Not Covered

COVERED SERVICES AND SUPPLIES

30

No prescription drug benefits will be paid for the following: Any amounts you are required to pay directly to the pharmacy for each prescription or refill Any charge for administration of drugs or insulin Smoking cessation medications, except as described below under Smoking Cessation Drugs that are excluded from coverage for a reason set forth later in this SPD under What’s Not

Covered by the EHP Medical Plan Methadone Schedule V-exempt narcotics Hypodermic needles and syringes (other than for diabetic use and for self-administered injections) Drugs that are non-prescription, non-legend or over-the-counter (except for certain prescribed

OTC drugs as explained below) Drugs or devices not approved by the FDA for marketing and/or for the prescribed treatment of a

specific diagnosis unless approved by the Care Management Program. This exclusion does not apply to a medical device to the extent Medicare would cover the device in accordance with Medicare Policy Manual Chapter 14

Medications to treat cosmetic conditions resulting from normal aging process Medications whose sole use is treatment of hair loss, hair thinning or related conditions Drugs dispensed in excess of the amounts prescribed or refills of any prescription in excess of the

number of refills specified by the prescriber or allowed by law Medications dispensed for any illness or injury covered by any workers compensation or

occupational disability law Immunization agents, biological sera, blood or blood plasma Medications taken by or administered to the member while a patient in a hospital, sanitarium,

extended care facility, nursing home, or similar institution that has on its premises a facility for dispensing pharmaceuticals

Medication delivery implants or devices Herbal, mineral and nutritional supplements

Over-the-Counter Drugs Prescription drug benefits are normally not provided for a drug or medication that is available “over-the-counter” (“OTC”). A drug or medication is considered to be OTC if it can be obtained without a prescription, regardless of whether or not your doctor gives you a prescription for it. However, prescription drug benefits are provided for Prilosec OTC, Claritin OTC and Claritin D OTC, but only if your doctor prescribes these drugs and you show the pharmacist your prescription at time of purchase. No copay applies when you obtain prescribed Prilosec OTC, Claritin OTC and Claritin D OTC. Smoking Cessation

COVERED SERVICES AND SUPPLIES

31

The Johns Hopkins EHP Medical Plan covers both prescription and OTC smoking cessation products at regular pharmacy copays, limited to FDA approved dosages. For coverage of OTC products, a prescription from a physician is required. The smoking cessation benefit also covers a 90 day supply per calendar year of Chantix. An additional 90 day supply of Chantix per calendar year will be covered if prescribed by your physician. When you first enroll and during annual open enrollment, you will have the opportunity to certify that you do not use tobacco products. If you certify that you do not use tobacco, you will receive a discount on your required contributions for coverage under the Medical Plan. If you cannot certify that you do not use tobacco, you can still receive the discount if you agree to take a smoking cessation program and/or obtain a prescription for smoking cessation medications. More information about the discount program is contained in the enrollment materials. For more information about available smoking cessation programs, contact Wellnet, Phipps Building Room 409, 410-955-9538 or by email to wellnet@jhmi.edu. You may also contact EHP Health Coaching at 1-800-957-9760 or healthcoach@jhhc.com. You can also get more information from the HR Service Center (Phipps 455; 410-955-6208). Emergency Services It is not easy to think clearly in a medical emergency. Knowing what to do before you are faced with an emergency can help you get appropriate care at the higher benefit level. Emergency Medical Situation In an emergency medical situation, you should go to the nearest medical facility for immediate care. An emergency medical situation means a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) so that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to: Place the health of the patient (including the unborn child of a pregnant woman) in serious

jeopardy; Result in serious impairment to bodily functions; or Result in serious dysfunction of any bodily organ or part.

Treatment by an emergency room (hospital or freestanding) for an emergency medical situation is covered under the Option 1 Network benefit regardless of whether or not the emergency room participates in the EHP Network. Emergency room facility charges are covered in full, after a $150 copay. The copay is waived if you are admitted. No deductible applies for the treatment in the

COVERED SERVICES AND SUPPLIES

32

emergency room, but the Option 1 or Option 2 deductible does apply if you are admitted to the hospital. If you go to an Out-of-Network emergency room, the EHP Medical Plan will not pay more than the Reasonable and Customary Charge for your treatment. If you are being treated at an Out-of-Network emergency room and your condition stabilizes so that it is no longer an emergency medical situation, and if you can be moved to an EHP Network facility and you choose not to be moved, then services and supplies provided after you can be moved will be paid under Option 2 at 70% of the Reasonable and Customary Charges, after the Option 2 deductible. If you receive treatment in an emergency room for a condition that is not an emergency medical situation, the EHP Medical Plan will not pay benefits. If at all possible, contact your PCP to coordinate your care before proceeding to an emergency room. You or your emergency room doctor can call your PCP directly from the emergency room, if necessary. He or she may be able to tell you the best way to handle your present situation to avoid a long, unnecessary wait in the emergency room. Urgent Care Centers An urgent care center is a facility (other than a hospital emergency room) that is licensed to provide medical services for unexpected illnesses or injuries that require prompt medical attention, but are not life- or limb-threatening. If you need prompt medical attention, you may go to an urgent care center. If you go to an EHP Network urgent care center, your care will be covered at 100% under Option 1, after a $40 copay. If you go to an Out-of-Network urgent care center, your care will be covered at 70% of the Reasonable and Customary Charge, after the Option 2 deductible. You are responsible for any amounts over the Reasonable and Customary Charge. Out-Of-Area Care and Coverage for Students The following Out-of-Area Care rules apply when you are travelling outside the EHP Network service area and need medical care that is not covered by the Emergency Medical Situation or Urgent Care Center provisions described above. The following Out-of Area Care rules apply based on whether care is foreseeable or unforeseeable. Unforeseeable care means medical treatment or prescription drugs received before it is safe to return to the EHP Network service area and that could not have reasonably been anticipated before leaving the area. Foreseeable care means all other medical treatment or prescription drugs. Claims for unforeseeable medical care or prescription drugs received while outside the EHP Network service area will be paid on the same terms as apply to care received from an In-Network provider

COVERED SERVICES AND SUPPLIES

33

under Option 1. However, benefits are calculated based only on the Reasonable and Customary Charge for the care received. In addition to any copay or coinsurance that might apply, you are responsible for all charges above the Reasonable and Customary Charge. Remember that a MultiPlan provider is an In-Network provider and therefore will not charge you above the Reasonable and Customary Charge. Claims for foreseeable out-of-area medical care from a MultiPlan provider will be paid under the Option 1 EHP Network level. Claims for foreseeable out-of-area medical care from a non-MultiPlan provider or for prescription drugs will be covered under Option 2 at the Out-of-Network benefit level. If your covered child goes to school outside the EHP Network service area, care received for medical treatment or prescription drugs is covered under the Out-of-Area Care rules.

You (or someone on your behalf) must notify Johns Hopkins Employer Health Programs at 410-424-4450 or 800-261-2393 of any Out-of-Area Care that results in an inpatient hospitalization within 48

hours after admission. If notice is not given on time, no coverage will be provided. Ambulance Services The EHP Medical Plan covers both air and ground ambulance transportation services when one of the following criteria are met: Because of an accident or emergency medical situation, it is medically necessary to transport

you to the hospital. It is medically necessary to transport you from a hospital as an inpatient to another hospital,

because: The first hospital lacks the equipment or expertise necessary to care for you; You are transported directly from a hospital to a skilled nursing/rehabilitation facility; or As determined medically appropriate by the Care Management Program.

You are medically stable and wish to transfer from a non-Hopkins Affiliated Facility to a Hopkins Affiliated Facility.

Air ambulance is covered only if it is medically necessary to be transported by air and not by ground. Vision Benefits The EHP Medical Plan covers a full range of optometry and ophthalmology vision care services through the Johns Hopkins Routine Vision Care Network. The Plan also covers vision care services from Out-of-Network providers. You can receive Johns Hopkins Routine Vision Care Network services at any of these provider sites: Wilmer Comprehensive Eye Care Services (located at The Wilmer Eye Institute at The Johns Hopkins Hospital), Green Spring Station, Severna Park, and the

COVERED SERVICES AND SUPPLIES

34

Bayview Medical Center. You can also receive Network optometry services at Pearle Vision Centers, Penn Optical, and other locations throughout the Baltimore Metropolitan area. For a complete listing of Network provider sites, refer to the Vision section of the EHP provider search, available on www.ehp.org, or contact EHP Customer Service at 410-424-4450. Vision benefits are paid as follows, depending upon whether you use a Johns Hopkins Routine Vision Care Network provider or an Out-of-Network provider:

Covered Vision Services Johns Hopkins Routine Vision Care Network

Out-of-Network

Routine exam or contact lens fitting fee (once every 12 months)

100%, after $10 copay Up to $35

Materials (once every 12 months): $10 copay, then:

Single Vision Up to $75 Up to $70

Bifocal Up to $92 Up to $80

Trifocal Up to $117 Up to $110

Lenticular Up to $176 Up to $160

Frames Up to $70 Up to $70

Contact Lenses

Medically Necessary

Up to $165 Up to $165

Elective Up to $95 Up to $95

Please Note: Benefits are provided for necessary or elective contact lenses in lieu of lenses and frames. This means that you can get either eyeglasses or contact lenses in a 12-month period, but not both. Network providers offer a group of selected frames at prices that do not exceed the maximum frame benefit set forth in the chart above. You are responsible for charges above the maximum benefit. Charges for the following are not covered under the EHP Medical Plan: Any eye examination or any corrective eye wear required as a condition of employment; Blended lenses; Charges for lost or broken lenses and frames, except at the normal intervals when services are

otherwise covered; Coating the lens or lenses;

COVERED SERVICES AND SUPPLIES

35

Cosmetic lenses and optional cosmetic processes; Laminating the lens or lenses; Material costs which exceed the maximum benefits as shown in the previous chart; Oversize lenses; Photochromic lenses; tinted lenses except Pink #1 and Pink #2; Progressive multifocal lenses; Services or supplies not provided by a licensed physician, optometrist, or ophthalmologist; Special procedure services and supplies such as orthoptics and vision training, or in connection

with medical or surgical treatment of the eye; Two pair of glasses in lieu of bifocals; and Ultraviolet (UV) protected lenses.

Maternity Benefits The EHP Medical Plan provides benefits during your pregnancy and delivery. The Plan covers 100% of your prenatal care and routine tests when you receive care that is provided by an EHP Network OB/GYN under Option 1. Delivery at an EHP Network licensed birthing center is also covered at 100% under Option 1. Midwife delivery services provided by a licensed midwife are also eligible for coverage. For delivery at an EHP Network hospital under Option 1, you pay a $300 copay and the Plan pays 90% of covered charges after you meet the Option 1 inpatient deductible. However, if you deliver at a Hopkins Affiliated hospital, or if you deliver at any other EHP Network hospital and are admitted before July 1, 2013, the copay is only $150 and the Plan pays 100% of covered charges with no deductible. Under Option 2, care received from an Out-of-Network OB/GYN and Out-of-Network hospital or birthing center expenses are covered at 70% of the Reasonable and Customary Charges, after the deductible, and you are responsible for any remaining charges. You must pay a $500 copay for a hospital admission. Midwife delivery services provided by a licensed midwife are also eligible for coverage. The EHP Medical Plan provides maternity benefits for a mother and eligible newborn child for hospital stays up to: 48 hours following a vaginal delivery; or 96 hours, if the delivery is performed by cesarean section.

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If the doctor and new mother agree that the stay does not need to be 48 (or 96) hours, the new mother and baby may leave the hospital as soon as it is medically approved. If the stay is to be longer than 48 hours (or 96 hours), Care Management must preauthorize the additional time. Infertility Treatment Benefits Infertility treatment (in-vitro fertilization (“IVF”) and artificial insemination) is covered under Option 1 at Hopkins Affiliated Facilities only. Treatment is covered for married opposite sex couples, married female same sex couples and eligible female same sex domestic partnership situations only. No infertility treatment benefits are provided for married male same sex couples. The following requirements must be met: In all cases: You (the employee) must have one continuous year of coverage by the EHP Medical Plan; Care Management Program must pre-authorize treatment; Treatment must be provided at a Hopkins Affiliated Facility. This requirement is waived for

IVF services if Hopkins will not provide the IVF services. However, this requirement is not waived if the reason why Hopkins will not provide the IVF services is because (1) the IVF services are not medically necessary, or (2) other infertility treatment (such as artificial insemination) should be tried first. Otherwise, infertility treatment received at a non-Hopkins Affiliated Facility is not covered, even if the provider is In-Network;

The order of infertility treatment options must have followed a logical succession of medically appropriate and cost-effective care;

There is a $30,000 lifetime maximum benefit for all infertility treatment combined including prescription drugs, lab work and X-rays; this maximum applies per employee, not per spouse/partner;

There is a maximum of three in-vitro fertilization attempts (any implantation of oocyte); this maximum applies per birth mother’s lifetime;

All expenses connected with obtaining donor sperm or eggs are not covered, including expenses for acquisition, freezing, storing or thawing of sperm, eggs or embryos; coverage is provided for implantation only; and

Infertility must not be related to a previous sterilization by you or your spouse/partner. For married opposite sex couples: You and your spouse must have a history of continuous infertility as a married couple for at

least two consecutive years immediately before receiving infertility treatment, or have a specific medically documented infertility diagnosis;

The husband’s sperm and the wife’s egg must be used for in-vitro fertilization treatment, unless there is a documented medical condition unrelated to age whereby use of the husband’s sperm and/or the wife’s egg is not possible; and

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The mother must be covered by the Plan. For married female same sex couples: If your spouse will be the birth mother, she must be covered by the Plan for one continuous

year; If you (the employee) will be the birth mother, your spouse does not have to be covered by the

Plan; and The birth mother’s egg must be used, unless there is a documented medical condition unrelated

to age whereby use of the birth mother’s egg is not possible. For female same sex domestic partnerships: If your partner will be the birth mother, she must be covered by the Plan for one continuous

year in accordance with the rules for same sex Domestic Partner coverage as explained earlier in this SPD;

If you (the employee) will be the birth mother, your partner does not have to be covered by the Plan, but she must satisfy the requirements to be eligible for coverage under the JHHSC/JHH Policy Regarding Employee Benefits for Domestic Partners (Same Sex); and

The birth mother’s egg must be used, unless there is a documented medical condition unrelated to age whereby use of the birth mother’s egg is not possible.

Medical and Modified Foods The EHP Medical Plan covers medical foods and low protein modified food products for the treatment of inherited metabolic diseases if the foods or products are prescribed as medically necessary for the therapeutic treatment of inherited metabolic diseases and administered under the direction of a physician. For this purpose: an "inherited metabolic disease" must be caused by an inherited abnormality of body chemistry,

and includes a disease for which the State of Maryland screens newborn babies. a “low protein modified food product" must be specially formulated to have less than 1 gram of

protein per serving and intended to be used under the direction of a physician for the dietary treatment of an inherited metabolic disease, and does not include a natural food that is naturally low in protein.

a "medical food" must be intended for the dietary treatment of a disease or condition for which nutritional requirements are established by medical evaluation and formulated to be consumed or administered enterally under the direction of a physician.

The EHP Medical Plan covers amino acid-based elemental formula, regardless of delivery method, if the patient’s physician states in writing that the formula is medically necessary for the treatment of one of the following diseases or disorders:

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Immunoglobulin E and non-Immunoglobulin E mediated allergies to multiple food proteins; severe food protein induced enterocolitis syndrome; eosinophilic disorders, as evidenced by the results of a biopsy; or impaired absorption of nutrients caused by disorders affecting the absorptive surface, functional

length, and motility of the gastrointestinal tract. Women’s Health and Cancer Rights Act The EHP Medical Plan provides benefits for participants electing breast reconstruction in connection with a mastectomy. These include: Reconstruction of the breast on which the mastectomy has been performed, Surgery and reconstruction of the other breast to provide a symmetrical appearance, and Prostheses and physical complications for all stages of a mastectomy, including lymphedemas

(swelling associated with the removal of lymph nodes). The manner of coverage is determined in consultation with the attending physician and patient. Normal plan copays, coinsurance and lifetime maximums will apply. Alternative Care Sometimes, following a serious illness or major surgery, you may need follow-up care. Generally, this care does not need to be provided in a hospital. Alternative care includes home health care and/or skilled nursing care. In the case of a terminal illness, hospice care is often a viable alternative to a hospital setting. The EHP Medical Plan covers a variety of these alternative care services. Home Health Care Benefits All home health care services must be preauthorized by Care Management. Home health care is often recommended when you are able to handle tasks like feeding and bathing yourself, but still require medical attention. It also offers the comfort of receiving care in familiar surroundings, rather than a hospital room. Home health care services and supplies must be provided by a licensed health care organization to be covered. No benefits are paid for services performed by a close relative or anyone living in your household. Each home health care visit is limited to four hours. Under Option 1, the Plan pays 100% of the charges for covered home health care services received from EHP Network providers.

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Under Option 2, the Plan pays 70% of the R&C charges, after the deductible, for covered services received from Out-of-Network providers and you are responsible for any remaining charges. Covered home health care services include: Part-time or intermittent skilled nursing care by a nurse; Part-time or intermittent home health aide services for a patient who is receiving covered nursing

or therapy services; Physical, respiratory, occupational and speech therapy when provided by a home health care

agency; Medical and surgical supplies when provided by a home health care agency (excluding non-

injectable prescription drugs); Injectable prescription drugs (subject to copay as described under Prescription Drug Benefits); Oxygen and its administration; and Medical and social service consultations.

Covered home health care services do not include the following: Domestic or housekeeping services; Rental or purchase of equipment or supplies; Meals-on-wheels or other similar food arrangements; Care provided in a nursing home or skilled nursing/rehabilitation facility (see Skilled

Nursing/Rehabilitation Facility Benefits discussed below); More than 40 visits per calendar year; Home care for mental health conditions; and Custodial care.

Skilled Nursing/Rehabilitation Facility Benefits Your stay in a skilled nursing/rehabilitation facility must be preauthorized by Care Management. A skilled nursing/rehabilitation facility is a special facility that offers 24-hour nursing care outside of a traditional hospital setting. Your stay in a skilled nursing/rehabilitation facility must be for treatment of the same or related condition for which you were hospitalized. Under Option 1, the Plan pays 100% of the charges for covered skilled nursing/rehabilitation services at an EHP Network facility.

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Under Option 2, the Plan pays 70% of the Reasonable and Customary Charges, after the deductible, for covered skilled nursing/rehabilitation services at an Out-of-Network facility and you are responsible for any remaining charges. Covered skilled nursing/rehabilitation facility services include: Room and board; Use of special treatment rooms; X-ray and laboratory examinations; Physical, occupational or speech therapy; Oxygen and other gas therapy; and Drugs, biological solutions, dressings and casts.

The patient’s physician must prescribe care in a skilled nursing/rehabilitation facility and the patient must be under a physician’s supervision throughout the stay. Benefits will not be provided for more than 120 days per calendar year. However, once in an employee’s lifetime up to an additional 75 days of benefits may be provided during one calendar year, subject to the following: the stay in the skilled nursing/rehabilitation facility must be required in connection with a

surgical procedure that is covered under the EHP Medical Plan; only employees are eligible for additional days, not spouses or dependents; home care must have been attempted but determined to be medically unsatisfactory; the employee must have at least 30 years of service with JHHSC/JHH.

In order to be covered by the EHP Medical Plan, a skilled nursing/rehabilitation facility may not: Be used mainly as a place for rest or a place for the aged; Provide treatment primarily for such mental disorders as drug addiction, alcoholism, chronic

brain syndrome, mental retardation or senile deterioration; or Provide custodial, hospice or educational care of any kind.

Hospice Care Benefits Hospice care must be preauthorized by Care Management. Hospice care is often recommended for terminally ill patients. Hospice care helps keep the patient as comfortable as possible and provides supportive services to the patient and his or her family. Patients who can no longer be helped by a hospital, but require acute medical care, can be moved to a hospice facility, if available. The patient is cared for by a team of professionals and volunteer workers, which generally includes a doctor and a registered nurse, and may include a dietary counselor, home health aide, medical social worker and others.

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The goals of the hospice are to provide an alert and pain-free existence for the patient and to keep the family actively involved in the care. Under Option 1, the Plan pays 100% of the charges for covered hospice care services from EHP Network providers. Under Option 2, the Plan pays 70% of the R&C charges, after the deductible, for covered hospice care services from Out-of-Network providers and you are responsible for any remaining charges. Covered hospice care services include: Inpatient care; Nutritional counseling and special meals; Part-time nursing; Homemaker services; Durable medical equipment; Doctor home visits; and Bereavement and counseling services.

Certain benefits may be paid for outpatient (in-home) hospice care. For details, please call EHP Customer Service. Hospice care services do not include the following: Any curative or life prolonging procedures; Services of a close relative or an individual who normally resides in the patient’s home; and Any period when the individual receiving care is not under a physician’s care.

Transplants All transplants must be preauthorized by Care Management. Procurement of the organ and performance of the transplant must take place at a Johns Hopkins Employer Health Programs designated transplant center in the United States. The EHP Medical Plan will pay benefits for non-experimental and non-investigational transplants of the human heart, kidney, lung, heart/lung, bone marrow, liver, pancreas and cornea. No benefits are paid for transplants that are experimental (as defined later in this SPD under What’s Not Covered by the EHP Medical Plan). Coverage is contingent upon continuing to meet the criteria for Employer Health Programs transplant approval until the date of the transplant. Covered services include:

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Inpatient or outpatient hospital charges for treatment and surgery by a Johns Hopkins Employer Health Programs designated transplant center;

Tissue typing; Removal of the organ; Obtaining, storing, and transporting the organ; and Travel expenses for the recipient, if medically necessary, to and from the transplant center.

No benefits will be paid for the following: Organ transplant charges incurred without preauthorization by the Care Management Program, or

at a transplant center which was not designated by Johns Hopkins Employer Health Programs; The transplant of an organ which is synthetic, artificial, or obtained from other than a human

body; An organ transplant or organ procurement performed outside the United States; An organ transplant which the Plan Administrator determines to be experimental; and Expenses of an organ donor, except when the recipient is a participant in this Plan who receives

the organ in a covered organ transplant. When coordinating with the donor’s health plan, the EHP Medical Plan will be secondary. If an organ is sold (i.e., not donated), no benefits are paid for the donor’s expenses.

Mental Health and Substance Abuse Treatment The Johns Hopkins EHP Medical Plan provides benefits for inpatient and outpatient mental health and substance/alcohol abuse treatment on the same terms that apply to other inpatient or outpatient medical treatment. Mental health and substance/alcohol abuse treatment is subject to the same copay, coinsurance, deductibles, limits and other requirements that apply to medical treatment, based on whether you receive treatment under Option 1 (EHP Network) or Option 2 (Out-of-Network). However, inpatient mental health and substance/alcohol abuse treatment received at an EHP Network facility under Option 1 will be covered on the terms that apply to treatment received at a Hopkins Affiliated Facility, regardless of whether or not the Network facility is Hopkins Affiliated. Like any other medical treatment, mental health and substance/alcohol abuse treatment is only covered if it is medically necessary (see the definition at the beginning of the Covered Services and Supplies section). Like any other medical treatment, the Care Management Program must preauthorize any inpatient admission (including inpatient residential, “partial hospitalization” day treatment programs and intensive outpatient care). Outpatient mental health and substance/alcohol abuse treatment does not have to be preauthorized by the Care Management Program. However, if you have your treatment preauthorized by the Care Management Program, you can be assured that your treatment will be considered medically necessary and therefore covered. The Care Management Program has mental health

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professionals who will help you determine the best course of treatment for you. Your Program manager will refer you to a provider (usually an EHP Network provider). If you wish, you may instead refer yourself to any provider in or out of the EHP Network. The choice is yours. However, if you refer yourself to a provider your treatment will only be covered if it is determined to be medically necessary. You can contact the Care Management Program at 410-424-4476 or 800-261-2429. You may contact the Faculty and Staff Assistance Program at 410-955-1220. EHP Network Providers The Johns Hopkins EHP Network includes a variety of specialists to meet your needs, including psychiatrists, psychologists and licensed certified social workers. All EHP Network providers are experienced, licensed professionals. They share the EHP Network’s philosophy of quality care provided in the least restrictive manner. Mental health and substance/alcohol abuse Network providers offer a full range of counseling services, including individual and group therapy, family counseling and addiction recovery programs. Note: You must receive preauthorization by Care Management before all inpatient admissions (including inpatient residential, partial hospitalization day treatment programs and intensive outpatient care) for mental health and substance/alcohol abuse treatment. The confidential number to call is 410-424-4476 or 800-261-2429. Failure to obtain preauthorization will result in reduced benefits as explained in the Medical Benefits At A Glance chart, or possibly a complete denial of coverage if your treatment is determined not to be medically necessary.

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What’s Not Covered by The EHP Medical Plan The Johns Hopkins EHP Medical Plan does not cover the following: Charges excluded under the Coordination of Benefits provisions set forth later in this SPD;

Charges that would not be made if no coverage by the Plan existed;

Charges for which you are not legally required to pay; Charges in excess of the Reasonable and Customary Charge or above the allowable lifetime or

annual maximums; Claims filed more than 12 months after the expenses were incurred; Contraceptive devices, unless required to be covered in comprehensive guidelines supported by the

Health Resources and Services Administration and approved by the Food and Drug Administration;

Controlled substances, hallucinogens or narcotics not administered on the advice of a doctor;

Convenience items, such as telephone and television rental, slippers, meals for family members, or first aid kits and supplies;

Cosmetic/reconstructive surgery. However, cosmetic/reconstructive surgery is covered if needed: because of an accidental injury or illness that is or would be covered by the Plan; because of a congenital malformation of a child, or following treatment for morbid obesity, as described earlier in this SPD under Covered

Services and Supplies; Coverages refused by another plan as a penalty for non-compliance with that plan’s requirements; Custodial care, residential care or rest cures;

Dental treatment except in connection with an accidental injury to sound natural teeth that is part of the initial emergency treatment within 48 hours after the accident;

Emergency room services in other than emergency medical situations;

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Equipment that does not meet the definition of Durable Medical Equipment provided earlier in this SPD under Covered Services and Supplies, including air conditioners, humidifiers, dehumidifiers, purifiers or physical fitness equipment, whether or not recommended by a doctor;

Experimental treatment, defined as the use of any treatment, procedure, equipment, device, drug or drug usage which the Plan Administrator determines, in its sole and absolute discretion, is being studied for safety, efficiency and effectiveness and/or which has not received or is awaiting endorsement for general use within the medical community by government oversight agencies, or other appropriate medical specialty societies at the time services are rendered.

The Plan Administrator will make a determination on a case by case basis, using the following principles as generally establishing that something is experimental:

If the drug or device cannot be lawfully marketed without approval of the U.S. Food and

Drug Administration and approval for marketing has not been given at the time the drug or device is furnished; this principle does not apply to a medical device to the extent Medicare would cover the device in accordance with Medicare Policy Manual Chapter 14;

If the drug, device, equipment, treatment or procedure, or the patient informed consent document utilized with the drug, device, equipment, treatment or procedure, was reviewed and approved by the treating facility’s Institutional Review Board or other body serving a similar function, or if Federal law requires such review or approval;

If Reliable Evidence shows that the drug, device, equipment, treatment or procedure is the subject of ongoing phase II clinical trials; is the subject of research, experimental study or the investigational arm of ongoing phase III clinical trials; or is otherwise under study to determine its maximum tolerated dose, its toxicity, its safety, its efficacy or its efficacy as compared with a standard means of treatment or diagnosis; a treatment will not be considered experimental merely because it is the subject of a clinical trial, to the extent Medicare would cover the treatment in accordance with a national coverage determination (or other binding pronouncement);

If Reliable Evidence shows that the prevailing opinion among experts regarding the drug, device, equipment, treatment or procedure is that further studies or clinical trials are necessary to determine its maximum tolerated dose, its toxicity, its safety, its efficacy or its efficacy as compared with a standard means of treatment or diagnosis.

“Reliable Evidence” means only published reports and articles in the authoritative medical and scientific literature; the written protocols used by the treating facility or the protocol(s) of another facility studying substantially the same drug, device, equipment, treatment or procedure; or the written informed consent used by the treating facility or by another facility studying substantially the same drug, device, equipment, treatment or procedure;

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Foot devices, unless (1) they are an integral part of a leg brace and the cost is included in the orthotist’s charge; or (2) they are custom-molded and related to a specific medical diagnosis. Orthopedic shoes (not integral to a brace), diabetic shoes, supportive devices for the feet and orthotics used for sport and leisure activities are not covered;

Glasses, contact lenses, eye refractions, or the examinations for their fitting or prescription, except

when medically necessary after cataract surgery or as described under Vision Benefits, earlier in this SPD;

Habilitative services (except for therapy for a person under age 19 with a congenital or genetic

birth defect as described under Covered Services and Supplies earlier in this SPD); Hearing aids, or the examination for their fitting or prescription (except for dependent children as

described under Covered Services and Supplies earlier in this SPD); Hypnosis or biofeedback training, except for treatment of voiding dysfunction as explained under

Covered Services and Supplies earlier in this SPD;

Immunizations related to travel unless approved by the Center for Disease Control guidelines for the countries to be visited;

Injury sustained or an illness contracted while committing a crime; Injury sustained or an illness resulting from war, act of war, act of terrorism, riot, rebellion, civil

disobedience, or from military service in any country;

Injury sustained while riding on a motorcycle, unless the covered person was wearing a helmet that meets applicable safety standards issued by the National Highway Traffic Safety Administration. This exclusion applies even when riding in a state that does not require wearing a helmet;

Marital counseling; Myopia or hyperopia correction by means of corneal microsurgery, such as keratomileusis,

keratophakia, radial keratotomy or laser surgery and all related services; Nicotine addiction treatment or smoking cessation programs, except as described under Smoking

Cessation earlier in this SPD; Obesity treatment, including surgical procedures for weight reduction or for treatment of

conditions resulting from being overweight, except as described under Covered Services and Supplies –“Obesity treatment” earlier in this SPD;

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Private room charges beyond the amount normally charged for a semi-private room, unless a

private room is medically necessary; Replacement of braces or prosthetic devices, unless there is sufficient change in the patient’s

physical condition to make the original brace or device no longer functional; Reversals of sterilization procedures, such as vasectomies and tubal ligations; Routine foot care (including any service or supply related to corns, calluses, flat feet, fallen arches,

non-surgical care of toenails, and other symptomatic complaints of the feet); Self-inflicted injury or illness and expenses resulting therefrom, unless the self-infliction was the

result of a mental illness such that application of this exclusion would violate ERISA Section 702;

Services or supplies received before your (or your dependent’s) effective date of coverage under the Plan or after the termination date of coverage;

Services and supplies paid in full or in part under any other plan of benefits provided by

JHHSC/JHH, a school, or a government, or for services you are not required to pay for; Services and supplies not recommended or approved by a doctor; Services and supplies required as a condition of employment; Services and supplies not specifically listed as covered in this SPD; Services performed by a doctor or other professional provider enrolled in an education, research, or

training program when such services are primarily provided for the purposes of education, research, or training program;

Sexual dysfunction treatment not related to organic disease; Support garments; Surgical treatment for overhanging, stretching or laxity of skin, except in connection with obesity

treatment as described under Covered Services and Supplies earlier in this SPD;

Surrogate motherhood treatment, including any charges related to giving birth or for treatment of the newborn child resulting from the surrogate motherhood;

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Telephone consultation charges, missed appointment charges or charges for the completion of claim forms;

Transsexualism, gender dysphoria, or sexual reassignment or change, including medication, implants, hormone therapy, surgery, medical or psychiatric treatment;

Treatment which is not medically necessary, as described under Covered Services and Supplies earlier in this SPD;

Treatment which is not performed by an appropriate licensed professional provider acting within the scope of the provider’s license;

Treatment for: an injury arising out of, or in the course of, any employment for wage or profit; or a disease covered with respect to your employment, by any Workers’ Compensation law,

occupational disease law, or similar legislation; Treatment covered by no-fault auto insurance, or any other federal or state-mandated law;

Treatment for which a third party may be liable, unless otherwise payable as described under When the EHP Medical Plan And Short Term Disability Plan May Recover Payment (Reimbursement and Subrogation), later in this SPD;

Treatment by a provider who is a close relative of the patient (spouse, child, grandchild, brother,

sister, brother in law, sister in law, parent or grandparent) or who resides in the patient’s home; Vision training or eye exercises to increase or enhance visual activity or coordination; and Wigs and artificial hair pieces (except in cases of baldness resulting from chemotherapy, radiation

therapy or surgery, in which case benefits are limited to one wig once every 24 months, not to exceed $400, as preauthorized by Care Management).

Please note: The above list cannot address all possible medical situations. If you are not sure if a service or supply is covered after reviewing this list, please call Johns Hopkins EHP Customer Service at (410) 424-4450 or (800) 261-2393.

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Johns Hopkins EHP Dental Plans The Johns Hopkins EHP Dental Plans benefits described in this section are administered by Johns Hopkins Employer Health Programs through United Concordia. There are two Johns Hopkins EHP Dental Plans for you to choose from: the Comprehensive Plan and the High Option Plan. You choose the Plan that you want each year during open enrollment. Both offer a broad range of dental care services for you and your family. The Dental Plans differ in the services they provide and how much you pay out of your pocket. Both Plans offer you basic and preventive care services, such as cleanings, X-rays, annual check-ups, and fillings. You can save money under either Plan when you use dentists who are in the Johns Hopkins EHP Dental Network. If you have any questions about your benefits under the EHP Dental Plans, call United Concordia EHP Dental Customer Service at 1-800-516-0646. Out-of-pocket Expenses When you receive services from EHP Network dentists, there is no annual deductible to meet under either Plan. However, you will have to pay an annual (calendar year) deductible under both Plans before benefits will be paid for services received from Out-of-Network dentists. The annual deductible amounts under both Plans are $50 per person and $150 per family. Expenses incurred by two or more individuals can meet the family deductible. However, no one individual will be required to satisfy more than the individual deductible. Maximum Benefits Under the Comprehensive Plan, there is a $1,500 combined annual (calendar year) benefit maximum per person for all preventive, basic and major dental services. Under the High Option Plan, the combined annual (calendar year) benefit maximum is $3,000 per person. In addition, there is a separate lifetime maximum benefit of $1,500 per person for orthodontic services (available under the High Option Plan only).

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Dental Benefits At-A-Glance The following chart provides a summary side-by-side comparison of the EHP Dental Plans. This chart is not a complete description of benefits. Refer to the description of the covered services which follows the chart for more detail.

Covered Services Comprehensive Plan High Option Plan

In-network

Out-of-network In-network

Out-of-network

Calendar year deductible None $50 per person

$150 per family

None $50 per person

$150 per family

Calendar year benefit maximum $1,500 combined per person per year

$3,000 combined per person per year

Preventive services

Exams (two per calendar year) 100% 80% of R&C, after deductible

100% 80% of R&C, after deductible

X-rays (once every 36 months) 100% 80% of R&C, after deductible

100% 80% of R&C, after deductible

Bitewing X-rays (once per calendar year)

100% 80% of R&C, after deductible

100% 80% of R&C, after deductible

Sealants for children under age 15 100% 80% of R&C, after deductible

100% 80% of R&C, after deductible

Topical fluoride treatment for children under age 18

100% 80% of R&C, after deductible

100% 80% of R&C, after deductible

NOTE: “R&C” (“Reasonable and Customary”) is the usual fee charged by similar providers for the same services or supplies in the same geographic area. Johns Hopkins Employer Health Programs determines what is a Reasonable and Customary Charge. An Out-of-Network provider can charge more than the Reasonable and Customary Charge and you will be responsible for the difference.

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Covered Services Comprehensive Plan High Option Plan

In-network

Out-of-network In-network Out-of-network

Basic services

Fillings 80% 60% of R&C, after deductible

80% 60% of R&C, after deductible

Endodontics 80% 60% of R&C, after deductible

80% 60% of R&C, after deductible

Oral surgery 80% 60% of R&C, after deductible

80% 60% of R&C, after deductible

Treatment of gum disease (Periodontics)

80% 60% of R&C, after deductible

80% 60% of R&C, after deductible

General anesthesia 80% 60% of R&C, after deductible

80% 60% of R&C, after deductible

Major services*

Crowns, Inlays and Onlays

50% 30% of R&C, after deductible

60% 40% of R&C, after deductible

Bridges 50% 30% of R&C, after deductible

60% 40% of R&C, after deductible

Dentures (full or partial) 50% 30% of R&C, after deductible

60% 40% of R&C, after deductible

Orthodontia Not covered

Not covered 50%, up to lifetime max

of $1,500

Not covered

NOTE: “R&C” (“Reasonable and Customary”) is the usual fee charged by similar providers for the same services or supplies in the same geographic area. Johns Hopkins Employer Health Programs determines what is a Reasonable and Customary Charge. An Out-of-Network provider can charge more than the Reasonable and Customary Charge and you will be responsible for the difference. *Pre-treatment review is recommended for all major services.

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What the EHP Dental Plans Cover Both the Comprehensive Plan and High Option Plan cover the following services at the levels shown on the Dental Benefits At-A-Glance chart: Preventive and Diagnostic Services Fluoride treatments for children under age 18, up to two applications per calendar year; Palliative emergency treatment; Routine oral exams and cleanings, not more than twice per calendar year; Sealant on permanent teeth for children under age 15, once per tooth every 36 months; and X-rays: A full mouth series, once every 36 months; and One set of bite-wing X-rays every calendar year.

Basic Services Endodontic treatment, including root canal therapy; Extractions; Fillings; General anesthetics given in connection with oral surgery when medically necessary; Injection of antibiotic drugs; Oral pathology biopsy; Oral surgery; Periodontal treatment and treatment of other diseases of the gums and tissues of the mouth, once

every 24 months; and Pulpotomy. Major Services Inlays, onlays, gold fillings, crowns and installation of fixed bridges for the first time. Gold fillings

are covered only if no other restoration method is possible; Installation of partial or full dentures for the first time, including adjustments for six months

following installation (dentures are not covered until you have been covered under an EHP Dental Plan for 12 consecutive months);

Repair or recementing of crowns, inlays, or bridges; Repair or relining of dentures (not more than once every 24 months); and Replacement of an existing partial or full denture, crown, or fixed bridge by a new denture, crown,

or fixed bridge, or the addition of teeth to an existing denture or bridge to replace extracted natural teeth (subject to the Prosthesis Replacement Rule, described below).

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Orthodontia Orthodontia benefits are provided for adults and children under the High Option Plan only. Only services provided by an EHP dental network orthodontist are covered. The Plan pays 25% of the orthodontist’s covered cost when treatment begins or is first covered by the Plan. The balance of the covered cost is paid out over the treatment period, up to a maximum period of 24 months. Services are covered at 50% with no deductible, up to a lifetime maximum of $1,500 per person. Please note that benefits will not be paid to repair or replace an orthodontic appliance. Also, if treatment stops before it is completed, only those services and supplies that are received before treatment stops will be covered. Prosthesis Replacement Rule To receive benefits for certain replacements or additions to existing dentures, crowns or bridgework, you must provide satisfactory proof that: The replacement or addition of teeth is required to replace one or more teeth extracted after the

existing crown, denture or bridgework was installed; or The present denture, crown or bridgework cannot be made serviceable, and it is at least five years

old; or The present denture is an immediate temporary one that cannot be made permanent. Replacement

by a permanent denture must be necessary and must take place within six months from the date the immediate temporary one was first installed.

In all cases, the patient must have been covered under an EHP Dental Plan for 12 consecutive months before prosthesis replacement services are covered. Pre-Treatment Review Pre-treatment review is designed to give you and your dentist a better understanding of the benefits payable under the EHP Dental Plans before services are provided. A pre-treatment review is recommended if dental services are expected to cost $500 or more, or for certain treatments including bone surgery, bridges, crowns, inlays (post and core) and onlays, periodontic procedures and veneers. For any of these treatments, we recommend that your dentist provide a proposed course of treatment and a pre-treatment estimate. Most dentists are familiar with pre-treatment review. Here’s how it works:

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1. Before beginning a course of treatment that is expected to cost $500 or more, ask your dentist to submit to Johns Hopkins Employer Health Programs a pre-treatment review form describing the treatment plan and indicating the itemized services and charges.

2. Based upon the treatment plan, Johns Hopkins Employer Health Programs will determine what

expenses are covered by the Plan and notify you and your dentist. 3. Ask your dentist to submit a revised treatment plan to Johns Hopkins Employer Health Programs if

there is a major change in your course of treatment. Please note: Emergency treatments and oral exams (including cleanings and X-rays) are considered part of a treatment plan. However, these services may be performed before the pre-treatment review is made. Use Network Dentists and Save Your Johns Hopkins EHP Dental Plans offer you the choice to receive dental services from Network or Out-of-Network dentists. However, you can save money on your dental bills by using Network dentists. That’s because the dentists who participate in the EHP Dental Network have agreed to charge reduced fees for their services, and both Plans pay a higher level of benefits for services received from Network dentists. The EHP Dental Network uses the United Concordia Advantage Plus dental network which includes over 3,500 participating dentists. To find a participating dentist go to www.unitedconcordia.com and look under the Advantage Plus network. Alternate Treatment There is often more than one solution to a dental problem. In dentistry, new technology and procedures give dentists many treatment choices – and the costs for each can vary greatly. When an alternate treatment can be performed without compromising the quality of care, the EHP Dental Plans will pay benefits only for the lower cost treatment. The purpose of this rule is to assure that your dentist is using cost-efficient alternatives. For example, let’s suppose your tooth can be restored with an amalgam filling, and you and your dentist select another type of restoration (gold, for example). The EHP Dental Plans will limit payment to the covered charge for the amalgam or other similar material. You and your dentist may decide to use gold fillings, but the Plans will only cover the cost of amalgam and you will be responsible for the difference. For this reason, it is important to obtain a pre-treatment estimate before you receive dental work. This way, you’ll know up front what the Plans will pay and what will not be covered. What The EHP Dental Plans Do Not Cover

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The EHP Dental Plans do not cover the following: Bleaching techniques; Crowns of porcelain or acrylic veneer or pontics on or replacing upper and lower first, second and

third molars; Devices or appliances that are lost, missing or stolen; Extra sets of dentures or other appliances; General anesthesia unless medically necessary and given in connection with oral surgery;

Implants (crowns for implants are covered);

Mouthguards, except for bruxism (clenching);

Procedures started before you became covered under the Plans (not applicable to orthodontia benefits);

Services or supplies for which coverage would be excluded for one of the reasons set forth under

What’s Not Covered Under the EHP Medical Plan; Services or supplies which are not dental services or supplies; Services or supplies provided by a JHHSC/JHH medical department, clinic or similar facility;

Services or supplies ordered while you are covered under the Plans, but not delivered or installed within 30 days after your coverage ends;

Services or supplies that do not meet the standards of dental practice; Services or supplies that are cosmetic in nature, including personalization of dentures, unless required

as a result of an accident or illness that occurred while covered by the Plans; Services or supplies to correct vertical dimension, periodontal splinting or implantology;

Temporomandibular joint dysfunction (TMJ) syndrome, disorders of the disc, muscles, and/or inflammation of the joints, Costen-Syndrome or similar disorder (these may be covered under your medical plan);

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Training or supplies used for dietary counseling, oral hygiene or plaque control; and Treatment by someone other than a dentist. However, the Plans do cover certain services when

provided by a dental hygienist acting within the scope of his or her license. Election of No Dental Benefits The EHP Dental Plans are optional benefits and are not included as part of EHP Medical Plan coverage. No coverage by the Dental Plans is provided unless you elect coverage in accordance with your Guide to Benefits booklet.

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Flexible Spending Accounts Your JHHSC/JHH Employee Benefits Plan for Non-Represented Employees offers you two tax-saving Flexible Spending Accounts (FSAs):

The Health Care Flexible Spending Account; and The Dependent Care Flexible Spending Account.

You can contribute part of your paycheck each pay period to one or both of these Accounts. Contributions are deducted from your paycheck on a pre-tax basis. Reimbursements of eligible expenses are non-taxable. You can contribute to an FSA regardless of whether you elect coverage under the EHP Medical Plan or you waive coverage. Health Care FSA When you contribute to the Health Care FSA, you can be reimbursed for eligible health care expenses with pre-tax dollars. Eligible expenses are those that meet IRS guidelines explained below and are not otherwise covered by any other health care plan. Dependent Care FSA When you contribute to the Dependent Care FSA, you can be reimbursed for eligible dependent day care expenses with pre-tax dollars. Eligible expenses are day care charges for qualifying dependent(s) as defined below during the time that you are at work. When You Can Contribute to an FSA You must sign up each year during open enrollment if you wish to contribute to an FSA. Your contributions will begin on January 1, or after your election to begin contributing following an eligible family status change (described earlier in this SPD under Changing Your Coverage). If you are a new employee, you can begin contributing on the first of the month following your date of hire, provided you have completed the online enrollment process within 30 days after your date of hire. How Much You Can Contribute to an FSA

Health Care FSA: you can contribute up to $2,500 per calendar year (minimum of $5.00 per bi-weekly pay, maximum of $96.15 per bi-weekly pay).

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Dependent Care FSA: you can contribute up to $5,000 per calendar year ($2,500 if you are married and file a separate tax return) (minimum of $10 per bi-weekly pay, maximum of $192.30 per bi-weekly pay).

It is better to contribute a little less than you think you will need, rather than more. As explained later in this section, if you do not use it, you will lose it. Each FSA is separate. Money contributed to a Health Care FSA can only be used to reimburse you for eligible health care expenses. Likewise, money contributed to a Dependent Care FSA can only be used to reimburse you for eligible dependent day care expenses. You may not move money from one FSA to the other. How to Use the FSAs To best take advantage of the tax savings offered by the FSAs, follow these steps. Step One -- Estimate Your Expenses Estimate the amount you spend on health care expenses that are not covered by your or your spouse’s health care plan, and/or the amount you spend on dependent day care expenses each year. To do this, you should review your expenses from previous years and think about predictable expenses in the upcoming year. Eligible expenses are described later in this Section. Please note: If you are a new hire or otherwise start contributing mid-year, estimate your expenses only from the date you start contributing to the end of the calendar year. Step Two -- Calculate Your Payroll Deductions Next, determine the amount that you will contribute to your FSA(s) each bi-weekly pay period. To do so, divide your annual expected eligible health care expenses and/or dependent care expenses by 26 pay periods. (The Health Care and Dependent Care FSA Worksheets set forth below can help you figure your expected eligible expenses.) This gives the amount you should elect to contribute to your FSA(s) each bi-weekly pay period (subject to the minimum and maximum contribution amounts set forth above). For example, suppose you expect to have $1,200 in uncovered health care expenses next calendar year. To be reimbursed for these expenses from your Health Care FSA, you could contribute $46.15 of your paycheck each pay period. Your taxable income would be reduced by $1,200 for the year and you would pay taxes on the reduced amount.

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Once you elect how much to contribute for a calendar year, you cannot change that election until the next year, unless you have a qualified family status change (see Changing Your Coverage, earlier in this SPD). Any change in the amount you contribute must be consistent with your family status change. If you enroll for part of the calendar year, because you are a new hire or had a qualified family status change, your annual contribution would be divided by the number of remaining pay periods in that year. That amount would then be deducted from your paycheck each pay period and contributed to your FSA for the remainder of that calendar year. For example, if you contribute to an FSA for 13 pay periods during a year and chose to contribute $260 for the year, you would contribute $20 per pay. Step Three -- Submit a Claim for Reimbursement When you have an eligible expense, you will need to submit a claim form to receive reimbursement from your FSA. Specific information about submitting claim forms to each of the FSAs is described later in this section. Use It or Lose It Be sure to estimate your health and dependent care expenses carefully. According to federal law, you lose any money left in your FSAs at the end of the calendar year. However, you do have until March 31 of the next calendar year to submit any expenses incurred during the previous year. After that time, any remaining money is lost. Eligible Health Care Expenses Some examples of eligible health care expenses that can be reimbursed from your Health Care FSA are set forth below. Under the Internal Revenue Code, these expenses must be incurred by you, your opposite sex spouse, or your child under age 26. Expenses incurred by a same sex spouse or domestic partner or the spouse/partner’s child cannot be reimbursed, unless the spouse/domestic partner or the spouse/partner’s child qualifies as your dependent for federal health plan tax purposes. Eligible health care expenses must be incurred during the calendar year for which you contribute, and while you are an employee. Expenses incurred after you terminate employment are not eligible expenses and cannot be reimbursed, unless you continue Health Care FSA coverage under COBRA.

Out-of-pocket medical, vision and dental care expenses, such as deductibles, copays, coinsurance amounts and amounts over annual maximums;

Out-of-pocket preventive care expenses;

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Non-prescription drugs that are used to treat an injury or illness (such as antacids, allergy medications, pain relievers, insulin and cold medicines), but only if the patient has a written prescription from his or her doctor for the drugs (no prescription required for insulin);

Laser eye surgery; Vision care, including out-of-pocket expenses for eyeglasses, contact lenses and contact lens

solution; Retin-A for acne treatment; Nicotine patches for smoking cessation; and Out-of-pocket hearing care expenses.

Some examples of expenses that may not be reimbursed from the Health Care FSA include:

Cosmetic surgery (unless to correct a deformity resulting from a congenital abnormality, an accidental injury, or a disfiguring disease);

Health club dues; Non-prescription drugs that are merely beneficial to your health (such as vitamins or dietary

supplements); Non-prescription drugs that are used to treat an injury or illness, if the patient does not have a

written prescription from his or her doctor (no prescription required for insulin); Cosmetics and toiletries; Weight loss programs (unless directed to participate by your physician to treat a specific disease); Non-prescription sunglasses; and Other health care insurance premiums.

For a complete list of eligible expenses, please see IRS Publication 502, available from the HR Service Center or go to www.irs.gov. Items shown in the list of “What Medical Expenses Are Deductible” in Publication 502 (other than health insurance or HMO premiums) are generally eligible for reimbursement from the Health Care FSA. Non-prescription drugs (which are not deductible) can also be reimbursed if they qualify as explained above. Health Care FSA Worksheets You may use the following worksheets to help you estimate your eligible health care expenses and calculate how much to contribute to your Health Care FSA. Take a look at your health care expenses that are not covered by any plan during the year, and try to predict your expenses for the following year. You should review your medical, dental and vision benefits carefully before trying to predict your expenses.

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Health Care FSA Worksheet # 1

Use this worksheet to help estimate your eligible health care expenses: Eligible Expenses Your estimated out-of-pocket costs Medical, dental and vision deductibles $____________________ Medical, dental and vision copays $____________________ Medical, dental and vision expenses over the amount covered by your benefit plans $____________________ Hearing expenses not covered by your medical plan $____________________ Special education or communication equipment for covered blind or deaf persons $____________________ Other non-covered health care expenses $____________________ Annual Total $____________________ Divided by the number of pay periods $____________________ (26 for a full calendar year) Remember, the maximum amount you may contribute to a Health Care FSA is $2,500, or $96.15 per bi-weekly pay period (minimum of $5.00 per bi-weekly pay period).

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Health Care FSA Worksheet # 2 If you itemize uninsured health care expenses and deduct them on your income tax return, you may not be reimbursed for the same expenses from your Health Care FSA. You may use this worksheet to help you decide which method will work best for you: deducting health care expenses on your tax return or using the Health Care FSA. 1. Calculate your adjusted gross income $_____________ 2. Multiply this amount by 7.5% X 7.5%_____________ 3. The minimum amount of health care expenses you must have to be

eligible to deduct health care expenses on your tax return $_____________ If your total uninsured health care expenses are less than the amount on Line 3, you cannot deduct any expenses on your tax return. However, you can be reimbursed for these expenses from your Health Care FSA on a pre-tax basis and thus save on your taxes. If your total uninsured expenses are more than the amount on Line 3, you have the choice of deducting the excess expenses on your tax return, or being reimbursed for all your expenses (up to the amount you contribute) from the Health Care FSA. Keep in mind, you may only deduct those expenses that are more than 7.5% of your adjusted gross income. Because of that, generally it is more advantageous to use the Health Care FSA.

Filing a Claim for Reimbursement From the Health Care FSA To receive reimbursement from your Health Care FSA, you must submit a claim form, available from the HR Service Center or www.ehp.org. Please provide your medical plan’s description of what was paid (if the expenses were covered under your or your spouse’s health care plan), as well as bills, receipts, and any other documentation of your expenses. If you submit a claim for more than the balance in your FSA, you will be reimbursed up to the full amount you elect to contribute over the entire year minus any reimbursements you have already received for the year. Your future contributions will cover the amount of your claim. You will receive an Explanation of Payment with your reimbursement check. Reimbursement checks are processed bi-weekly.

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You may fax your claim to 1-888-342-5333 or mail it to:

Ceridian FSA Services P.O. Box 9101 Clearwater, FL 33758-9101

Using the Dependent Care FSA You may be reimbursed from the Dependent Care Flexible Spending Account for day care expenses incurred for a qualifying dependent who requires care either inside or outside of your home. Reimbursements are tax free. Under the Internal Revenue Code, to qualify a dependent must be:

Your child under age 13 for whom you can claim an income tax exemption; Your child (age 13 and older) or your parent, who qualifies as your dependent for federal health

plan tax purposes, who is physically or mentally unable to care for him or herself, and who lives in your home for at least half of the calendar year;

Your opposite sex spouse who is physically or mentally unable to care for him or herself and who lives in your home for at least half of the calendar year; or

Your same sex spouse or domestic partner, or a child of your same sex spouse or domestic partner of any age, who qualifies as your dependent for federal health plan tax purposes, who is physically or mentally unable to care for him or herself, and who lives in your home for at least half of the calendar year.

Eligible Dependent Care Expenses Following are examples of eligible dependent care expenses that may be reimbursed from the Dependent Care FSA:

Day care centers for children or the elderly; Day camp; Nursery school (not kindergarten); Day care in a nursing home; and In-home day care.

You may not use the Dependent Care FSA for dependent health care expenses.

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Eligible Day Care Providers You may be reimbursed for dependent care expenses only if the person or organization providing the care is not your own child under age 19 or a dependent you are claiming on your income tax return. If the day care provider is an individual, you must show that person’s Social Security Number when you submit your claim for reimbursement. If the day care provider is an organization, you must provide their tax identification number to receive reimbursement. When You May Use the Dependent Care FSA You are eligible for reimbursements from a Dependent Care FSA if you are a single parent, or if you are married and your spouse:

Works; Is looking for work; Goes to school full-time; or Is mentally or physically incapable of caring for themselves.

When Both Spouses Participate in Dependent Care FSAs You and your spouse may both contribute to the Dependent Care FSA if you both work for JHHSC/JHH. In addition, if you contribute to the FSA and your spouse’s employer also offers a dependent care FSA, you and your spouse may both contribute to these separate FSAs. If you do, the amount that you may contribute depends upon the amount your spouse contributes. The combined maximum amount that you and your spouse can contribute to dependent care FSAs in a calendar year is $5,000. You may divide the contributions however you like between your FSA and your spouse’s FSA. For example, you may both wish to contribute $2,500, or you may wish to contribute $1,000 and your spouse $4,000. It is up to you. The Dependent Care Tax Credit You may be eligible for a dependent care tax credit on your income taxes. You can claim a tax credit on eligible expenses up to $3,000 per calendar year for one dependent, or $6,000 per year for two or more dependents. But you can't use your Dependent Care FSA and the tax credit for the same expenses. If you use a combination of tax credits and FSA, the tax credit will be reduced, dollar for dollar, by the amount you are reimbursed from your Dependent Care FSA. Generally, if your family’s annual income is approximately $25,000 or more, the FSA will save you more in taxes. On the other hand, if your total household income is less than approximately $25,000, it

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is probably better to take the tax credit. Use the following worksheet to help determine which method will work best in your situation. Dependent Care FSA Worksheet Use this worksheet to help estimate your eligible dependent care expenses for the next calendar year: Step 1. Estimate your total eligible expenses: $_______________ times ________________ = $________________________ (cost per week) (weeks of care) (annual dependent care expenses) Step 2. Calculate the FSA tax savings and the Federal Tax Credit: FSA tax savings 1. Enter your expenses up to $5,000 if you are single or married and filing jointly, or $2,500 if married and filing separately: $_______________ 2. Enter your marginal tax rate from Chart 1 (on the next page):_________% 3. Item 1 X Item 2 = $__________ (Your Dependent Care FSA Tax Savings) Federal tax credit 1. Enter your expenses up to $2,400 if care is for one dependent, $4,800 if for two dependents: $_________________ 2. Enter your tax credit percentage from Chart 2 (on the next page):__________% 3. Item 1 X Item 2 = $___________ (Your Federal Tax Credit Tax Savings) Step 3. Compare the tax savings using an FSA vs. the Tax Credit. Which is larger?

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Chart 1: Marginal Federal Tax Rate

This chart approximates the rate at which a reduction in your taxable income affects your income and Social Security taxes, based on 2013 tax tables. Find the range and filing status that fits your family’s total income. Then, look in the right-hand column for the marginal tax rate that applies to your income.

Single:

Taxable Income Marginal Tax Rate*** $0 – 8,925 10% $8,926 – 36,250 15% $36,251 – 87,850 25% $87,851 – 183,250 28% $183,251 – 398,350 33% $398,351 – 400,000 35% $400,001 and up 39.6%

Married Filing Jointly:

Taxable Income Marginal Tax Rate*** $0 – 17,850 10% $17,851 – 72,500 15% $72,501 – 146,400 25% $146,401 – 223,050 28% $223,051 – 398,350 33% $398,351 – 450,000 35% $450,001 and up 39.6%

Head of Household:

Taxable Income Marginal Tax Rate*** $0 – 12,750 10% $12,751 – 48,600 15% $48,601 – 125,450 25% $125,451 – 203,150 28% $203,151 – 398,350 33% $398,351 – 425,000 35% $425,001 and up 39.6%

***Add 7.65% to the percentages above for Social Security taxes for earnings up to $113,700 in 2013, and add 1.45% for all earnings above that amount. Chart 2 Federal Tax Credit Percentage

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Taxable Income Tax Credit Up to $15,000 35% $ 15,001 - 17,000 34% $ 17,001 - 19,000 33% $ 19,001 - 21,000 32% $ 21,001 - 23,000 31% $ 23,001 - 25,000 30% $ 25,001 - 27,000 29% $ 27,001 - 29,000 28% $ 29,001 - 31,000 27% $ 31,001 - 33,000 26% $ 33,001 - 35,000 25% $ 35,001 - 37,000 24% $ 37,001 - 39,000 23% $ 39,001 - 41,000 22% $ 41,001 - 43,000 21% $ 43,001 and up 20%

Filing a Claim for the Dependent Care FSA

To receive reimbursement from your Dependent Care FSA, you must submit a claim form, available from the HR Service Center. You must include the following information with your claim:

The name of the person receiving the care; The type of service provided (such as day care) and the date the service was provided; The amount paid for the service; and The name and Social Security number or tax identification number of the person or organization

providing the care.

If you submit a claim for more than the balance in your FSA, you will be reimbursed only up to your balance at that time. You will be reimbursed for the remaining amount once you contribute additional money to your FSA. You will receive an Explanation of Payment with your reimbursement check. Reimbursement checks are processed bi-weekly. You may fax your claim to 1-888-342-5333 or mail it to:

Ceridian FSA Services P.O. Box 9101 Clearwater, FL 33758-9101

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Short Term Disability Benefits Your Short Term Disability benefits are designed to provide you with a continuing source of income during short periods of illness or injury. Coverage is provided by JHHSC/JHH at no cost to you; you do not pay anything for this coverage. You are eligible for benefits if you are regularly scheduled to work 20 or more hours per week, effective the first day of the month following your date of hire and completion of any employment probationary period that may apply to you. However, your coverage will not begin unless and until you complete the online enrollment process. Weekend option nurses are not eligible for Short Term Disability benefits. If you are injured in an accident for which you might recover from a third party or from your own insurance (such as personal injury protection), please refer to the reimbursement and subrogation provisions explained below at When the EHP Medical Plan and Short Term Disability Plan May Recover Payment. Payment of Benefits Short Term Disability pays benefits when you cannot perform your regular job duties due to an illness or injury. You will receive benefits equal to 60% of your regular bi-weekly base pay (including regular shift differential and excluding overtime and commissions). This benefit amount is payable to you for up to 11 weeks of disability. Benefits begin after you have been unable to work for 14 consecutive calendar days. You must be under a doctor’s care to be considered disabled. Your Short Term Disability benefits will be supplemented by any time you may have available in your Sick Bank or PTO Bank up to 100% of your regular bi-weekly base pay. Please note that you must submit your claim for Short Term Disability benefits within 90 days from the date of the illness or injury that caused your disability to occur.

Short Term Disability benefits are not provided for an illness or injury that is work-related. These kinds of claims should be submitted to Workers’ Compensation.

Short Term Disability benefits are not provided for an illness or injury that occurs or begins while you are on a leave of absence.

Short Term Disability benefits are administered through Johns Hopkins HealthCare. If you need to speak with the Short Term Disability Coordinator about the amount or duration of your benefits you can call 410-762-5312.

Benefits From Other Sources

You may be eligible to receive benefits from other disability plans, such as other group insurance plans or government disability programs. If that happens, your JHHSC/JHH Short Term Disability benefits will be reduced by any amounts payable under these other plans.

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Return to Work When your Short Term Disability benefits begin, you will usually be approved for a specified number of weeks of benefits based on your doctor’s certification of how long you are expected to be unable to work. If you return to work before the approved number of weeks is up, please notify the Short Term Disability coordinator at 410-762-5312. Recurring Disabilities If you recover and return to work but then suffer a relapse, you may be eligible for additional disability benefits. The amount of your disability benefits depends on the nature of the disability and how long you have been back to work. If you have been back to work for less than two weeks and become disabled again from the same or a related cause, the second period of disability will be considered a continuation of the first one. If you have been back to work for less than two weeks and become disabled from a different and unrelated cause, a new disability benefit period would begin after you have been unable to work for 14 consecutive calendar days. Any disability that occurs after you have been back to work for two weeks or more, whether it is a relapse or a new condition, will be considered a new disability period. Benefits would begin after you have been unable to work for 14 consecutive calendar days.

Partial Disability

If you are able to continue or return to work at JHHSC/JHH on a part time basis after an illness or injury, you may qualify for Partial Short Term Disability benefits. You will be considered partially disabled and entitled to partial Short Term Disability benefits if the number of hours you are regularly scheduled to work is reduced by at least 20% due to a disabling condition. If you are partially disabled, your Short Term Disability benefits will be reduced by 50% of your JHHSC/JHH reduced schedule pay. The combination of your Short Term Disability benefits and reduced schedule pay may not exceed 100% of your regular bi-weekly base pay.

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The following example explains how partial disability benefits are calculated:

1. Regular bi-weekly base pay $2,000 2. Multiplied by the regular percentage for STD benefit x 60% 3. Regular weekly STD benefit (one half of Line 1 x Line 2) $600 per Week 4. Pay received for reduced schedule employment $500 per Week 5. Multiplied by Partial Disability Offset percentage x 50% 6. Partial Disability Offset $250 per Week 7. Regular weekly STD Benefit minus Partial Disability Offset (Line

3 - Line 6) $350 per Week

8. Plus pay received for reduced schedule employment $500 per Week 9. Total pay and STD Benefits (Line 7 + Line 8) $850 per Week

Days of partial disability count the same as days of total disability for determining your entitlement to disability benefits. Thus, partial disability days count as full days to determine if you have been unable to work for the required 14 days before benefits begin. Similarly, days for which partial disability benefits are paid count as full days towards the maximum 11 weeks of benefits. What’s Not Covered By Short Term Disability Benefits Short Term Disability benefits are not paid for any of the following:

Any disability arising from an injury or illness for which coverage is excluded as described under What’s Not Covered by the EHP Medical Plan earlier in this SPD, regardless of whether you have coverage under the Medical Plan;

Any disability for which you are eligible to receive benefits under Workers’ Compensation, or

which results from an injury or illness you incur in the course of any employment. This exclusion does not apply if a claim for Workers' Compensation benefits is made and is denied on the grounds that the injury or illness that caused the disability was not work related;

Any disability for which you are eligible to receive payment under motorcycle insurance or any

disability resulting from an injury while riding a motorcycle without a helmet that meets applicable safety standards issued by the National Highway Traffic Safety Administration This exclusion applies even when riding in a state that does not require wearing a helmet;

Any period of disability beginning prior to your effective date of coverage under this Plan; and

Any period of disability during which you are not under the regular care of a physician.

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When Short Term Disability Benefits End Your Short Term Disability benefits will end on the earliest of when you: Are no longer under the regular care of a physician; Are no longer disabled; Fail to supply proof of your illness or injury; End your employment; or Receive the maximum amount of benefits, as described earlier in this section. Mid Term Disability Benefits You may extend your Short Term Disability benefits with Mid Term Disability benefits, but only if you have enrolled for Long Term Disability insurance coverage (as explained in your Guide to Benefits booklet). Mid Term Disability benefits extend your Short Term Disability benefits for up to an additional 13 weeks of disability after Short Term benefits run out. The Mid Term Disability benefit is calculated the same way and operates under the same rules as your Short Term Disability benefits.

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Administrative Information About Your Johns Hopkins EHP Benefits Filing A Claim With Employer Health Programs You do not have to file a claim form with Employer Health Programs if you receive services from an EHP Network provider under the EHP Medical Plan or under the EHP Dental Plans. EHP Network providers will file claims for you. However, there are certain times when you do need to file a claim form with Employer Health Programs. These include: If you receive services from an Out-of-Network provider, or Out-of-Network care that is covered

as explained under Emergency Services and Out-of-Area Care earlier in this SPD, unless the Out-of-Network provider files the claim for you. It is your responsibility to determine if the Out-of-Network provider files a claim for you;

If you use the Mail Order Drug program (or receive emergency prescription drugs from an out-of-area non-Network pharmacy);

If you receive dental services from an Out-of-Network provider; or If you are applying for Short Term Disability benefits. To submit your claim, complete a claim form, attach your itemized bills to it, and send it to the address shown on the form. Claims should be reported promptly, and no claims will be accepted after one year from the date services or supplies were provided. Itemized bills must include the following information: The date(s) that services or supplies were received; A description and diagnosis of the services or supplies rendered; The charge for each service or supply; The name, address and professional status of the provider; and The full name of the individual who received the care. More information about your claims and appeals rights is set forth below under Claims for Benefits in the Administrative Information section.

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What Happens When You Have Duplicate Coverage You and members of your family could be covered under more than one group health plan or health insurance coverage. These other plans may include health care insurance available through your spouse’s employer. You may also qualify for benefits from state no-fault automobile laws. The Johns Hopkins EHP Medical Plan and the Dental Plans, like most plans, include a Coordination of Benefits (COB) provision. The purpose of this provision is to limit the total amount you may receive from all medical or dental plans to no more than 100% of the covered charges. The COB rules apply to both the Medical Plan and the Dental Plans. The plan that pays first is the Primary Plan. The Secondary Plan makes up the difference between the benefit paid (or deemed paid) by the Primary Plan and the maximum amount that would be paid under the Secondary Plan if there were no Primary Plan. If the EHP Medical Plan is your Secondary Plan, only covered expenses up to the Plan’s fee schedule may be covered. Any applicable copays, coinsurance or deductibles under the two plans still apply. The plan of the patient’s employer is the Primary Plan. To determine benefits for covered dependent children, the plan of the parent whose birthday falls earlier in the year is the Primary Plan for children. However, if the other health care plan does not include this “birthday rule” on children’s coverage, or if both parents have the same birthday, the plan of the parent that has covered the dependent for a longer period of time is the Primary Plan and pays first. The other parent’s plan will be Secondary. The Coordination of Benefits rules usually do not apply in cases where parents are divorced or legally separated. The plan of the parent with a court order setting responsibility for health care expenses will usually be the only plan that covers a child. The Coordination of Benefits rules only apply when a child is actually covered under the separate plans of both parents. When both plans have a COB provision, the following chart shows you how the Primary Plan is determined for your husband or wife. If you are: And the other plan is

sponsored by: And expenses are for: Then your plan is:

Husband Your wife’s employer Yourself Your wife

Primary Secondary

Wife Your husband’s employer

Your husband Yourself

Secondary Primary

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If you have enrolled your spouse in the EHP Medical Plan and your spouse loses coverage under his or her other plan, the EHP Medical Plan becomes primary for both of you and any covered dependent children. Please note that the EHP Medical Plan is the Secondary Plan to any other plan covering a qualified beneficiary who has elected COBRA. The EHP Medical Plan is the Primary Plan if you are covered under the Plan as an active employee and you are also covered by Medicare or Medicaid. Similarly, the EHP Medical Plan is the Primary Plan for your covered spouse if your spouse is covered by Medicare and if you are an active employee. The Medical Plan is the Primary Plan for your dependent children if they are covered by Medicaid or CHIP. When the EHP Medical Plan is the Secondary Plan, it will deem the Primary Plan to have made all benefit payments that would have been made had you complied with all the rules of the Primary Plan. For example, if you fail to submit a claim on time to the Primary Plan or if you do not get the required preauthorization for treatment, the EHP Medical Plan will make its Secondary Plan payment based on the payment the Primary Plan would have made if you submitted the claim on time or if you obtained the required preauthorization. Coverage by Affiliated EHP Plans and the EHP Medical Plan Inter-Affiliate Transfer Policy Special annual deductible and out-of-pocket maximum rules apply to an employee and his or her dependents who have been covered by an EHP Medical or Dental plan sponsored by an employer that has adopted the Johns Hopkins Health System Corporation Inter-Affiliate Transfer Policy. We refer to such an employer’s plan as an “Affiliated EHP Plan.” Currently, Johns Hopkins Health System Corporation/The Johns Hopkins Hospital, Bayview Medical Center, Johns Hopkins Medical Management, Howard County General Hospital, Howard County Health Services and Suburban Hospital have adopted the Inter-Affiliate Transfer Policy. The special rules apply whenever an employee transfers coverage from an Affiliated EHP Plan to this Plan during a plan year. Any expenses incurred by an employee and his or her dependents which count against an annual deductible or out-of-pocket maximum under the prior Affiliated EHP Plan will also be counted against the applicable annual deductible or out of pocket maximum under this EHP Medical Plan.

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Prior Coverage Under the EHP Basic and Premium Plans If you were covered under the EHP Basic Plan and/or Premium Plan before 2013, then any benefits provided by those Plans are treated as benefits provided under the current EHP Medical Plan when applying lifetime limits. Employees Whose Worksite Is Outside The United States Employees whose worksite is outside the United States do not have coverage under the EHP Medical or Dental Plans. Instead, a policy offered by CIGNA provides the health and dental insurance coverages. Employees whose worksite is outside the United States are still be eligible for Short Term and Mid Term Disability benefits and the Health Care and Dependent Care Flexible Spending Accounts as described in this Summary Plan Description. When the EHP Medical Plan and Short Term Disability Plan May Recover Payment If you or your dependents have an injury, illness or other condition that is covered by the EHP Medical Plan and for which a third party might be liable, you must notify Johns Hopkins Employer Health Programs as soon as possible. You must comply with the EHP Medical Plan’s Reimbursement and Subrogation rights set forth below. Reimbursement The EHP Medical Plan’s reimbursement provisions apply when you or your dependents receive, or in the future may receive, any amounts by settlement, verdict or otherwise, including from an insurance carrier, for an injury, illness or other condition. We call these amounts a “Recovery”. These reimbursement provisions also apply to your Short Term and Mid Term Disability benefits. If you or your dependents have received a Recovery, the Plan will subtract the amount of the Recovery from the benefits it would otherwise pay for treatment of the injury, illness or other condition or for Short or Mid Term Disability. If there is a possible future Recovery, the Plan may delay paying benefits until the Recovery is received, and then subtract the amount of the Recovery. If the Plan has already paid benefits to or on behalf of you or your dependents for treatment of an injury, illness or other condition or for Short or Mid Term Disability, you or your dependents (or the legal representatives, estate or heirs of you or your dependents) must promptly reimburse the Plan from any Recovery received for the amount of benefits paid by the Plan. Reimbursement must be made regardless of whether you or your dependents are fully compensated (“made whole”) by the Recovery. In order to secure the Plan’s reimbursement rights, by participating in the Plan you and your dependents, to the full extent of the Plan’s claim for reimbursement, (1) grant the Plan a first priority

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lien against the proceeds of any Recovery received; (2) assign to the Plan any benefits you or your dependents may have under any insurance policy or other coverage and (3) agree to hold in trust for the Plan the proceeds of any Recovery received. You and your dependents are obligated to cooperate with the Plan and its agents in order to protect the Plan’s reimbursement rights. Cooperation means providing the Plan or its agents with any relevant information requested, signing and delivering any documents as the Plan or its agents reasonably request, obtaining the written consent of the Plan or its agents before releasing any party from liability, taking actions as the Plan or its agents reasonably request to assist the Plan in making a full recovery, and taking no action that may prejudice the Plan’s rights. The Plan is only responsible for those legal costs to which it agrees in writing, and will not otherwise bear the legal costs of you and your dependents. If you take any action to prevent the Plan from enforcing its reimbursement rights, you will also be liable to reimburse the Plan for any legal expenses that the Plan or its agents incur in enforcing the Plan’s reimbursement rights. Subrogation The EHP Medical Plan’s subrogation provisions apply when another party (including an insurance carrier) is or may be liable for your or your dependents’ injury, illness or other condition, and the EHP Medical Plan has already paid benefits for treatment of the injury, illness or other condition. These subrogation provisions also apply to your Short Term and Mid Term Disability benefits. The Plan is subrogated to all of your and your dependents’ rights against any party (including an insurance carrier) that is or may be liable for your and your dependents’ injury, illness or other condition or for paying for treatment of the injury, illness or other condition. The Plan is subrogated to the extent of the amount of the medical and/or Short or Mid Term Disability benefits it pays to or on behalf of you or your dependents. The Plan may assert its subrogation right independently of you and your dependents. You and your dependents are obligated to cooperate with the Plan and its agents in order to protect the Plan’s subrogation rights. Cooperation means providing the Plan or its agents with any relevant information requested, signing and delivering any documents as the Plan or its agents reasonably request, obtaining the written consent of the Plan or its agents before releasing any party from liability, taking actions as the Plan or its agents reasonably request to assist the Plan in making a full recovery, and taking no action that may prejudice the Plan’s rights. If you or your dependents enter into litigation or settlement negotiations regarding the obligations of other parties, you and your dependents must not prejudice the Plan’s subrogation rights in any way. The Plan’s legal costs in subrogation matters will be borne by the Plan. However, if you take any action to prevent the Plan from enforcing its subrogation rights, you will be liable to reimburse the

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Plan for any legal expenses that the Plan or its agents incur in enforcing the Plan’s subrogation rights. Your and your dependents’ legal costs will be borne by you and your dependents. Benefits Paid by Mistake If the Plan pays benefits that you are not entitled to under the terms of the Plan, this is called a benefit paid by mistake. If the Plan pays a benefit by mistake, the Plan is entitled to recover the mistaken payment from the person it was paid to. If a mistaken payment is made to you, then you agree to hold the mistaken payment for the benefit of the Plan and to repay it to the Plan. When Benefit Plan Coverage Ends Your coverage under the benefit plans described in this SPD will end on the earliest of the following dates: The end of the month in which you end your employment or are no longer an eligible employee; The end of the month preceding the effective date of your waiver of coverage under the plan; The end of the month for which you last make the required contributions for coverage; The date the plan is discontinued; The date on which you report for active duty as a full-time member of the armed forces of any

country. Coverage for a dependent will end on the earliest of the following dates: The date your coverage ends; The end of the month in which he/she no longer qualifies as an eligible dependent; The end of the month preceding the effective date of your election to drop dependent coverage; The end of the month for which you last make the required contributions for dependent coverage;

or The date on which your dependent enters military service. Your coverage under the EHP Medical Plan will also end if you certify that you do not use tobacco when you enroll for coverage, and it is later determined by the Plan Administrator that your certification was false when made. In that event, you may also be required to reimburse the Plan for any expenses paid by the Plan for medical treatment that was related to tobacco use. For certain of the above events, you or your dependents may be able to continue coverage by self-payment under COBRA, as explained next. If you take an unpaid medical leave of absence from your employment (including a leave covered by the Family and Medical Leave Act (FMLA)), you must continue making your required contributions for benefit plan coverage to remain in effect. If you do not make your required contributions, your benefit plan coverage will end at the end of the month

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preceding the date you stop making the required contributions. If your leave is covered under FMLA, you may be allowed to resume coverage upon your return from leave. Leaves of absence are discussed in more detail below under Benefit Coverage During FMLA and Other Leaves of Absence. COBRA Continuation Coverage COBRA allows you, your spouse or former spouse and your dependents to continue your coverage under the EHP Medical and/or Dental Plans for a specified period of time after certain qualifying events take place. Except as explained below for newborn or adopted children, only persons who are actually covered under a Plan on the date of the qualifying event may continue coverage by that Plan under COBRA. You, your spouse, and your adult dependents have separate election rights. To continue coverage under COBRA, the covered person must pay the full premium rates, plus a 2% administrative charge. Same sex domestic partners, same sex spouses and the partner/spouse’s children are not eligible for COBRA coverage. However, if the same sex partner/spouse’s child also qualifies as your child as explained earlier in this SPD under Dependent Coverage, then the child is eligible for COBRA coverage. If your employment ends during the plan year in which you contribute to a Health Care FSA, COBRA also allows you to continue making after-tax contributions to the FSA. You may continue these contributions until the close of the plan year. You may not continue contributions to your Dependent Care FSA. Length of COBRA Coverage Coverage under your EHP Medical and Dental Plans may be continued under COBRA for up to 18 months after regular coverage ends for you, your spouse, and your eligible dependents, if regular coverage ends due to one of the following qualifying events: Your employment ends for reasons other than gross misconduct; or Your work hours are reduced so that you are no longer eligible. COBRA coverage may be continued for up to 24 months after regular coverage ends if your employment ends because you are called up for military duty that is covered by the Uniformed Services Employment and Reemployment Rights Act (commonly known as “USERRA”). Dependent children include children born to you, adopted by you, or placed with you for adoption while you are covered under COBRA. For such a child to qualify for COBRA, you must notify the HR Service Center in writing and elect COBRA coverage for the new child as soon as possible, but in no case later than 30 days after the event. If notice is given and the election is made on a timely basis,

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the newborn or adopted child will be covered under COBRA as of the date of the birth, adoption, or placement for adoption. If you are at least age 62 and have at least 15 “Years of Vesting Service” under the Johns Hopkins Health System Corporation Retirement Plan when you lose regular coverage due to one of the above qualifying events, you may continue coverage under COBRA until the end of the month in which you reach age 65. This allows you to continue coverage under COBRA until you are eligible for Medicare. You may also cover your spouse while you are receiving this extended COBRA coverage. If you cover your spouse until you reach age 65 (when your COBRA coverage ends), your spouse may thereafter continue COBRA coverage until the end of the month in which he or she reaches age 65 or has been on COBRA for 36 months in total, whichever occurs first. If you are eligible for extended COBRA coverage as explained in the preceding paragraph, but you do not elect COBRA because you are already eligible for Medicare when you lose regular coverage due to one of the above qualifying events, your spouse may elect COBRA coverage until the end of the month in which he or she reaches age 65 or has been on COBRA for 36 months in total, whichever occurs first. Extended COBRA coverage for you and your spouse is subject to all the rules that otherwise apply to COBRA coverage as explained in this SPD. If you, your spouse or any of your dependents is Social Security disabled at any time during the first 60 days of COBRA coverage, coverage for the disabled individual and each of the individual’s family members may be extended for an additional 11 months, for a total of 29 months. Premiums for the additional 11 months will increase from 102% to 150% of the full cost. The HR Service Center must be notified in writing of the Social Security disability within 60 days after the date of the determination and before the first 18 months of COBRA coverage ends, or the 11 additional months of COBRA coverage will not be provided. However, in the case of a disabled employee (but not a family member) whose application for Social Security disability benefits is pending at the end of the first 18 months of COBRA coverage, written notice of the disability determination may be given to the HR Service Center after the first 18 months of COBRA coverage ends if:

the employee applied for Social Security disability benefits no later than 60 days after COBRA coverage began;

the Social Security Administration’s failure to make a determination before the first 18 months of COBRA ends is not the employee’s fault;

the employee is found to be disabled under the long term disability plan of the employee’s employer;

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the employee requests the additional 11 months of COBRA before the first 18 months of COBRA ends;

the Social Security Administration makes its determination no later than 210 days after the first 18 months of COBRA ends, which determination finds that the disability began before the start of COBRA coverage, and

the employee gives written notice to the HR Service Center of the Social Security determination within 30 days after the employee receives the determination.

If notice of an employee’s Social Security disability determination is given after the first 18 months of COBRA ends as provided above, only the employee (and not any family member) is entitled to the additional 11 months of COBRA coverage. If the Social Security Administration notifies you or any of your dependents that he or she is no longer disabled, then the additional 11 months of COBRA coverage no longer applies and you must notify the HR Service Center in writing within 30 days of the Social Security notice. Please contact the HR Service Center if you have any questions about your eligibility. Your spouse and dependent children may individually elect COBRA continuation coverage for up to 36 months after regular coverage ends because of: Your divorce; Your legal separation; Your entitlement to Medicare; or Your death. Please note: You may not elect coverage on behalf of a divorced spouse, but he or she may personally elect to continue coverage. Your dependent children may individually elect COBRA continuation coverage for up to 36 months after regular coverage ends if they stop being eligible for dependent coverage as explained in General Information About Your Benefits, under Who Is Eligible. In the case of divorce, separation, or a dependent child no longer being eligible for dependent coverage, you, your spouse, or your child must notify the HR Service Center in writing within 60 days after that event occurs. If that notice is given on time, your spouse or child will be notified of the right to continue coverage under COBRA. If written notice of the event is not given on time, then your spouse and child will have no rights to continue coverage under COBRA. You, your spouse or dependents will be notified of the right to continue coverage under COBRA if:

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Your employment ends for reasons other than gross misconduct; Your work hours are reduced so that you are no longer eligible; or You die. The employer will notify the HR Service Center of one of the above events no later than 30 days after the date you lose regular coverage. If one of the above events that allow COBRA coverage to be continued for 36 months occurs after an event that allows COBRA coverage to be continued for 18 months but before the 18 months has expired, then COBRA coverage (if initially elected) may be continued for up to 36 months, measured from the date regular coverage ends because of the first event. If another event occurs, you, your spouse or dependent child must notify the HR Service Center in writing within 60 days after the second event. If the HR Service Center is not notified in time, COBRA may not be continued past 18 months. You must notify the HR Service Center in writing if you, your spouse or dependent child change addresses. The HR Service Center will only send communications to a recipient’s last known address. Electing COBRA Coverage You, your spouse or dependent children have 60 days from the date regular coverage would otherwise end or from the time notice of COBRA rights is given (whichever is later) to elect to continue coverage under the EHP Medical Plan or Dental Plans under COBRA. If COBRA is not elected, coverage under the Medical Plan and Dental Plans will end. If COBRA coverage is elected on a timely basis, you, your spouse or your dependent children will have an additional 45-day period to pay the first premium, starting on the date the election was made. All premium payments must be made directly to the address shown on your COBRA election notice. Each individual who elects to continue coverage under COBRA must pay the full premium cost, plus 2% for administrative expenses. You will be advised of the monthly cost of COBRA coverage per person at the appropriate time. After you, your spouse or dependent children have elected to continue coverage under COBRA and have paid the required premiums, coverage will be reinstated back to the date regular coverage was lost. The EHP Medical and Dental Plans will not pay any claims made in the interim. Upon reinstatement of coverage, invoices may be submitted or re-submitted to the Plans for payment. If the benefits or coverage costs under the EHP Medical or Dental Plans change for active employees, the COBRA coverage benefits and costs will change as well. Covered persons will be notified of any changes.

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When COBRA Coverage Ends The right to COBRA continuation coverage will end before the conclusion of the coverage periods set forth above, whichever applies, if:

A covered individual becomes covered under another group medical plan after COBRA coverage is elected (unless a pre-existing condition limitation would prevent the individual from receiving benefits from the new plan for a particular illness or injury);

A covered individual becomes covered by Medicare after COBRA coverage is elected; The premium is not received on a timely basis; or JHHSC/JHH stops providing group medical coverage for all active employees. Benefit Coverage During FMLA Leaves of Absence Under the Family and Medical Leave Act (FMLA), you may be eligible to take up to 12 weeks of time off, as determined by the HR Service Center. If you are approved for FMLA leave, there are certain rules that apply for you to continue coverage under your benefit plans. While you are on FMLA leave, you will be billed for your required employee contributions for the benefit plan coverage you have elected. If you pay the required contributions on time, you (and your spouse and dependent children, if you elected coverage for them) will remain covered under the elected benefit plans. If you do not pay the required contributions on time, benefit plan coverage for you (and your spouse and dependent children) will end at the end of the month for which you last made the required contributions. If you do not return to employment with JHHSC/JHH at the end of your FMLA leave, you (and your spouse and dependent children) may elect COBRA coverage under the EHP Medical and/or Dental Plans at the level of coverage that you (or your spouse or dependent children) were covered by on the day before the FMLA leave began (or become covered by during the FMLA leave). You may elect COBRA even if your regular coverage under the EHP Medical and/or Dental Plans ends during your leave for failure to make required employee contributions. If properly elected, COBRA continuation coverage will begin on the first day of the month following the end of your FMLA leave. For example, if you take all your FMLA leave and do not to return to work, your COBRA continuation coverage (if properly elected) would begin on the first day of the month following your last day of FMLA leave. If you notify the HR Service Center before your FMLA leave is over that you do not plan to return to work, your COBRA continuation coverage (if

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properly elected) will begin on the first day of the month after the date you notify the HR Service Center. For more information about the Family and Medical Leave Act, please contact the HR Service Center. Benefit Coverage During Other (Non-FMLA) Leaves of Absence Approved Medical Leaves While you are on an approved medical leave of absence that is not an FMLA leave, you will be billed for your required employee contributions for the benefit plan coverage you have elected. If you pay the required contributions on time, you (and your spouse and dependent children, if you elected coverage for them) will remain covered under the elected benefit plans. If you do not pay the required contributions on time, benefit plan coverage for you (and your spouse and dependent children) will end at the end of the month for which you last made the required contributions. If you do not return to employment with JHHSC/JHH at the end of your non-FMLA medical leave, you (and your spouse and dependent children) may elect COBRA coverage under the EHP Medical and/or Dental Plans at the level of coverage that you (or your spouse or dependent children) were covered by, if any, on the day your non-FMLA medical leave ended. You may not elect COBRA if your regular coverage under the EHP Medical and/or Dental Plans ends during your leave for failure to make required employee contributions or for any other reason. Approved Non-Medical Leaves An approved leave of absence that is not FMLA protected and that is not a medical leave of absence is treated as a termination of employment for benefits purposes. Your benefit plan coverage ends on the last day of the month in which you are treated as terminating employment, except to the extent you elect to continue coverage in accordance with the COBRA continuation of coverage rules described above. When You Become Covered By Medicare When you reach age 65, you will be eligible for Medicare benefits. You may become eligible for Medicare benefits at an earlier date if you become permanently disabled. If you are still an active employee when you reach age 65 and become covered by Medicare, your EHP Medical Plan coverage will continue as your primary medical plan unless you elect to waive EHP Medical Plan coverage. Before your 65th birthday, you should get an explanation of Medicare benefits from the Social Security Administration. Make sure that you are actually enrolled for Medicare when you turn age 65.

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Enrollment does not happen automatically – you must go to the Social Security Administration and apply in order to have Medicare coverage. If you do not enroll in Medicare Part A when first eligible, you may incur penalties and delays in obtaining Medicare coverage later. You may delay enrolling in Medicare Part B without penalty as long as you remain actively employed with JHHSC/JHH. The EHP Medical Plan prescription drug benefit is, on average for all plan participants, expected to pay as much in benefits as the standard Medicare Part D prescription drug coverage would be expected to pay. That means the EHP prescription drug benefit constitutes “creditable coverage” for Medicare Part D purposes. You should receive a Creditable Coverage Notice shortly before you become eligible for Medicare that has more information about electing Medicare Part D coverage. If you do not receive that Notice, contact the HR Service Center. Medicare and End Stage Renal Disease If you have End Stage Renal Disease (ESRD) and need kidney dialysis treatment, you are generally eligible for Medicare starting with your fourth month of dialysis. You should enroll for Medicare Part A and Part B as soon as possible, regardless of your age. If you are eligible for EHP Medical Plan coverage as an active employee, the EHP Medical Plan will continue as your primary insurance for up to 30 months after your Medicare coverage can begin. Thereafter, the EHP Medical Plan will only pay as your secondary insurance to the benefits provided by Medicare Part A and Part B. If you fail to enroll for Medicare Part A or Part B, the EHP Medical Plan will still pay secondary to the benefits that would have been provided by Parts A and B as if you had enrolled. This could result in your having no coverage for the dialysis treatment until you enroll. Plan Information Following is information regarding the administration and funding of your benefit Plan. Plan Sponsor The Johns Hopkins Hospital sponsors the Johns Hopkins Health System Corporation/The Johns Hopkins Hospital Employee Benefits Plan for Non-Represented Employees, which contains the benefit plans described in this SPD. The Employee Benefits Plan covers eligible non-represented employees of the Johns Hopkins Hospital and the Johns Hopkins Health System Corporation. The Johns Hopkins Hospital’s Employer Identification Number (EIN) is 52-0591656. Plan Administrator

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The Plan Administrator manages the Employee Benefits Plan on a day-to-day basis and resolves questions about Plan details and entitlement to benefits. The Plan Administrator is the Vice President, Human Resources of JHHSC/JHH. If you have questions about your benefits and how they are administered, you should contact:

Benefits Office Attention: Director of Benefits The Johns Hopkins Hospital 600 North Wolfe Street, Phipps 455 Baltimore, MD 21287-1454 Telephone: 410-955-6208

Plan Year The Plan Year for ERISA purposes is July 1 – June 30. However, annual benefit limits under the Employee Benefits Plan are determined on a calendar year (January 1 - December 31) basis. Plan Funding

Except for Long Term Disability, Life and Accidental Death and Dismemberment insurance benefits, the benefits provided by the Employee Benefits Plan are not financed or administered by an insurance company. Benefits are paid from the general assets of JHHSC/JHH through a contract with Johns Hopkins Employer Health Programs. You can contact Johns Hopkins Employer Health Programs at:

Johns Hopkins Employer Health Programs 6704 Curtis Court Glen Burnie, Maryland 21060 410-424-4450 or 800-261-2393

Information about the funding of the Long Term Disability, Life and Accidental Death and Dismemberment insurance benefits is contained in their separate summary plan description. Plan Number

The plan number is 506. Legal Action

The agent for service of legal process is:

JHHSC/JHH General Counsel 600 N. Wolfe Street Administration Building

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Baltimore, Maryland 21287 You may also serve legal process on the Plan Administrator. Claims And Appeals In order for you to receive Medical, Dental or Short Term and Mid Term Disability benefits under the Employee Benefits Plan, you or your provider must file a claim. Claims are filed for you by EHP Network providers under the EHP Medical and Dental Plans. An Out-of-Network medical provider can file your claim for you, but if your provider doesn’t file the claim you must file it yourself. You must file claims for Out-of-Network care that is covered as explained under Emergency Services and Out-of-Area Care earlier in this SPD, for dental services rendered by Out-of-Network dental providers, and for Short Term and Mid Term Disability benefits. All claims for benefits under an insured plan (Long Term Disability, Life and Accidental Death and Dismemberment) must be made to the insurance company that issues the policy for the plan in accordance with the policy’s rules. Claims for the Health Care and Dependent Care Flexible Spending Accounts must be made as explained earlier in this SPD under Flexible Spending Accounts. Following are the Plan’s procedures for filing claims and appealing claim denials involving Medical, Dental, Vision and Short Term and Mid Term Disability benefits. The Plan’s procedures do not apply until a claim is filed with Employer Health Programs. A “claim” is a request to Employer Health Programs for coverage of treatment you already received or a request for preauthorization of coverage by Employer Health Programs for treatment you want to receive. A decision by your doctor or other provider that you do not need a certain treatment is not a claim covered by the procedures. The Plan’s procedures also apply to a determination by your employer that you are not covered under the Plan. If you are covered by the Plan and your employer determines that you are no longer entitled to coverage for a reason other than your failure to maintain enrollment or pay the required employee contribution, your coverage will not end until you have exhausted your rights under these procedures. The filing requirements, and other procedures related to claims and appeals, differ depending on whether you have an “Urgent Care Claim,” a “Pre-Service Claim” or a “Post-Service Claim”. There are special rules if a pre-approved course of treatment is reduced or terminated, or if you want to extend a pre-approved course of treatment. Medical benefits claims can be any of the foregoing types of claims. On the other hand, claims for Dental or Short Term and Mid Term Disability benefits are always handled under the Post-Service Claims rules.

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Urgent Care Claims, Pre-Service Claims and Post-Service Claims Certain services and supplies must be preauthorized by Care Management in order to be covered or to avoid a penalty. See the earlier discussion in this SPD about the Care Management Program and the Medical Benefits At-A-Glance chart. If a service or supply must be preauthorized, a request for preauthorization is a “Pre-Service Claim”. (Pre-treatment review for major Dental services is recommended so you and your provider will know in advance what benefits will be paid. However, pre-treatment review is not required in order for the services to be covered and there is no penalty for failing to request review.) If service or supply must be preauthorized and it is needed for urgent care, it is an “Urgent Care Claim”. A service or supply is for Urgent Care if following the time limits (set forth below) for Pre-Service Claims: could seriously jeopardize the life or health of the patient or the ability of the patient to regain

maximum function, or in the opinion of a physician with knowledge of the patient’s medical condition, would subject the

patient to severe pain that cannot be adequately managed without the service or supply. In general, whether a service or supply is for Urgent Care is determined by Employer Health Programs based on the standards of a prudent layperson with average knowledge of health and medicine. However, if a physician with knowledge of the patient’s medical condition determines that the service or supply is for Urgent Care, it will be treated as such. If a service or supply does not need to be preauthorized, a claim for payment is a “Post-Service Claim”. (All Dental and Short Term and Mid Term Disability benefit claims are Post-Service Claims.) Filing a Claim See the Care Management Program discussion earlier in this SPD for how to request preauthorization (for either a Pre-Service or Urgent Care Claim). To file a Post-Service Claim, you or your provider must complete and submit a claim form and attach itemized bills with the information described below. (Remember, an EHP Network provider will file claims for you.) Claims should be reported promptly, and no claims will be accepted more than 12 months after the treatment was provided. Unless a different address is shown on the top of the form, send all Post-Service Claims to:

JHHSC/JHH EHP Medical Plan

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c/o Johns Hopkins Employer Health Programs 6704 Curtis Court Glen Burnie, Maryland 21060

Itemized bills must include the following information: the date(s) the services, drugs or supplies were received; the diagnosis; a description of the treatment received; the charge for each service, drug or supply; the name, address and professional status of the provider; and the full name of the patient.

Claim forms are available at the Johns Hopkins Hospital HR Service Center and from Johns Hopkins Employer Health Programs at www.ehp.org. To avoid delay in handling your claim, answer all questions completely and accurately. Claims cannot be processed without your signature where required on the form. Reducing or Terminating an Approved Course of Treatment If Care Management preauthorizes a specific period or number of treatments, it may in rare cases later determine that the preauthorized period or number of treatments should be reduced or terminated. If that happens, Care Management will notify you in advance and give you time to file an appeal and receive a determination before the reduction or termination takes effect. Special time limits apply -- see “Claims and Appeals Procedures” below. Extending an Approved Course of Treatment If Care Management preauthorizes a specific period or number of treatments, and you or your provider want the period or number to be extended, you or your provider must file a request to extend the approved course of treatment. A request that is filed before the additional treatment is provided is a Pre-Service Claim. A request that is filed after the additional treatment is provided is a Post-Service Claim. Special time limits apply – see “Claims and Appeals Procedures” below. Authorized Representative An authorized representative may file a claim or appeal a denial of benefits for you. To name an authorized representative, you must use a Designation of Authorized Representative form which you can get from Employer Health Programs on www.ehp.org or by calling an EHP Customer Service Representative.

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Note: You do not need to file a Designation of Authorized Representative form for your provider to file your initial claim. You also do not need to file a Designation of Authorized Representative form for your provider to file your First Level Appeal of a Pre-Service Claim or to file your First Level Appeal or Final Appeal of an Urgent Care Claim. However, you must file a Designation of Authorized Representative form for your provider to file your First Level Appeal of a Post-Service Claim and to file any other Final Appeal for you. Claims and Appeals Procedures If your claim for benefits (Urgent Care, Pre- or Post-Service) is denied in whole or in part, you must follow the procedures in this section and exhaust your appeal rights before you may file suit in court. Once your claim has been filed and Employer Health Programs has all of the necessary information, your claim will be processed as set forth below and you will be notified of the decision. Urgent Care Claims If an Urgent Care Claim is improperly filed, Employer Health Programs will notify you within 24 hours. The notice may be oral, unless you request that it be written. Unless additional information is needed, you will be notified of an Urgent Care Claim decision within 72 hours after the claim is properly filed. However, if your Urgent Care Claim involves a request to extend an approved course of treatment, and your request is received at least 24 hours before the end of the approved course of treatment, you will be notified of the decision within 24 hours. Pre-Service Claims If a Pre-Service Claim is improperly filed, Employer Health Programs will notify you within five days. The notice may be oral, unless you request that it be written. Unless additional information is needed, you will be notified of a Pre-Service Claim decision within 15 days after the claim is properly filed. If there are matters beyond Employer Health Programs’ control, this period may be extended up to 15 more days. If an extension is needed, you will be told before the initial 15 day period ends why an extension is needed and when a decision is expected. Post-Service Claims Unless additional information is needed, if a Post-Service Claim for medical or dental benefits is denied, you will be notified within 30 days after the claim is properly filed. You will be notified within 45 days for a denial of a Short Term or Mid Term Disability benefit claim. If there are matters beyond Employer Health Programs’ control, this period may be extended up to 15 more days (up to two 30 day extensions for Disability benefits). If an extension is needed, you will be told before the initial 30 day (or 45 day) period ends why an extension is needed and when a decision is expected.

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If Additional Information is Needed Pre-Service and Post-Service Claims If Employer Health Programs needs more information to decide a Pre-Service or Post Service Claim, you will be told what additional information is needed and you will have 45 days to supply it. The time limit for Employer Health Programs to decide your claim is suspended until you supply the additional information. If you do not supply the information within 45 days, your claim will be processed without the additional information, and Employer Health Programs may draw reasonable presumptions from your failure to supply the additional information. Urgent Care Claims If Employer Health Programs needs more information to decide an Urgent Care Claim, you will be told within 24 hours what additional information is needed and you will have 48 hours to supply it. The time limit for Employer Health Programs to decide your Urgent Care Claim is suspended until you supply the additional information. You will be notified of Employer Health Programs’ decision on your Urgent Care Claim within 24 hours after the earlier of when (1) you supply the additional information or (2) the time for you to supply the additional information expires. If you do not supply the information within 48 hours, your claim will be processed without the additional information, and Employer Health Programs may draw reasonable presumptions from your failure to supply the additional information. If Your Claim is Denied You will be notified in writing if your claim (Urgent, Pre- or Post-Service) is denied in whole or in part. The notice will tell you why the claim was denied and the specific Plan provisions on which the denial is based. It will also describe any additional information that could change the decision. The notice will tell you how and when you can appeal the denial. The notice will tell you if an internal rule or guideline was relied on to deny your claim, and how to request a free copy of the rule or guideline. The notice will tell you if your claim was denied because the treatment is not medically necessary or is experimental, and how to request a free explanation of the scientific or clinical judgment relied upon. For an Urgent Care Claim, the notice will explain the expedited review process. First Level Appeal

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If you think Employer Health Programs made a mistake in denying your claim, or in reducing, terminating or refusing to extend an approved course of treatment, or if you are otherwise dissatisfied with a claim decision, you may file a First Level Appeal. Your First Level Appeal must be filed within 180 days after you are notified that your claim has been denied. However, if you are notified of a proposed reduction or termination of an approved course of treatment and you wish to appeal the proposed action and have a decision on your appeal before the proposed action takes effect, your First Level Appeal must be filed within 10 days after you are notified. If you file a First Level Appeal more than 10 days after you are notified of a proposed reduction or termination, the reduction or termination will probably take effect before you have a decision on your Appeal. If you do not file a First Level Appeal within the time allowed, you lose all rights to appeal.

Except for an appeal of a denial of an Urgent Care Claim, your First Level Appeal must be in writing. You may hand deliver it to Employer Health Programs or file by mail. If you file by mail, a notice of receipt will be sent to you. The address for First Level Appeals is:

Johns Hopkins HealthCare Appeals Department 6704 Curtis Court Glen Burnie, MD 21060

A First Level Appeal of a denial of an Urgent Care Claim may be made orally or in writing. You should supply all information for an Urgent Care Claim appeal by telephone, fax, hand delivery or other similar method. You may appeal a denial of an Urgent Care Claim by hand delivery to the address above, or by telephone or fax to:

Telephone: 410-424-4400 FAX: 410-424-4806 Attention: Urgent Care Claims Appeals

Please note that this fax number is for Urgent Care Claims Appeals only and should not be used for any other claims. All First Level Appeals will be submitted to the Appeals Department. You may submit written comments, documents, records and other information relating to your claim. The Appeals Department will consider everything you submit, regardless of whether it was submitted or considered in the initial claim determination. Upon written request and free of charge, you will be provided with reasonable access to and copies of all Plan documents, records and other information relevant to your claim.

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During the First Level Appeal process, you will be provided, free of charge, with any new or additional evidence considered, relied upon, or generated by (or at the direction of) the Plan in connection with your claim, and with any new or additional rationale for denying your claim. In either case, the evidence or rationale will be provided to you as soon as possible and sufficiently in advance of the date on which the Appeals Department will decide your First Level Appeal, so as to give you a reasonable opportunity to respond prior to that date. If the denial of your claim involved a medical judgment (such as whether a treatment is experimental or medically necessary), a health care professional in the Appeals Department with training and experience in the field of medicine involved will review your appeal. If medical or vocational experts were consulted when your claim was denied, they will be identified upon your request. When Your First Level Appeal Will Be Decided The time in which your First Level Appeal will be decided depends on whether it involves an Urgent Care Claim, a Pre-Service Claim, a Post-Service Claim, or a reduction, termination or denial of a request to extend an approved course of treatment.

Urgent Care Claim—You will be notified of the decision within 36 hours after your First Level Appeal is filed.

Pre-Service Claim -- You will be notified of the decision within 15 days after your First Level Appeal is filed.

Post-Service Claim -- You will be notified of the decision on a medical or dental benefit claim within 30 days after your First Level Appeal is filed. You will be notified within 45 days for a Short Term or Mid Term Disability benefit claim. (If more time is needed to decide a Disability claim, this period may be extended up to another 45 days. If an extension is needed, you will be told before the initial 45 day period ends why an extension is needed and when a decision is expected.)

Reduction or termination of an approved course of treatment -- You will be notified of the decision within 30 days after your appeal is filed. However, if you filed your appeal within 10 days after being notified of the proposed action, the course of treatment will not be reduced or terminated before your appeal is decided. (See below for additional Final Appeal rights you may have before treatment is reduced or terminated.)

Request to extend an approved course of treatment -- If your appeal is filed before the additional treatment has been provided, the Pre-Service Claim time applies. If your appeal is filed after the additional treatment has been provided, the Post-Service Claim time applies.

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You will be sent a written notice of the Appeals Department’s decision. If your appeal is denied, the notice will tell you why and the specific Plan provisions on which the denial is based. The notice will tell you if an internal rule or guideline was relied on to deny your appeal, and how to request a free copy of the rule or guideline. The notice will tell you if your appeal was denied because the treatment is not medically necessary or is experimental, and how to request a free explanation of the scientific or clinical judgment relied upon. The notice will also tell you how and when you can file a Final Appeal. If your claim is an Urgent Care Claim, the notice will explain the expedited Final Appeal process. Final Appeal

If your First Level Appeal is denied, you may make a Final Appeal to the Plan Administrator. Except for an appeal of a denial of an Urgent Care claim, your Final Appeal must be in writing and must include details about your claim and why you think it should not be denied. You must submit your Final Appeal to the Plan Administrator in care of Johns Hopkins HealthCare Appeals Department at the address shown above. A Final Appeal of a denial of an Urgent Care Claim may be made orally or in writing. You should supply all information for an Urgent Care Claim appeal by telephone, fax, hand delivery or other similar method. You may make a Final Appeal of a denial of an Urgent Care Claim by hand delivery to the address above, or by telephone or fax to:

Telephone: 410-424-4400 FAX: 410-424-4806 Attention: Urgent Care Claims Appeals

Please note that this fax number is for Urgent Care Claims Appeals only and should not be used for any other claims. Except for an appeal of a reduction or termination of an approved course of treatment, a Final Appeal to the Plan Administrator must be filed within the later of (1) 90 days after you are notified of the Appeals Department’s denial of your First Level Appeal or (2) 180 days after you were initially notified that your claim was denied. If the Appeals Department denied your First Level Appeal of a proposed reduction or termination of an approved course of treatment and you wish to file a Final Appeal and have a decision on your appeal before the proposed action takes effect, your Final Appeal must be filed within five days after you are notified of the Department’s decision. If you file a Final Appeal more than five days after you are notified of the Department’s decision, the reduction or termination will probably take effect before you have a decision on your Final Appeal. If you don’t file a Final Appeal within the time allowed, you lose all rights to appeal.

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Your Final Appeal will be submitted to the Plan Administrator. You may submit written comments, documents, records and other information relating to your claim. The Plan Administrator will consider everything you submit, regardless of whether it was submitted or considered in the initial benefit determination or your First Level Appeal. Upon written request and free of charge, you will be provided with reasonable access to and copies of all Plan documents, records and other information relevant to your claim. During the Final Appeal process, you will be provided, free of charge, with any new or additional evidence considered, relied upon, or generated by (or at the direction of) the Plan in connection with your claim, and with any new or additional rationale for denying your claim. In either case, the evidence or rationale will be provided to you as soon as possible and sufficiently in advance of the date on which the Plan Administrator will decide your Final Appeal, so as to give you a reasonable opportunity to respond prior to that date. If the denial of your claim or the First Level Appeal decision involved a medical judgment (such as whether a treatment is experimental or medically necessary), the Plan Administrator will consult with a health care professional with training and experience in the field of medicine involved. If medical or vocational experts were consulted when your First Level Appeal was decided, they will be identified upon your request. The time limit for deciding your Final Appeal depends on whether it involves an Urgent Care Claim, a Pre-Service Claim, a Post-Service Claim, or a reduction, termination or denial of a request to extend an approved course of treatment.

Urgent Care claim -- You will be notified of the decision within 36 hours after your Final Appeal is filed.

Pre-Service Claim -- You will be notified of the decision within 15 days after your Final Appeal is filed.

Post-Service Claim -- You will be notified of the decision on a medical or dental benefit claim within 30 days after your Final Appeal is filed. You will be notified within 45 days for a Short Term or Mid Term Disability benefit claim.

Reduction or termination of an approved course of treatment -- You will be notified of the decision within 30 days after your Final Appeal is filed. However, if you filed your final appeal within five days after being notified of the Appeals Department’s decision on your First Level Appeal, the approved course of treatment will not be reduced or terminated before your Final Appeal is decided.

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Request to extend an approved course of treatment -- If your Final Appeal is filed before the additional treatment has been provided, the Pre-Service Claim time applies. If your Final Appeal is filed after the additional treatment has been provided, the Post-Service Claim time applies.

You will be sent a written notice of the Plan Administrator’s decision. If your Final Appeal is denied, the notice will contain the same type of information as the notice from the Appeals Department. If you disagree with the Plan Administrator’s decision, you may bring a civil action against the Plan under ERISA Section 502. Employer Health Programs and the Plan Administrator may not make any decisions regarding hiring, compensation, termination, promotion or other similar matters regarding any individual based on the likelihood that the individual will support a denial of benefits. External Review If your Final Appeal is denied in whole or in part, you may be eligible to request External Review of the denial by an Independent Review Organization (IRO). Except as explained below, you must complete all levels of the internal Claims and Appeals process described above before you can request External Review. Your Authorized Representative may act for you in the External Review process. The notice of denial of your Final Appeal will explain if you are eligible to request External Review and how to do so, and will include a copy of the Request for External Review Form. You must submit the completed Request for External Review Form to EHP at the address shown on the Form within 123 days after the date you receive the notice of denial of your Final Appeal. If you do not request External Review in writing within 123 days, you cannot submit your claim to External Review. You are not required to submit your claim to External Review, and doing so will not affect your right to bring a civil action against the Plan under ERISA Section 502. Whether or not you submit your claim to External Review will have no effect on your rights to any other benefits under the Plan. There is no charge for you to submit your claim to External Review. The External Review process will be administered in accordance with regulations and guidance issued by the Department of Labor under Public Health Service Act Section 2719. Request for External Review You can request External Review if both A and B are met:

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A. Your Final Appeal has been denied in whole or in part; or EHP or the Plan Administrator

do not follow the internal Claims and Appeals process set forth above.

B. Your appeal relates to a rescission of your coverage (meaning a retroactive cancellation of coverage that was previously in effect), or your claim being appealed involves medical judgment (meaning whether the treatment was medically necessary or experimental).

A failure to follow the internal Claims and Appeals process does not entitle you to External Review if the failure was minor, not likely to harm you, for good cause or beyond EHP or the Plan Administrator’s control, and part of an ongoing good faith exchange between you and EHP or the Plan Administrator. An appeal based on your eligibility for coverage (other than retroactive cancellation) is not eligible for External Review. Preliminary Review Within six business days following receipt of your request for External Review, EHP will notify you in writing whether you are eligible for External Review and whether your request contains all necessary paperwork. If your request is not eligible for External Review, the notice will explain why. If your request is incomplete, the notice will describe the additional information needed. You must supply the additional information before the end of the original 123 day request period (or within 48 hours after receipt of the notice, if later). Referral to IRO If your request is eligible for External Review, EHP will assign an accredited IRO to conduct the External Review, and will provide the IRO with the documents and other information considered during the internal appeal process. Note that information submitted to the IRO will include your “Protected Health Information” (described below in this SPD). EHP will notify you in writing when your request is accepted for External Review by the IRO. Within 10 business days after you receive this notice, you may submit to EHP any additional information that you want considered by the IRO as part of the External Review. The IRO may, but is not required to, consider information that you submit after 10 business days. The IRO will review all of the information and documents you timely submit. In reaching a decision on your claim, the IRO will not be bound by any decisions or conclusions reached during the internal claims and appeals process. In addition to the information and documents provided, in reaching a decision the IRO will consider the following (if available and considered appropriate by the IRO):

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Your medical records; The treating provider’s recommendation; Reports from appropriate health care professionals and other documents submitted by EHP, the

Plan Administrator, you or your treating provider; The terms of the Plan (unless inconsistent with the law); Appropriate practice guidelines, including evidence-based standards and other practice

guidelines developed by the Federal government, national or professional medical societies, boards, and associations;

Clinical review criteria developed and used by EHP (unless inconsistent with the Plan or the law); and

The opinion of the IRO's clinical reviewer(s) after considering the above information. EHP will provide you with written notice of the IRO’s External Review decision within 45 days after the IRO receives the request for the External Review. The IRO will maintain records of all materials associated with its External Review decision for six years, and will make the records available for your examination upon written request, except where disclosure would violate State or Federal privacy laws. Following receipt of an External Review decision that reverses a denial of your claim, the Plan will provide coverage or payment in accordance with the decision, subject to the right of the Plan and the Plan Administrator to seek judicial review of the decision and other remedies available under state or federal law. The IRO’s External Review decision is binding on you and the Plan, except to the extent that other remedies are available under state or federal law. If you submit your claim to External Review, the statute of limitations deadline by which you would have to bring a civil action against the Plan (and any other defense based on timeliness) is “tolled” (i.e., suspended) from the time you submit until the IRO issues its decision. Expedited External Review You may make a written request for an expedited External Review if:

Your Urgent Care Claim is denied, you have filed a request for an expedited internal appeal, and you have a medical condition where the timeframe for completion of the expedited internal review process would seriously jeopardize your life or health or would jeopardize your ability to regain maximum function; or

Denial of your Urgent Care Claim is upheld on Final Appeal, and either:

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you have a medical condition where the timeframe for completion of the standard External Review process would seriously jeopardize your life or health or would jeopardize your ability to regain maximum function; or

your Claim concerns an admission, availability of care, continued stay, or health care item

or service for which you received emergency services, but have not been discharged from a facility.

As soon as possible following receipt of your written request for expedited External Review, EHP will notify you in writing whether you are eligible for expedited External Review and whether your request contains all necessary paperwork. If eligible, EHP will assign your request to an IRO as explained above using the most expeditious means of transmission reasonably available. EHP will provide you with oral or written notice of the IRO’s decision on your request for expedited External Review as expeditiously as possible under the circumstances of your medical condition, but not later than 72 hours after the IRO receives the request. If the notice is oral, EHP will provide written confirmation of the IRO’s decision within 48 hours after the oral notice was given. Protected Health Information The Employee Benefits Plan may create or obtain information, which relates to your physical or mental health condition, treatment or payment for your health care. When this information is individually identifiable to you, it is called “Protected Health Information (PHI)”. The Plan may disclose PHI to the Plan Sponsor, and the Plan Sponsor may use or disclose PHI obtained from the Plan, only for Plan administration purposes, as set forth in the Employee Benefits Plan document. The Plan has a Notice of Privacy Practices which describes how your PHI may be used and disclosed and how you can get access to your PHI. You may request a copy of the Notice from the Plan Administrator at any time. The Plan has implemented safeguards that protect the confidentiality, integrity and availability of PHI which is transmitted or maintained by electronic media. Your Rights Under ERISA As a Plan participant, you are entitled to the following rights and protections under the Employee Retirement Income Security Act of 1974 -- commonly called ERISA: You can examine, free of charge, all of the official documents related to the plans (such as plan

documents, insurance contracts, annual reports, SPDs, any other plan agreements, or any other

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documents filed with the U.S. Department of Labor). You can examine copies of these documents in the Plan Administrator’s office.

If you wish, you can get your own copies of the Plan documents by writing to the Plan

Administrator. You may have to pay a reasonable charge to cover the cost of photocopying. Additional ERISA Rights In addition to creating rights for plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plans. These people are called fiduciaries. ERISA requires that fiduciaries act prudently and solely in the interest of you and other plan participants and beneficiaries. Moreover, no one, including your employer or any other person, may fire you or otherwise discriminate against you in any way for the purpose of preventing you from obtaining a benefit under these plans or exercising your rights under ERISA. If your claim for a benefit is denied in whole or in part, you must receive a written explanation of the reason for the denial. You have the right to have the Plan Administrator review and reconsider your claim. Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request certain materials from the plan and do not receive them within 31 days, you may file suit in a federal court to enforce your rights. In such a case, the court may require the Plan Administrator to pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Plan Administrator. If you have a claim for benefits which is denied or ignored in whole or in part, you may file suit in a state or federal court. If it should happen that plan fiduciaries misuse the plan’s money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, for example if it finds your claim is frivolous. If you have any questions about this plan, you should contact the Plan Administrator. If you have any questions about this statement or your rights under ERISA, you should contact the nearest Area Office of the Employee Benefits Security Administration, U.S. Department of Labor, as listed in the telephone directory, or contact the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Ave., N.W., Washington, D.C., 20210.

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JHHSC/JHH’s Rights

The benefit plans described in this SPD are for non-bargaining unit employees only. The Johns Hopkins Health System Corporation/The Johns Hopkins Hospital expects to continue these plans indefinitely, but reserves the right to amend or terminate any plan at any time, and for any reason without prior notification. You will be notified of any changes to these plans and how they affect your benefits, if at all. The plans described in this SPD are governed by contracts and plan documents, which are available for examination in the HR Service Center. You should not rely on any oral descriptions of the plans, since the written descriptions in this SPD will always govern. To the extent any benefit under a plan is provided by an insurance policy, no benefits are provided by the plan except for those benefits, if any, which are paid by the insurance company which issues the policy. Not A Contract Of Employment This SPD and the plans described in this SPD do not constitute a contract of employment. You have the right to terminate your employment at any time. JHHSC/JHH retains the same right regardless of any other documents or oral or written statements issued by the employer or its representatives. Plan Administrator’s Authority

The Plan Administrator has discretionary authority to interpret the terms of the benefit plans described in this SPD and to decide any questions of fact which relate to entitlement to benefits under the plans. For More Information

If you have questions, you can speak with an EHP Customer Service Representative by calling 800-261-2393 or 410-424-4450. Or, contact the HR Service Center.

Life and Accidental Death & Dismemberment

Insurance

CC.FP-2 CC.FP-1 (1/1/2010) 1

CERTIFICATE OF COVERAGE The Group Insurance Policy providing coverage under this certificate was issued in a jurisdiction other than Maryland and may not provide all the benefits required by Maryland Law. Unum Life Insurance Company of America (referred to as Unum) welcomes you as a client. This is your certificate of coverage as long as you are eligible for coverage and you become insured. You will want to read it carefully and keep it in a safe place. Unum has written your certificate of coverage in plain English. However, a few terms and provisions are written as required by insurance law. If you have any questions about any of the terms and provisions, please consult Unum's claims paying office. Unum will assist you in any way to help you understand your benefits. If the terms and provisions of the certificate of coverage (issued to you) are different from the Summary of Benefits (issued to the Employer), the Summary of Benefits will govern. The Summary of Benefits may be changed in whole or in part. Only an officer or registrar of Unum can approve a change. The approval must be in writing and endorsed on or attached to the Summary of Benefits. Any other person, including an agent, may not change the Summary of Benefits or waive any part of it. The Summary of Benefits is delivered in and is governed by the laws of the governing jurisdiction and to the extent applicable by the Employee Retirement Income Security Act of 1974 (ERISA) and any amendments. When making a benefit determination under the Summary of Benefits, Unum has discretionary authority to determine your eligibility for benefits and to interpret the terms and provisions of the Summary of Benefits. For purposes of effective dates and ending dates under the group Summary of Benefits, all days begin at 12:01 a.m. and end at 12:00 midnight standard time at the Employer's address.

Unum Life Insurance Company of America 2211 Congress Street Portland, Maine 04122

TOC-1 (1/1/2010) 2

TABLE OF CONTENTS

BENEFITS AT A GLANCE..........................................................................................B@G-LIFE-1

LIFE INSURANCE PLAN............................................................................................B@G-LIFE-1

BENEFITS AT A GLANCE..........................................................................................B@G-AD&D-1

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE PLAN ........................B@G-AD&D-1

CLAIM INFORMATION...............................................................................................LIFE-CLM-1

LIFE INSURANCE......................................................................................................LIFE-CLM-1

CLAIM INFORMATION...............................................................................................AD&D-CLM-1

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE ..................................AD&D-CLM-1

GENERAL PROVISIONS ...........................................................................................EMPLOYEE-1

LIFE INSURANCE......................................................................................................LIFE-BEN-1

BENEFIT INFORMATION...........................................................................................LIFE-BEN-1

OTHER BENEFIT FEATURES ...................................................................................LIFE-OTR-1

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE ..................................AD&D-BEN-1

BENEFIT INFORMATION...........................................................................................AD&D-BEN-1

OTHER BENEFIT FEATURES ...................................................................................AD&D-OTR-1

GLOSSARY ...............................................................................................................GLOSSARY-1

B@G-LIFE-1 (1/1/2010) 3

BENEFITS AT A GLANCE

LIFE INSURANCE PLAN

This life insurance plan provides financial protection for your beneficiary(ies) by paying a benefit in the event of your death. The amount your beneficiary(ies) receive(s) is based on the amount of coverage in effect just prior to the date of your death according to the terms and provisions of the plan. You also have the opportunity to have coverage for your dependents. EMPLOYER'S ORIGINAL PLAN EFFECTIVE DATE: January 1, 2003 PLAN YEAR:

January 1, 2003 to January 1, 2004 and each following January 1 to January 1 IDENTIFICATION NUMBER: 573627 012 ELIGIBLE GROUP(S):

All full-time eligible, non-represented Employees of The Johns Hopkins Hospital, The Johns Hopkins Health System Corporation, The Johns Hopkins Home Care Group, Inc., Johns Hopkins Pharmaquip, Inc., Johns Hopkins Pediatrics At Home Inc., Johns Hopkins Home Health Services, Inc., and the Triad Corporation, including weekend option Nurses, but excluding temporary and seasonal employees, in active employment in the United States with the Employer

MINIMUM HOURS REQUIREMENT:

Employees must be working at least 20 hours per week.

WAITING PERIOD:

For employees in an eligible group on or before January 1, 2003: None For employees entering an eligible group after January 1, 2003: First of the month following the date you enter an eligible group

WHO PAYS FOR THE COVERAGE:

For You:

Basic Benefit:

Your Employer pays the cost of your coverage.

Additional Benefit:

You pay the cost of your coverage. For Your Dependents:

You pay the cost of your dependent coverage.

ELIMINATION PERIOD:

Premium Waiver: 180 days Disability-based benefits begin the day after Unum approves your claim and the elimination period is completed.

B@G-LIFE-2 (1/1/2010) 4

LIFE INSURANCE BENEFIT:

AMOUNT OF LIFE INSURANCE FOR YOU

BASIC BENEFIT

1 x annual earnings, rounded to the next higher multiple of $1,000, if not already an exact multiple thereof, to a maximum of $300,000.

ADDITIONAL BENEFIT OPTIONS: Option A 1 x annual earnings, rounded to the next higher multiple of $1,000, if not already an exact multiple thereof, to a maximum of $450,000.

Option B 2 x annual earnings, rounded to the next higher multiple of $1,000, if not already an exact multiple thereof, to a maximum of $450,000.

AMOUNT OF LIFE INSURANCE AVAILABLE IF YOU BECOME INSURED AT CERTAIN AGES OR HAVE REACHED CERTAIN AGES WHILE INSURED

If you have reached age 65, but not age 70, your amount of life insurance will be 65% of the amount of life insurance you had prior to age 65. If you have reached age 70 or more, your amount of life insurance will be 50% of the amount of life insurance you had prior to your first reduction. Any increases or decreases in the amount of your insurance due to a change in your annual earnings will be added or subtracted from the original amount in force prior to age 65 and the recalculated amount will be reduced according to the above reductions. Should you become insured on or after age 65, the reduction shown above will be applied to your amount of insurance.

EVIDENCE OF INSURABILITY IS NOT REQUIRED FOR ANY AMOUNT OF INSURANCE DURING THE INITIAL ENROLLMENT ELIGIBILITY PERIOD OR WITHIN 31 DAYS OF YOUR ELIGIBILITY DATE

OVERALL MAXIMUM BENEFIT OF LIFE INSURANCE FOR YOU (BASIC AND ADDITIONAL BENEFITS COMBINED):

$750,000

AMOUNT OF LIFE INSURANCE FOR YOUR DEPENDENTS

Spouse: $10,000 Children:

Live birth through the end of the calendar year in which your child(ren) turn age 25: $5,000

THE AMOUNT OF LIFE INSURANCE FOR A DEPENDENT WILL NOT BE MORE THAN 100% OF YOUR AMOUNT OF LIFE INSURANCE.

SOME LOSSES MAY NOT BE COVERED UNDER THIS PLAN - refer to page LIFE-BEN-6 for more information.

B@G-LIFE-3 (1/1/2010) 5

OTHER FEATURES:

Accelerated Benefit Conversion

Portability

The above items are only highlights of this plan. For a full description of your coverage, continue reading your certificate of coverage section.

B@G-AD&D-1 (1/1/2010) 6

BENEFITS AT A GLANCE

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE PLAN This accidental death and dismemberment insurance plan provides financial protection for your beneficiary(ies) by paying a benefit in the event of your death or for you in the event of any other covered loss. The amount you or your beneficiary(ies) receive(s) is based on the amount of coverage in effect just prior to the date of your death or any other covered loss according to the terms and provisions of the plan. EMPLOYER'S ORIGINAL PLAN EFFECTIVE DATE: January 1, 2010 PLAN YEAR:

January 1, 2010 to January 1, 2011 and each following January 1 to January 1 IDENTIFICATION NUMBER: 573627 012 ELIGIBLE GROUP(S):

All full-time eligible, non-represented Employees of The Johns Hopkins Hospital, The Johns Hopkins Health System Corporation, The Johns Hopkins Home Care Group, Inc., Johns Hopkins Pharmaquip, Inc., Johns Hopkins Pediatrics At Home Inc., Johns Hopkins Home Health Services, Inc., and the Triad Corporation, including weekend option Nurses, but excluding temporary and seasonal employees, in active employment in the United States with the Employer

MINIMUM HOURS REQUIREMENT:

Employees must be regularly scheduled to work at least 20 hours per week. WAITING PERIOD:

For employees in an eligible group on or before January 1, 2010: None For employees entering an eligible group after January 1, 2010: First of the month following the date you enter an eligible group

WHO PAYS FOR THE COVERAGE:

Basic Benefit:

Your Employer pays the cost of your coverage.

Additional Benefit:

You pay the cost of your coverage.

ACCIDENTAL DEATH AND DISMEMBERMENT BENEFIT: AMOUNT OF ACCIDENTAL DEATH AND DISMEMBERMENT (AD&D) INSURANCE FOR YOU (FULL AMOUNT)

BASIC BENEFIT

1 x annual earnings, rounded to the next higher multiple of $1,000, if not already an exact multiple thereof, to a maximum of $300,000.

ADDITIONAL BENEFIT OPTIONS: Option A

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1 x annual earnings, rounded to the next higher multiple of $1,000, if not already an exact multiple thereof, to a maximum of $450,000.

Option B 2 x annual earnings, rounded to the next higher multiple of $1,000, if not already an exact multiple thereof, to a maximum of $450,000.

AMOUNT OF ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE AVAILABLE IF YOU BECOME INSURED AT CERTAIN AGES OR HAVE REACHED CERTAIN AGES WHILE INSURED

If you have reached age 65, but not age 70, your amount of AD&D insurance will be 65% of the amount of AD&D insurance you had prior to age 65. If you have reached age 70 or more, your amount of AD&D insurance will be 50% of the amount of life insurance you had prior to your first reduction. Any increases or decreases in the amount of your insurance due to a change in your annual earnings will be added or subtracted from the original amount in force prior to age 65 and the recalculated amount will be reduced according to the above reductions. Should you become insured on or after age 65, the reduction shown above will be applied to your amount of insurance.

REPATRIATION BENEFIT FOR YOU

Maximum Benefit Amount: Up to $5,000 The Repatriation Benefit is separate from any accidental death and dismemberment benefit which may be payable. To receive the Repatriation Benefit, your accidental death benefit must be paid first. SEATBELT(S) AND AIR BAG BENEFIT FOR YOU Benefit Amount: Seatbelt(s): 10% of the Full Amount of your accidental death and dismemberment insurance benefit. Air Bag: 5% of the Full Amount of your accidental death and dismemberment insurance benefit.

Maximum Benefit Payment: Seatbelt(s): $25,000 Air bag: $5,000 The Seatbelt(s) and Air Bag Benefit is separate from any accidental death and dismemberment benefit which may be payable. To receive the Seatbelt(s) and Air Bag Benefit, your accidental death benefit must be paid first. EDUCATION BENEFIT Each Qualified Child Benefit Amount per Academic Year for which a Qualified Child is enrolled: 6% of the Full Amount of the employee's accidental death and dismemberment insurance to a maximum of $6,000. Maximum Benefit Payments: 4 per lifetime

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Maximum Benefit Amount: $24,000 Maximum Benefit Period: 6 years from the date the first benefit payment has been made.

The Education Benefit is separate from any accidental death and dismemberment benefit which may be payable. In order for your Qualified Child to receive the Education Benefit, your accidental death benefit must be paid first. EXPOSURE AND DISAPPEARANCE BENEFIT FOR YOU

Maximum Benefit Amount: The Full Amount subject to Covered Loss Amounts

COMA BENEFIT FOR YOU

Monthly Benefit Amount: 1% of the Full Amount of your accidental death and dismemberment insurance benefit Maximum Number of Months: 100 months

HUMAN IMMUNODEFICIENCY VIRUS BENEFIT FOR YOU Maximum Benefit Amount: 20% of the Full Amount of your accidental death and dismemberment insurance benefit. This benefit will be paid in equal monthly installments. Maximum Number of Installments: 24 equal monthly installments

SOME LOSSES MAY NOT BE COVERED UNDER THIS PLAN.

OTHER FEATURES:

Portability

The above items are only highlights of this plan. For a full description of your coverage, continue reading your certificate of coverage section.

LIFE-CLM-1 (1/1/2010) 9

CLAIM INFORMATION

LIFE INSURANCE WHEN DO YOU OR YOUR AUTHORIZED REPRESENTATIVE NOTIFY UNUM OF A CLAIM?

We encourage you or your authorized representative to notify us as soon as possible, so that a claim decision can be made in a timely manner. If a claim is based on your disability, written notice and proof of claim must be sent no later than 90 days after the end of the elimination period. If a claim is based on death, written notice and proof of claim must be sent no later than 90 days after the date of death. If it is not possible to give proof within these time limits, it must be given no later than 1 year after the proof is required as specified above. These time limits will not apply during any period you or your authorized representative lacks the legal capacity to give us proof of claim. The claim form is available from your Employer, or you or your authorized representative can request a claim form from us. If you or your authorized representative does not receive the form from Unum within 15 days of the request, send Unum written proof of claim without waiting for the form. If you have a disability, you must notify us immediately when you return to work in any capacity, regardless of whether you are working for your Employer.

HOW DO YOU FILE A CLAIM FOR A DISABILITY?

You or your authorized representative, and your Employer must fill out your own sections of the claim form and then give it to your attending physician. Your physician should fill out his or her section of the form and send it directly to Unum.

WHAT INFORMATION IS NEEDED AS PROOF OF YOUR CLAIM?

If your claim is based on your disability, your proof of claim, provided at your expense, must show: - that you are under the regular care of a physician; - the date your disability began; - the cause of your disability; - the extent of your disability, including restrictions and limitations preventing you

from performing your regular occupation or any gainful occupation; and - the name and address of any hospital or institution where you received

treatment, including all attending physicians.

We may request that you send proof of continuing disability indicating that you are under the regular care of a physician. This proof, provided at your expense, must be received within 45 days of a request by us.

LIFE-CLM-2 (1/1/2010) 10

If claim is based on death, proof of claim, provided at your or your authorized representative's expense, must show the cause of death. Also a copy of the death certificate must be given to us.

In some cases, you will be required to give Unum authorization to obtain additional medical and non-medical information as part of your proof of claim or proof of continuing disability. Unum will deny your claim if the appropriate information is not submitted.

WHEN CAN UNUM REQUEST AN AUTOPSY?

In the case of death, Unum, at its own expense, will have the right and opportunity to request an autopsy where not forbidden by law.

HOW DO YOU DESIGNATE OR CHANGE A BENEFICIARY? (Beneficiary Designation)

At the time you become insured, you should name a beneficiary on your enrollment form for your death benefits under your life insurance. You may change your beneficiary at any time by filing a form approved by Unum with your Employer. The new beneficiary designation will be effective as of the date you sign that form. However, if we have taken any action or made any payment before your Employer receives that form, that change will not go into effect.

It is important that you name a beneficiary and keep your designation current. If more than one beneficiary is named and you do not designate their order or share of payments, the beneficiaries will share equally. The share of a beneficiary who dies before you, or the share of a beneficiary who is disqualified, will pass to any surviving beneficiaries in the order you designated. If you do not name a beneficiary, or if all named beneficiaries do not survive you, or if your named beneficiary is disqualified, your death benefit will be paid to your estate. Instead of making a death payment to your estate, Unum has the right to make payment to the first surviving family members of the family members in the order listed below: - spouse; - child or children; - mother or father; or - sisters or brothers.

If we are to make payments to a beneficiary who lacks the legal capacity to give us a release, Unum may pay up to $2,000 to the person or institution that appears to have assumed the custody and main support of the beneficiary. This payment made in good faith satisfies Unum's legal duty to the extent of that payment and Unum will not have to make payment again. Also, at Unum's option, we may pay up to $1,000 to the person or persons who, in our opinion, have incurred expenses for your last sickness and death.

LIFE-CLM-3 (1/1/2010) 11

In addition, if you do not survive your spouse, and dependent life coverage is continued, then your surviving spouse should name a beneficiary according to the requirements specified above for you.

HOW WILL UNUM MAKE PAYMENTS?

If your or your dependent's life claim is at least $10,000, Unum will make available to the beneficiary a retained asset account (the Unum Security Account).

Payment for the life claim may be accessed by writing a draft in a single sum or drafts in smaller sums. The funds for the draft or drafts are fully guaranteed by Unum. If the life claim is less than $10,000, Unum will pay it in one lump sum to you or your beneficiary. Also, you or your beneficiary may request the life claim to be paid according to one of Unum's other settlement options. This request must be in writing in order to be paid under Unum's other settlement options. If you do not survive your spouse, and dependent life coverage is continued, then your surviving spouse's death claim will be paid to your surviving spouse's beneficiary. All other benefits will be paid to you.

WHAT HAPPENS IF UNUM OVERPAYS YOUR CLAIM?

Unum has the right to recover any overpayments due to: - fraud; and - any error Unum makes in processing a claim. You must reimburse us in full. We will determine the method by which the repayment is to be made. Unum will not recover more money than the amount we paid you.

WHAT ARE YOUR ASSIGNABILITY RIGHTS FOR THE DEATH BENEFITS UNDER YOUR LIFE INSURANCE? (Assignability Rights)

The rights provided to you by the plan for life insurance are owned by you, unless:

- you have previously assigned these rights to someone else (known as an "assignee"); or

- you assign your rights under the plan(s) to an assignee. We will recognize an assignee as the owner of the rights assigned only if: - the assignment is in writing, signed by you, and acceptable to us in form; and - a signed or certified copy of the written assignment has been received and

registered by us at our home office.

LIFE-CLM-4 (1/1/2010) 12

We will not be responsible for the legal, tax or other effects of any assignment, or for any action taken under the plan(s') provisions before receiving and registering an assignment.

AD&D-CLM-1 (1/1/2010) 13

CLAIM INFORMATION

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE WHEN DO YOU OR YOUR AUTHORIZED REPRESENTATIVE NOTIFY UNUM OF A CLAIM?

We encourage you or your authorized representative to notify us as soon as possible, so that a claim decision can be made in a timely manner. If a claim is based on death or other covered loss, written notice and proof of claim must be sent no later than 90 days after the date of death or the date of any other covered loss. If a claim is based on the Education Benefit, written notice and proof of claim must be sent no later than 60 days after the date of your death. If it is not possible to give proof within these time limits, it must be given no later than 1 year after the time proof is required as specified above. These time limits will not apply during any period you or your authorized representative lacks the legal capacity to give us proof of claim. The claim form is available from your Employer, or you or your authorized representative can request a claim form from us. If you or your authorized representative does not receive the form from Unum within 15 days of your request, send Unum written proof of claim without waiting for the form.

HOW DO YOU FILE A CLAIM FOR A COVERED LOSS?

You or your authorized representative and your Employer must fill out your own sections of the claim form and then give it to your attending physician. Your physician should fill out his or her section of the form and send it directly to Unum.

WHAT INFORMATION IS NEEDED AS PROOF OF CLAIM?

If claim is based on death or other covered loss, proof of claim for death or covered loss, provided at your or your authorized representative's expense, must show: - the cause of death or covered loss; - the extent of the covered loss; - the date of covered loss; and - the name and address of any hospital or institution where treatment was

received, including all attending physicians.

Also, in case of death, a certified copy of the death certificate must be given to us. In some cases, you will be required to give Unum authorization to obtain additional medical and non-medical information as part of your proof of claim. Unum will deny your claim if the appropriate information is not submitted. If a claim is based on the Education Benefit, proof of claim, provided at your authorized representative's expense, must show:

AD&D-CLM-2 (1/1/2010) 14

- the date of enrollment of your qualified child in an accredited post-secondary institution of higher learning;

- the name of the institution; - a list of courses for the current academic term; and - the number of credit hours for the current academic term.

WHEN CAN UNUM REQUEST AN AUTOPSY?

In the case of death, Unum, at its own expense, will have the right and opportunity to request an autopsy where not forbidden by law.

HOW DO YOU DESIGNATE OR CHANGE A BENEFICIARY? (Beneficiary Designation)

At the time you become insured, you should name a beneficiary on your enrollment form for your death benefits under your accidental death and dismemberment insurance. You may change your beneficiary at any time by filing a form approved by Unum with your Employer. The new beneficiary designation will be effective as of the date you sign that form. However, if we have taken any action or made any payment before your Employer receives that form, that change will not go into effect.

It is important that you name a beneficiary and keep your designation current. If more than one beneficiary is named and you do not designate their order or share of payments, the beneficiaries will share equally. The share of a beneficiary who dies before you, or the share of a beneficiary who is disqualified, will pass to any surviving beneficiaries in the order you designated. If you do not name a beneficiary, or if all named beneficiaries do not survive you, or if your named beneficiary is disqualified, your death benefit will be paid to your estate. Instead of making a death payment to your estate, Unum has the right to make payment to the first surviving family members of the family members in the order listed below: - spouse; - child or children; - mother or father; or - sisters or brothers.

If we are to make payments to a beneficiary who lacks the legal capacity to give us a release, Unum may pay up to $2,000 to the person or institution that appears to have assumed the custody and main support of the beneficiary. This payment made in good faith satisfies Unum's legal duty to the extent of that payment and Unum will not have to make payment again. Also, at Unum's option, we may pay up to $1,000 to the person or persons who, in our opinion, have incurred expenses for your last sickness and death.

AD&D-CLM-3 (1/1/2010) 15

HOW WILL UNUM MAKE PAYMENTS?

If your accidental death or dismemberment claim is at least $10,000 Unum will make available to you or your beneficiary a retained asset account (the Unum Security Account).

Payment for the accidental death or dismemberment claim may be accessed by writing a draft in a single sum or drafts in smaller sums. The funds for the draft or drafts are fully guaranteed by Unum. If the accidental death or dismemberment claim is less than $10,000, Unum will pay it in one lump sum to you or your beneficiary. Also, your beneficiary may request the accidental death claim to be paid according to one of Unum's other settlement options. This request must be in writing in order to be paid under Unum's other settlement options.

The Education Benefit will be paid to your qualified child or the qualified child's legal representative.

All other benefits will be paid to you.

WHAT HAPPENS IF UNUM OVERPAYS YOUR CLAIM?

Unum has the right to recover any overpayments due to: - fraud; and - any error Unum makes in processing a claim. You must reimburse us in full. We will determine the method by which the repayment is to be made. Unum will not recover more money than the amount we paid you.

WHAT ARE YOUR ASSIGNABILITY RIGHTS FOR THE DEATH BENEFITS UNDER YOUR ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE BENEFITS? (Assignability Rights)

The rights provided to you by the plan(s) for accidental death insurance benefits are owned by you, unless:

- you have previously assigned these rights to someone else (known as an

"assignee"); or - you assign your rights under the plan(s) to an assignee. We will recognize an assignee as the owner of the rights assigned only if: - the assignment is in writing, signed by you, and acceptable to us in form; and - a signed or certified copy of the written assignment has been received and

registered by us at our home office. We will not be responsible for the legal, tax or other effects of any assignment, or for any action taken under the plan(s') provisions before receiving and registering an assignment.

EMPLOYEE-1 (1/1/2010) 16

GENERAL PROVISIONS

WHAT IS THE CERTIFICATE OF COVERAGE?

This certificate of coverage is a written statement prepared by Unum and may include attachments. It tells you: - the coverage for which you may be entitled; - to whom Unum will make a payment; and - the limitations, exclusions and requirements that apply within a plan.

WHEN ARE YOU ELIGIBLE FOR COVERAGE?

If you are working for your Employer in an eligible group, the date you are eligible for coverage is the later of: - the plan effective date; or - the day after you complete your waiting period.

WHEN DOES YOUR COVERAGE BEGIN?

This plan provides different benefit options in addition to the basic benefit. When you first become eligible for coverage, you may apply for any option, however, you cannot be covered under more than one option at a time. Evidence of insurability is required for any amount of life insurance over the amount shown in the LIFE INSURANCE "BENEFITS AT A GLANCE" page. Your Employer pays 100% of the cost of your coverage under the basic benefit. You will automatically be covered under the basic benefit at 12:01 a.m. standard time on the date you are eligible for coverage.

When you and your Employer share the cost of your coverage for any option under a plan or when you pay 100% of the cost yourself for any option, you will be covered at 12:01 a.m. standard time on the latest of: - the date you are eligible for coverage, if you apply for insurance on or before that

date or within 31 days after your eligibility date; or - the date Unum approves your application, if evidence of insurability is required.

WHEN CAN YOU APPLY FOR ADDITIONAL BENEFIT OPTIONS IF YOU APPLY MORE THAN 31 DAYS AFTER YOUR ELIGIBILITY DATE? (LATE ENTRANTS)

You can apply for additional benefit options only during an annual enrollment period or within 31 days of a change in status. Evidence of insurability is required for any amount of insurance. Unum and your Employer determine when the annual enrollment period begins and ends. Coverage will begin at 12:01 a.m. standard time on the date Unum approves your evidence of insurability form.

EMPLOYEE-2 (1/1/2010) 17

WHEN CAN YOU CHANGE YOUR COVERAGE BY CHOOSING ANOTHER ADDITIONAL BENEFIT OPTION? (This does not apply to Late Entrants)

You can change your coverage by applying for a different additional benefit option only during an annual enrollment period or within 31 days of a change in status.

You can decrease your coverage any number of levels. Evidence of insurability is required if you increase your coverage by any level. If you are not approved for the increase in your coverage, you will automatically remain at the same level you had prior to applying for the increase. Unum and your Employer determine when the annual enrollment period begins and ends. A change in coverage that is made during an annual enrollment period will begin at 12:01 a.m. standard time on the later of: - the first day of the next plan year; or - the date Unum approves your evidence of insurability form, if evidence of

insurability is required.

A change in coverage due to change in status will begin at 12:01 a.m. standard time on the latest of: - the date of the change in status, if you apply on or before that date; or - the date you apply, if you apply within 31 days after the date of the change in

status; or - the date Unum approves your evidence of insurability form, if evidence of

insurability is required. Changes in coverage must be consistent with the change in status.

If you end employment and are rehired within the same plan year, you may be insured on your eligibility date for the coverage that you had under the plan when you ended employment. You cannot change your coverage until the next annual enrollment period or change in status. An evidence of insurability form can be obtained from your Employer.

WHAT IF YOU ARE ABSENT FROM WORK ON THE DATE YOUR COVERAGE WOULD NORMALLY BEGIN?

If you are absent from work due to injury, sickness, temporary layoff or leave of absence, your coverage will begin on the date you return to active employment.

ONCE YOUR COVERAGE BEGINS, WHAT HAPPENS IF YOU ARE NOT WORKING DUE TO INJURY OR SICKNESS?

If you are not working due to injury or sickness, and if premium is paid, you may continue to be covered for up to one year.

EMPLOYEE-3 (1/1/2010) 18

ONCE YOUR COVERAGE BEGINS, WHAT HAPPENS IF YOU ARE TEMPORARILY NOT WORKING?

If you are on a temporary layoff, and if premium is paid, you will be covered through the end of the month that immediately follows the month in which your temporary layoff begins.

If you are on a leave of absence, and if premium is paid, you will be covered through the end of the month that immediately follows the month in which your leave of absence begins.

WHAT HAPPENS TO YOUR COVERAGE UNDER THE SUMMARY OF BENEFITS WHILE YOU ARE ON A FAMILY AND MEDICAL LEAVE OF ABSENCE?

We will continue your coverage in accordance with your Employer's Human Resource policy on family and medical leaves of absence if premium payments continue and your Employer approved your leave in writing. Coverage will be continued until the end of the latest of: - the leave period required by the federal Family and Medical Leave Act of 1993,

and any amendments; or - the leave period required by applicable state law; or - the leave period provided to you for injury or sickness. If your Employer's Human Resource policy doesn't provide for continuation of a plan for you during a family and medical leave of absence, your coverage will be reinstated when you return to active employment. We will not: - apply a new waiting period; or - require evidence of insurability.

WHEN WILL CHANGES TO YOUR COVERAGE TAKE EFFECT?

Once your coverage begins, any increased or additional coverage due to a change in your annual earnings will take effect immediately and will not require evidence of insurability. Any increased or additional coverage due to a plan change requested by your Employer will take effect immediately or on the date Unum approves your evidence of insurability form, if evidence of insurability is required. If you are not in active employment due to injury or sickness, any increased or additional coverage due to a change in your annual earnings or due to a plan change will begin on the date you return to active employment. Any decrease in coverage will take effect immediately but will not affect a payable claim that occurs prior to the decrease.

WHEN DOES YOUR COVERAGE END?

Your coverage under the Summary of Benefits or a plan ends on the earliest of: - the date the Summary of Benefits or a plan is cancelled;

EMPLOYEE-4 (1/1/2010) 19

- the date you no longer are in an eligible group; - the date your eligible group is no longer covered; - the last day of the period for which you made any required contributions; or - the last day you are in active employment unless continued due to a covered layoff

or leave of absence or due to an injury or sickness, as described in this certificate of coverage.

Unum will provide coverage for a payable claim which occurs while you are covered under the Summary of Benefits or plan.

WHEN ARE YOU ELIGIBLE TO ELECT DEPENDENT COVERAGE?

If you elect coverage for yourself or are insured under the plan, you are eligible to elect dependent coverage for your spouse only, your dependent children only or both.

WHEN ARE YOUR DEPENDENTS ELIGIBLE FOR COVERAGE?

The date your dependents are eligible for coverage is the later of: - the date your insurance begins; or - the date you first acquire a dependent.

WHAT DEPENDENTS ARE ELIGIBLE FOR COVERAGE?

The following dependents are eligible for coverage under the plan: - Your lawful spouse, including a legally separated spouse. You may cover your

spouse as a dependent if your spouse is enrolled for coverage as an employee. "Spouse" wherever used includes domestic partner. - Your domestic partner. Your domestic partner is the person named in your

declaration of domestic partnership. You must execute and provide the plan administrator with such a declaration which states and gives proof that the domestic partner has had the same permanent residence as you for a minimum of 6 consecutive months prior to the date insurance would become effective for that domestic partner. You must not have signed a declaration of domestic partnership with anyone else within the last 6 months of signing the latest declaration of domestic partnership. Also, the domestic partner must be at least 18 years of age, competent to contract, not related by blood closer than would bar marriage, the sole named domestic partner, not married to anyone else and the declaration of domestic partnership must be approved and recorded by the plan administrator. You may not cover your domestic partner as a dependent if your domestic partner is enrolled for coverage as an employee.

- Your unmarried children from live birth. Eligible dependent children are covered through the end of the year in which they turn age 25. Stillborn children are not eligible for coverage. Children include your own natural offspring, lawfully adopted children and stepchildren. They also include foster children and other children who are dependent on you for main support and living with you in a regular parent-child

EMPLOYEE-5 (1/1/2010) 20

relationship. A child will be considered adopted on the date of placement in your home. No dependent child can be covered as both an employee and a dependent.

WHEN DOES YOUR DEPENDENT COVERAGE BEGIN?

This plan provides different benefit options for your dependents. When your dependents become eligible for coverage, you may apply for any dependent option. However, your dependents cannot be covered under more than one option at a time. When you and your Employer share the cost of your dependent coverage for any option under a plan or when you pay 100% of the cost yourself for any option, your dependents will be covered at 12:01 a.m. standard time on the later of: - the date your dependents are eligible for coverage, if you apply for insurance on or

before that date; or - the date you apply for dependent insurance, if you apply within 31 days after your dependents' eligibility date.

WHEN CAN YOU APPLY FOR DEPENDENT COVERAGE IF YOU APPLY MORE THAN 31 DAYS AFTER YOUR DEPENDENTS' ELIGIBILITY DATE? (Late Entrants)

You can apply for dependent coverage only during an annual enrollment period or within 31 days of a change in status. Evidence of insurability is required for any amount of dependent life insurance. Unum and your Employer determine when the annual enrollment period begins and ends. Dependent coverage will begin at 12:01 a.m. standard time on the date Unum approves your dependent's evidence of insurability form.

WHEN CAN YOU CANCEL YOUR DEPENDENT COVERAGE?

You can cancel your dependent coverage at any time. A cancellation will take effect immediately but will not affect a payable claim that occurs prior to the cancellation.

WHAT IF YOUR DEPENDENT IS TOTALLY DISABLED ON THE DATE YOUR DEPENDENT'S COVERAGE WOULD NORMALLY BEGIN?

If your eligible dependent is totally disabled, your dependent's coverage will begin on the date your eligible dependent no longer is totally disabled. This provision does not apply to a newborn child while dependent insurance is in effect.

WHEN WILL CHANGES TO YOUR DEPENDENT'S COVERAGE TAKE EFFECT?

Once your dependent's coverage begins, any increased or additional dependent coverage due to a plan change requested by your Employer will take effect immediately or on the date Unum approves your dependent's evidence of insurability form, if evidence of insurability is required, provided your dependent is not totally disabled. You must be in active employment or on a covered layoff or leave of absence.

EMPLOYEE-6 (1/1/2010) 21

If you are not in active employment due to injury or sickness, any increased or additional dependent coverage due to a plan change will begin on the date you return to active employment. If your dependent is totally disabled, any increased or additional dependent coverage will begin on the date your dependent is no longer totally disabled. Any decreased coverage will take effect immediately but will not affect a payable claim that occurs prior to the decrease.

WHEN DOES YOUR DEPENDENT'S COVERAGE END?

Your dependent's coverage under the Summary of Benefits or a plan ends on the earliest of: - the date the Summary of Benefits or a plan is cancelled; - the date you no longer are in an eligible group; - the date your eligible group is no longer covered; - the date of your death; - the last day of the period for which you made any required contributions; or - the last day you are in active employment unless continued due to a covered layoff

or leave of absence or due to an injury or sickness, as described in this certificate of coverage.

Coverage for any one dependent will end on the earliest of: - the date your coverage under a plan ends; - the date your dependent ceases to be an eligible dependent; - for a spouse, the date of divorce or annulment; or - for a domestic partner, the date your domestic partnership ends. Unum will provide coverage for a payable claim which occurs while your dependents are covered under the Summary of Benefits or plan.

WILL COVERAGE CONTINUE FOR A CHILD AGE 19 OR OVER WHO BECAME DISABLED WHILE COVERED UNDER THE PLAN?

Coverage will be continued for a child age 19 or over who became physically or mentally disabled while covered under the plan provided: - the child is unmarried; - the disability was acquired before the child's coverage would have ended; - the child is incapable of self-support and remains so incapable; - you are the main source of support and maintenance. Unum must receive proof within 31 days of the date the child attains age 19 and as required during the first two years. After the first two years Unum will ask for proof when needed but not more than once a year.

EMPLOYEE-7 (1/1/2010) 22

WHAT ARE THE TIME LIMITS FOR LEGAL PROCEEDINGS?

You or your authorized representative can start legal action regarding a claim 60 days after proof of claim has been given and up to 3 years from the time proof of claim is required, unless otherwise provided under federal law.

HOW CAN STATEMENTS MADE IN YOUR APPLICATION FOR THIS COVERAGE BE USED?

Unum considers any statements you or your Employer make in a signed application for coverage or an evidence of insurability form a representation and not a warranty. If any of the statements you or your Employer make are not complete and/or not true at the time they are made, we can: - reduce or deny any claim; or - cancel your coverage from the original effective date. We will use only statements made in an application signed by the Employer, a copy of which has been given to the Employer, or an application or evidence of insurability form signed by you, a copy of which has been given to you or, in the event of your death or incapacity, your beneficiary, as a basis for doing this.

Except in the case of fraud, Unum can take action only in the first 2 years coverage is in force.

If the Employer gives us information about you that is incorrect, we will: - use the facts to decide whether you have coverage under the plan and in what

amounts; and - make a fair adjustment of the premium.

HOW WILL UNUM HANDLE INSURANCE FRAUD?

Unum wants to ensure you and your Employer do not incur additional insurance costs as a result of the undermining effects of insurance fraud. Unum promises to focus on all means necessary to support fraud detection, investigation, and prosecution. It is a crime if you knowingly, and with intent to injure, defraud or deceive Unum, or provide any information, including filing a claim, that contains any false, incomplete or misleading information. These actions, as well as submission of materially false information, will result in denial of your claim, and are subject to prosecution and punishment to the full extent under state and/or federal law. Unum will pursue all appropriate legal remedies in the event of insurance fraud.

DOES THE SUMMARY OF BENEFITS REPLACE OR AFFECT ANY WORKERS' COMPENSATION OR STATE DISABILITY INSURANCE?

The Summary of Benefits does not replace or affect the requirements for coverage by any workers' compensation or state disability insurance.

EMPLOYEE-8 (1/1/2010) 23

DOES YOUR EMPLOYER ACT AS YOUR AGENT OR UNUM'S AGENT?

For the purposes of the Summary of Benefits, your Employer acts on its own behalf or as your agent. Under no circumstances will your Employer be deemed the agent of Unum.

LIFE-BEN-1 (1/1/2010) 24

LIFE INSURANCE

BENEFIT INFORMATION

WHEN WILL YOUR BENEFICIARY RECEIVE PAYMENT?

Your beneficiary(ies) will receive payment when Unum approves your death claim.

WHAT DOCUMENTS ARE REQUIRED FOR PROOF OF DEATH?

Unum will require a copy of the death certificate, enrollment documents and a Notice and Proof of Claim form.

HOW MUCH WILL UNUM PAY YOU IF UNUM APPROVES YOUR DEPENDENT'S DEATH CLAIM?

Unum will determine the payment according to the amount of insurance shown in the LIFE INSURANCE "BENEFITS AT A GLANCE" page.

HOW MUCH WILL UNUM PAY YOUR BENEFICIARY IF UNUM APPROVES YOUR DEATH CLAIM?

Unum will determine the payment according to the amount of insurance shown in the LIFE INSURANCE "BENEFITS AT A GLANCE" page.

WHAT ARE YOUR ANNUAL EARNINGS?

All Non-Union Employees of JHHSC/JHH "Annual Earnings" means your gross annual income from your Employer in effect just prior to the date of loss. It includes your total income before taxes plus shift differential pay. It is prior to any deductions made for pre-tax contributions to a qualified deferred compensation plan, Section 125 plan, or flexible spending account. It does not include income received from commissions, bonuses, overtime pay or any other extra compensation, or income received from sources other than your Employer.

All Employees of Johns Hopkins Community Physicians "Annual Earnings" means your gross annual income from your Employer in effect just prior to the date of loss. It includes your total income before taxes plus shift differential and geographical differential pay. It is prior to any deductions made for pre-tax contributions to a qualified deferred compensation plan, Section 125 plan, or flexible spending account. It does not include income received from commissions, bonuses, overtime pay or any other extra compensation, or income received from sources other than your Employer.

WHAT WILL WE USE FOR ANNUAL EARNINGS IF YOU BECOME DISABLED DURING A COVERED LAYOFF OR LEAVE OF ABSENCE?

If you become disabled while you are on a covered layoff or leave of absence, we will use your annual earnings from your Employer in effect just prior to the date your absence began.

LIFE-BEN-2 (1/1/2010) 25

WHAT HAPPENS TO YOUR LIFE INSURANCE COVERAGE IF YOU BECOME DISABLED?

Your life insurance coverage may be continued for a specific time and your life insurance premium will be waived if you qualify as described below.

HOW LONG MUST YOU BE DISABLED BEFORE YOU ARE ELIGIBLE TO HAVE LIFE PREMIUMS WAIVED?

You must be disabled through your elimination period. Your elimination period is 180 days.

WHEN WILL YOUR LIFE INSURANCE PREMIUM WAIVER BEGIN?

Your life insurance premium waiver will begin when we approve your claim, if the elimination period has ended and you meet the following conditions. Your Employer may continue premium payments until Unum notifies your Employer of the date your life insurance premium waiver begins. Your life insurance premium will be waived if you meet these conditions: - you are less than 60 and insured under the plan. - you become disabled and remain disabled during the elimination period. - you meet the notice and proof of claim requirements for disability while your life

insurance is in effect or within three months after it ends. - your claim is approved by Unum. After we approve your claim, Unum does not require further premium payments for you while you remain disabled according to the terms and provisions of the plan. Your life insurance amount will not increase while your life insurance premiums are being waived. Your life insurance amount will reduce or cease at any time it would reduce or cease if you had not been disabled.

WHEN WILL YOUR LIFE INSURANCE PREMIUM WAIVER END?

The life insurance premium waiver will automatically end if: - you recover and you no longer are disabled; - you fail to give us proper proof that you remain disabled; - you refuse to have an examination by a physician chosen by Unum; - you reach age 70; or - premium has been waived for 12 months and you are considered to reside outside

the United States. You will be considered to reside outside the United States when you have been outside the United States for a total period of 6 months or more during any 12 consecutive months for which premium has been waived.

HOW DOES UNUM DEFINE DISABILITY FOR LIFE PREMIUM WAIVER?

You are disabled when Unum determines that: - during the elimination period, you are not working in any occupation due to your

injury or sickness; and

LIFE-BEN-3 (1/1/2010) 26

- after the elimination period, due to the same injury or sickness, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by training, education or experience.

You must be under the regular care of a physician in order to be considered disabled.

The loss of a professional or occupational license or certification does not, in itself, constitute disability. We may require you to be examined by a physician, other medical practitioner or vocational expert of our choice. Unum will pay for this examination. We can require an examination as often as it is reasonable to do so. We may also require you to be interviewed by an authorized Unum Representative.

APPLYING FOR LIFE INSURANCE PREMIUM WAIVER Ask your Employer for a life insurance premium waiver claim form. The form has instructions on how to complete and where to send the claim.

WHAT INSURANCE IS AVAILABLE WHILE YOU ARE SATISFYING THE DISABILITY REQUIREMENTS? (See Conversion Privilege)

You may use this life conversion privilege when your life insurance terminates while you are satisfying the disability requirements. Please refer to the conversion privilege below. You are not eligible to apply for this life conversion if you return to work and, again, become covered under the plan. If an individual life insurance policy is issued to you, any benefit for your death under this plan will be paid only if the individual policy is returned for surrender to Unum. Unum will refund all premiums paid for the individual policy. The amount of your death benefit will be paid to your named beneficiary for the plan. If, however, you named a different beneficiary for the individual policy and the policy is returned to Unum for surrender, that different beneficiary will not be paid. If you want to name a different beneficiary for this group plan, you must change your beneficiary as described in the Beneficiary Designation page of this group plan.

WHAT INSURANCE IS AVAILABLE WHEN COVERAGE ENDS? (Conversion Privilege)

When coverage ends under the plan, you and your dependents can convert your coverages to individual life policies, without evidence of insurability. The maximum amounts that you can convert are the amounts you and your dependents are insured for under the plan. You may convert a lower amount of life insurance. You and your dependents must apply for individual life insurance under this life conversion privilege and pay the first premium within 31 days after the date: - your employment terminates; or - you or your dependents no longer are eligible to participate in the coverage of the

plan.

LIFE-BEN-4 (1/1/2010) 27

If you convert to an individual life policy, then return to work, and, again, become insured under the plan, you are not eligible to convert to an individual life policy again. However, you do not need to surrender that individual life policy when you return to work. Converted insurance may be of any type of the level premium whole life plans then in use by Unum. The person may elect one year of Preliminary Term insurance under the level premium whole life policy. The individual policy will not contain disability or other extra benefits.

WHAT LIMITED CONVERSION IS AVAILABLE IF THE SUMMARY OF BENEFITS OR THE PLAN IS CANCELLED? (Conversion Privilege)

You and your dependents may convert a limited amount of life insurance if you have been insured under your Employer's group plan with Unum for at least five (5) years and the Summary of Benefits or the plan: - is cancelled with Unum; or - changes so that you no longer are eligible. The individual life policy maximum for each of you will be the lesser of: - $10,000; or - your or your dependent's coverage amounts under the plan less any amounts that

become available under any other group life plan offered by your Employer within 31 days after the date the Summary of Benefits or the plan is cancelled.

PREMIUMS Premiums for the converted insurance will be based on: - the person's then attained age on the effective date of the individual life policy; - the type and amount of insurance to be converted; - Unum's customary rates in use at that time; and - the class of risk to which the person belongs. If the premium payment has been made, the individual life policy will be effective at the end of the 31 day conversion application period.

DEATH DURING THE THIRTY-ONE DAY CONVERSION APPLICATION PERIOD If you or your dependents die within the 31 day conversion application period, Unum will pay the beneficiary(ies) the amount of insurance that could have been converted. This coverage is available whether or not you have applied for an individual life policy under the conversion privilege.

EMPLOYER NOTICE Your Employer must notify each person of their conversion privileges 15 days before the date that person's life insurance terminates. If your Employer does not notify that person 15 days before that person's life insurance terminates, the time allowed for that person to exercise their life

LIFE-BEN-5 (1/1/2010) 28

conversion privilege will be extended 15 days from the date your Employer does notify that person. In no event will the time allowed for a person to exercise their life conversion privilege be extended beyond 60 days from the date that person's life insurance terminates. APPLYING FOR CONVERSION Ask your Employer for a conversion application form which includes cost information. When you complete the application, send it with the first premium amount to:

Unum - Conversion Unit 2211 Congress Street Portland, Maine 04122-1350 1-800-343-5406

WILL UNUM ACCELERATE YOUR OR YOUR DEPENDENT'S DEATH BENEFIT FOR THE PLAN IF YOU OR YOUR DEPENDENT BECOMES TERMINALLY ILL? (Accelerated Benefit)

Benefits paid may be taxable. Unum is not responsible for any tax or other effects of any benefit paid. As with all tax matters, you or your dependent should consult your personal tax advisor to assess the impact of this benefit. If you or your dependent becomes terminally ill while you or your dependent is insured by the plan, Unum will pay you a portion of your or your dependent's life insurance benefit one time. The payment will be based on 50% of your or your dependent's life insurance amount. However, the one-time benefit paid will not be greater than $750,000. Your or your dependent's right to exercise this option and to receive payment is subject to the following: - you or your dependent requests this election, in writing, on a form acceptable to

Unum; - you or your dependent must be terminally ill at the time of payment of the

Accelerated Benefit; - your or your dependent's physician must certify, in writing, that you or your

dependent is terminally ill and your or your dependent's life expectancy has been reduced to less than 12 months; and

- the physician's certification must be deemed satisfactory to Unum. The Accelerated Benefit is available on a voluntary basis. Therefore, you or your dependent is not eligible for benefits if: - you or your dependent is required by law to use this benefit to meet the claims of

creditors, whether in bankruptcy or otherwise; or - you or your dependent is required by a government agency to use this benefit in

order to apply for, get, or otherwise keep a government benefit or entitlement.

LIFE-BEN-6 (1/1/2010) 29

Premium payments must continue to be paid on the full amount of life insurance unless you qualify to have your life premium waived. Also, premium payments must continue to be paid on the full amount of your dependent's life insurance.

If you have assigned your rights under the plan to an assignee or made an irrevocable beneficiary designation, Unum must receive consent, in writing, that the assignee or irrevocable beneficiary has agreed to the Accelerated Benefit payment on your behalf in a form acceptable to Unum before benefits are payable. An election to receive an Accelerated Benefit will have the following effect on other benefits: - the death benefit payable will be reduced by any amount of Accelerated Benefit

that has been paid; and - any amount of life insurance that would be continued under a disability

continuation provision or that may be available under the conversion privilege will be reduced by the amount of the Accelerated Benefit paid. The remaining life insurance amount will be paid according to the terms of the Summary of Benefits subject to any reduction and termination provisions.

WHAT LOSSES ARE NOT COVERED UNDER YOUR PLAN?

Your plan does not cover any losses where death is caused by, contributed to by, or results from: - suicide occurring within 24 months after your or your dependent's initial effective

date of insurance; and - suicide occurring within 24 months after the date any increases or additional

insurance become effective for you or your dependent. The suicide exclusion will apply to any amounts of insurance for which you pay all or part of the premium. The suicide exclusion also will apply to any amount that is subject to evidence of insurability requirements and Unum approves the evidence of insurability form and the amount you or your dependent applied for at that time.

LIFE-OTR-1 (1/1/2010) 30

LIFE INSURANCE

OTHER BENEFIT FEATURES WHAT COVERAGE IS AVAILABLE IF YOU END EMPLOYMENT OR YOU WORK REDUCED HOURS? (Portability)

If your employment ends with or you retire from your Employer or you are working less than the minimum number of hours as described under Eligible Groups in this plan, you may elect portable coverage for yourself and your dependents. In case of your death, your insured dependents also may elect portable coverage for themselves. However, children cannot become insured for portable coverage unless the spouse also becomes insured for portable coverage. PORTABLE INSURANCE COVERAGE AND AMOUNTS AVAILABLE The portable insurance coverage will be the current coverage and amounts that you and your dependents are insured for under your Employer's group plan. However, the amount of portable coverage for you will not be more than: - the highest amount of life insurance available for employees under the plan; or - 5x your annual earnings; or - $750,000 from all Unum group life and accidental death and dismemberment

plans combined, whichever is less.

The amount of ported life insurance must be equal to or greater than the amount of ported accidental death and dismemberment insurance.

The amount of portable coverage for your spouse will not be more than: - the highest amount of life insurance available for spouses under the plan; or - 100% of your amount of portable coverage; or - $750,000 from all Unum group life and accidental death and dismemberment

plans combined, whichever is less.

The amount of ported life insurance must be equal to or greater than the amount of ported accidental death and dismemberment insurance.

The amount of portable coverage for a child will not be more than: - the highest amount of life insurance available for children under the plan; or - 100% of your amount of portable coverage; or - $20,000, whichever is less.

The amount of ported life insurance must be equal to or greater than the amount of ported accidental death and dismemberment insurance.

LIFE-OTR-2 (1/1/2010) 31

The minimum amount of coverage that can be ported is $5,000 for you and $1,000 for your dependents. If the current amounts under the plan are less than $5,000 for you and $1,000 for your dependents you and your dependents may port the lesser amounts. Your or your dependent's amount of life insurance will reduce or cease at any time it would reduce or cease for your eligible group if you had continued in active employment with your Employer. APPLYING FOR PORTABLE COVERAGE

You must apply for portable coverage for yourself and your dependents and pay the first premium within 31 days after the date: - your coverage ends or you retire from your Employer; or - you begin working less than the minimum number of hours as described under

Eligible Groups in this plan. Your dependents must apply for portable coverage and pay the first premium within 31 days after the date you die. You are not eligible to apply for portable coverage for yourself if: - you have an injury or sickness, under the terms of this plan, which has a material

effect on life expectancy; - the policy is cancelled (the Policy is the group policy issued to the Trustees of the

Select Group Insurance Trust in which your Employer participates); or - you failed to pay the required premium under the terms of this plan. You are not eligible to apply for portable coverage for a dependent if: - you do not elect portable coverage for yourself; - you have an injury or sickness, under the terms of this plan, which has a material

effect on life expectancy ; - your dependent has an injury or sickness, under the terms of this plan, which has

a material effect on life expectancy; - the policy is cancelled (the Policy is the group policy issued to the Trustees of the

Select Group Insurance Trust in which your Employer participates); or - you failed to pay the required premium under the terms of this plan. In case of your death, your spouse is not eligible to apply for portable coverage if: - your surviving spouse is not insured under this plan; - your surviving spouse has an injury or sickness, under the terms of this plan,

which has a material effect on life expectancy; - the policy is cancelled (the Policy is the group policy issued to the Trustees of the

Select Group Insurance Trust in which your Employer participates); or - you failed to pay the required premium under the terms of this plan for your

spouse. In case of your death, your child is not eligible for portable coverage if: - your surviving spouse is not insured under this plan;

LIFE-OTR-3 (1/1/2010) 32

- your surviving spouse is insured under this plan and chooses not to elect portable coverage;

- your surviving spouse has an injury or sickness, under the terms of this plan, which has a material effect on life expectancy;

- your child has an injury or sickness, under the terms of this plan, which has a material effect on life expectancy;

- the policy is cancelled (the Policy is the group policy issued to the Trustees of the Select Group Insurance Trust in which your Employer participates); or

- you failed to pay the required premium under the terms of this plan for your child. If we determine that because of an injury or sickness, which has a material effect on life expectancy, you or your dependents were not eligible for portability at the time you or your dependents elected portable coverage, the benefit will be adjusted to the amount of whole life coverage the premium would have purchased under the Conversion Privilege. APPLYING FOR INCREASES OR DECREASES IN PORTABLE COVERAGE

You or your dependents may increase or decrease the amount of life insurance coverage. The minimum and maximum benefit amounts are shown above. However, the amount of life insurance coverage cannot be decreased below $5,000 for you and $1,000 for your dependents. All increases are subject to evidence of insurability. Portable coverage will reduce at the ages and amounts shown in the LIFE INSURANCE "BENEFITS AT A GLANCE" page. ADDING PORTABLE COVERAGE FOR DEPENDENTS

If you choose not to enroll your dependents when your dependents were first eligible for portable coverage, you may enroll your dependents at any time for the amounts allowed under the group plan. Evidence of insurability is required. You may enroll newly acquired dependents at any time for the amounts allowed under the group plan. Evidence of insurability is required. WHEN PORTABLE COVERAGE ENDS

Portable coverage for you will end for the following reasons: - the date you fail to pay any required premium; or - the date the policy is cancelled (the Policy is the group policy issued to the

Trustees of the Select Group Insurance Trust in which your Employer participates). Portable coverage for a spouse will end for the following reasons: - the date you fail to pay any required premium; - the date your surviving spouse fails to pay any required premium; or - the date the policy is cancelled (the Policy is the group policy issued to the

Trustees of the Select Group Insurance Trust in which your Employer participates). Portable coverage for a child will end for the following reasons: - the date you fail to pay any required premium; - the date your surviving spouse fails to pay any required premium;

LIFE-OTR-4 (1/1/2010) 33

- the date the policy is cancelled (the Policy is the group policy issued to the Trustees of the Select Group Insurance Trust in which your Employer participates);

- the date your child no longer qualifies as a dependent; or - the date the surviving spouse dies. If portable coverage ends due to failure to pay required premium, portable coverage cannot be reinstated. PREMIUM RATE CHANGES FOR PORTABLE COVERAGE

Unum may change premium rates for portable coverage at any time for reasons which affect the risk assumed, including those reasons shown below: - changes occur in the coverage levels; - changes occur in the overall use of benefits by all insureds; - changes occur in other risk factors; or - a new law or a change in any existing law is enacted which applies to portable

coverage. The change in premium rates will be made on a class basis according to Unum's underwriting risk studies. Unum will notify the insured in writing at least 31 days before a premium rate is changed.

APPLYING FOR CONVERSION, IF PORTABLE COVERAGE ENDS OR IS NOT AVAILABLE

If you or your dependent is not eligible to apply for portable coverage or portable coverage ends, then you or your dependent may qualify for conversion coverage. Refer to Conversion Privilege under this plan. Ask your Employer for a conversion application form which includes cost information. When you complete the application, send it with the first premium amount to: Unum - Conversion Unit 2211 Congress Street Portland, Maine 04122-1350 1-800-343-5406

AD&D-BEN-1 (1/1/2010) 34

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE

BENEFIT INFORMATION

WHEN WILL YOUR BENEFICIARY RECEIVE PAYMENT IN THE EVENT OF YOUR DEATH IF YOUR DEATH IS THE DIRECT RESULT OF AN ACCIDENT?

Your beneficiary(ies) will receive payment when Unum approves your death claim. WHAT DOCUMENTS ARE REQUIRED FOR PROOF OF ACCIDENTAL DEATH?

Unum will require a certified copy of the death certificate, enrollment documents and a Notice and Proof of Claim form.

WHEN WILL YOU RECEIVE PAYMENT IN THE EVENT OF CERTAIN OTHER COVERED LOSSES IF THE LOSS IS THE DIRECT RESULT OF AN ACCIDENT?

You will receive payment when Unum approves the claim. HOW MUCH WILL UNUM PAY YOUR BENEFICIARY IN THE EVENT OF YOUR ACCIDENTAL DEATH OR YOU FOR CERTAIN OTHER COVERED LOSSES?

If Unum approves the claim, Unum will determine the payment according to the Covered Losses and Benefits List below. The benefit Unum will pay is listed opposite the corresponding covered loss. The benefit will be paid only if an accidental bodily injury results in one or more of the covered losses listed below within 365 days from the date of the accident.

Also, the accident must occur while you are insured under the plan. Covered Losses Benefit Amounts Life The Full Amount Both Hands or Both Feet or Sight of Both Eyes The Full Amount One Hand and One Foot The Full Amount One Hand and Sight of One Eye The Full Amount One Foot and Sight of One Eye The Full Amount Speech and Hearing The Full Amount Quadriplegia The Full Amount Triplegia Three Quarters The Full Amount Paraplegia Three Quarters The Full Amount

AD&D-BEN-2 (1/1/2010) 35

One Hand or One Foot One Half The Full Amount Sight of One Eye One Half The Full Amount Speech or Hearing One Half The Full Amount Hemiplegia One Half The Full Amount Thumb and Index Finger of Same Hand One Quarter The Full Amount Uniplegia One Quarter The Full Amount

The most Unum will pay for any combination of Covered Losses from any one accident is the full amount. The Full Amount is the amount shown in the ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE "BENEFITS AT A GLANCE" page.

WHAT ARE YOUR ANNUAL EARNINGS?

All Non-Union Employees of JHHSC/JHH "Annual Earnings" means your gross annual income from your Employer in effect just prior to the date of loss. It includes your total income before taxes plus shift differential pay. It is prior to any deductions made for pre-tax contributions to a qualified deferred compensation plan, Section 125 plan, or flexible spending account. It does not include income received from commissions, bonuses, overtime pay or any other extra compensation, or income received from sources other than your Employer.

All Employees of Johns Hopkins Community Physicians "Annual Earnings" means your gross annual income from your Employer in effect just prior to the date of loss. It includes your total income before taxes plus shift differential and geographical differential pay. It is prior to any deductions made for pre-tax contributions to a qualified deferred compensation plan, Section 125 plan, or flexible spending account. It does not include income received from commissions, bonuses, overtime pay or any other extra compensation, or income received from sources other than your Employer.

WHAT WILL WE USE FOR ANNUAL EARNINGS IF YOU BECOME DISABLED DURING A COVERED LAYOFF OR LEAVE OF ABSENCE?

If you have an accidental bodily injury that results in one or more of the covered losses while you are on a covered layoff or leave of absence, we will use your annual earnings from your Employer in effect just prior to the date your absence began.

WHAT REPATRIATION BENEFIT WILL UNUM PROVIDE?

Unum will pay an additional benefit for the preparation and transportation of your body to a mortuary chosen by you or your authorized representative. Payment will

AD&D-BEN-3 (1/1/2010) 36

be made if, as the result of a covered accident, you suffer loss of life at least 100 miles away from your principal place of residence. However, when combined with two or more Unum accidental death and dismemberment insurance plans, the combined overall maximum for these plans together cannot exceed the actual expenses for the preparation and transportation of your body to a mortuary. The maximum benefit amount is shown in the ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE "BENEFITS AT A GLANCE" page.

WHAT SEATBELT(S) AND AIR BAG BENEFIT WILL UNUM PROVIDE?

Unum will pay you or your authorized representative an additional benefit if you sustain an accidental bodily injury which causes your death while you are driving or riding in a Private Passenger Car, provided: For Seatbelt(s): - the Private Passenger Car is equipped with seatbelt(s); and - the seatbelt(s) were in actual use and properly fastened at the time of the covered

accident; and - the position of the seatbelt(s) are certified in the official report of the covered

accident, or by the investigating officer. A copy of the police accident report must be submitted with the claim.

Also, if such certification is not available, and it is clear that you were properly wearing seatbelt(s), then we will pay the additional seatbelt benefit. However, if such certification is not available, and it is unclear whether you were properly wearing seatbelt(s), then we will pay a fixed benefit of $1,000.

An automatic harness seatbelt will not be considered properly fastened unless a lap belt is also used.

For Air Bag: - the Private Passenger Car is equipped with an air bag for the seat in which you

are seated; and - the seatbelt(s) must be in actual use and properly fastened at the time of the

covered accident.

No benefit will be paid if you are the driver of the Private Passenger Car and do not hold a current and valid driver's license. No benefit will be paid if Unum is able to verify that the air bag(s) had been disengaged prior to the accident. The accident causing your death must occur while you are insured under the plan. The maximum benefit amount is shown in the ACCIDENTAL DEATH AND DISMEMBERMENT "BENEFITS AT A GLANCE" page.

AD&D-BEN-4 (1/1/2010) 37

WHAT EDUCATION BENEFIT WILL UNUM PROVIDE FOR YOUR QUALIFIED CHILDREN?

Unum will pay your authorized representative on behalf of each of your qualified children a lump sum payment if: - you lose your life:

• as a result of an accidental bodily injury; and • within 365 days after the date of the accident causing the accidental bodily injury;

- the accident causing your accidental bodily injury occurred while you were insured under the plan;

- proof is furnished to Unum that the child is a qualified child; and - the qualified child continues to be enrolled as a full-time student in an accredited

post-secondary institution of higher learning beyond the 12th grade level. The benefit amount per academic year, maximum benefit payments, maximum benefit amount and maximum benefit period are shown in the ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE "BENEFITS AT A GLANCE" page.

WHEN WILL THE EDUCATION BENEFIT END FOR EACH QUALIFIED CHILD?

The education benefit will terminate for each qualified child on the earliest of the following dates: - the date your qualified child fails to furnish proof as required by us; - the date your qualified child no longer qualifies as a dependent child for any

reason except your death; or - the end of the maximum benefit period.

WHAT COVERAGE FOR EXPOSURE AND DISAPPEARANCE BENEFIT WILL UNUM PROVIDE?

Unum will pay a benefit if you sustain an accidental bodily injury and are unavoidably exposed to the elements and suffer a loss. We will presume you suffered loss of life due to an accident if: - you are riding in a common public passenger carrier that is involved in an accident

covered under the Summary of Benefits; and - as a result of the accident, the common public passenger carrier is wrecked, sinks,

is stranded, or disappears; and - your body is not found within 1 year of the accident. Also, the accident must occur while you are insured under the plan. The maximum benefit amount is shown in the ACCIDENTAL DEATH AND DISMEMBERMENT "BENEFITS AT A GLANCE" page.

WHAT COMA BENEFIT WILL UNUM PROVIDE?

Unum will pay a benefit to your beneficiary if you sustain an accidental bodily injury which directly results in your being in a coma or a (persistent) vegetative state. The coma must begin within 31 days of the accident.

AD&D-BEN-5 (1/1/2010) 38

No benefits are payable for the first 31 days that you are in a coma. We will use the Rancho Los Amigos Levels of Cognitive Functioning scale to evaluate the coma. Also, the accident must occur while you are insured under the plan. The most Unum will pay for any combination of Covered Losses from any one accident is the full amount. The Full Amount is the amount shown in the ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE "BENEFITS AT A GLANCE" page. The monthly benefit amount and maximum number of months are shown in the ACCIDENTAL DEATH AND DISMEMBERMENT "BENEFITS AT A GLANCE" page.

WHAT HUMAN IMMUNODEFICIENCY VIRUS BENEFIT WILL UNUM PROVIDE?

Unum will pay you a benefit if you sustain an accidental bodily injury in the performance of your occupational duties causing you to acquire and test positive for Human Immunodeficiency Virus (HIV) within one year of the date of the accident. In order to receive the HIV benefit, you must: - submit a Worker's Compensation injury report to your Employer within 72 hours of

the accident; and - submit to us, a blood test for HIV antibody, performed within 72 hours of the

accident; and - the accident must occur while you are insured under the plan. If the initial blood test is negative and you subsequently test positive for HIV within one year of the accident, Unum will begin monthly payments. Payment of this benefit will reduce your total accidental death and dismemberment benefit if you experience another loss due to your HIV infection. However, if the loss was unrelated to the HIV infection, your accidental death and dismemberment benefit will not be reduced and Unum will pay the appropriate accidental death and dismemberment benefit for that loss. The HIV benefit will terminate on the earlier of the following dates: - the date you die; or - the date the last of the maximum number of installments is paid The maximum benefit amount and maximum number of installments are shown in the ACCIDENTAL DEATH AND DISMEMBERMENT "BENEFITS AT A GLANCE" page.

WHAT ACCIDENTAL LOSSES ARE NOT COVERED UNDER YOUR PLAN?

Your plan does not cover any accidental losses caused by, contributed to by, or resulting from:

- suicide, intentional self destruction while sane, intentionally self-inflicted injury

while sane, or self-inflicted injury while insane.

AD&D-BEN-6 (1/1/2010) 39

- active participation in a riot. - committing or attempting to commit an assault or felony. - the use of any prescription or non-prescription drug, poison, fume, or other

chemical substance unless used according to the prescription or direction of your physician. This exclusion will not apply to you if the chemical substance is ethanol.

- service on full-time active duty in the Armed Forces of any country or international authority.

- travel or flight in any vehicle or device for aerial navigation, including boarding or alighting from it while: - it is being used for test or experimental purposes; - you are operating, learning to operate or serving as a member of the crew; - it is being operated by or for or under the direction of any military authority. This exclusion does not apply to: - transport type aircraft operated by the Military Airlift Command of the United

States; or - similar air transport service of any other country.

- travel or flight in any aircraft or device for aerial navigation, including boarding or alighting from it, owned or leased by or on behalf of your Employer.

- disease of the body or diagnostic, medical or surgical treatment or mental disorder as set forth in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders.

- operating any motorized vehicle while intoxicated. - war, declared or undeclared, or any act of war.

AD&D-OTR-1 (1/1/2010) 40

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE

OTHER BENEFIT FEATURES WHAT COVERAGE IS AVAILABLE IF YOU END EMPLOYMENT OR YOU WORK REDUCED HOURS? (Portability)

If your employment ends with or you retire from your Employer or you are working less than the minimum number of hours as described under Eligible Groups in this plan, you may elect portable coverage for yourself.

PORTABLE INSURANCE COVERAGE AND AMOUNTS AVAILABLE The portable insurance coverage will be the current coverage and amounts that you are insured for under your Employer's group plan. However, the amount of portable coverage for you will not be more than: - the highest amount of accidental death and dismemberment insurance available

for employees under the plan; or - 5x your annual earnings; or - $750,000 from all Unum group life and accidental death and dismemberment

plans combined, whichever is less. The amount of ported life insurance must be equal to or greater than the amount of ported accidental death and dismemberment insurance. The minimum amount of coverage that can be ported is $5,000. If the current amounts under the plan are less than $5,000, you may port the lesser amounts. Your amount of AD&D insurance will reduce or cease at any time it would reduce or cease for your eligible group if you had continued in active employment with your Employer. APPLYING FOR PORTABLE COVERAGE

You must apply for portable coverage for yourself and pay the first premium within 31 days after the date: - your coverage ends or you retire from your Employer; or - you begin working less than the minimum number of hours as described under

Eligible Groups in this plan. You are not eligible to apply for portable coverage for yourself if: - you have an injury or sickness, under the terms of this plan, which has a material

effect on life expectancy; - the policy is cancelled (the Policy is the group policy issued to the Trustees of the

Select Group Insurance Trust in which your Employer participates); or - you failed to pay the required premium under the terms of this plan.

AD&D-OTR-2 (1/1/2010) 41

APPLYING FOR INCREASES OR DECREASES IN PORTABLE COVERAGE

You may increase or decrease the amount of AD&D insurance coverage. The minimum and maximum benefit amounts are shown above. However, the amount of accidental death and dismemberment insurance coverage cannot be decreased below $5,000. Portable coverage will reduce at the ages and amounts shown in the ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE "BENEFITS AT A GLANCE" page. WHEN PORTABLE COVERAGE ENDS

Portable coverage for you will end for the following reasons: - the date you fail to pay any required premium; or - the date the policy is cancelled (the Policy is the group policy issued to the

Trustees of the Select Group Insurance Trust in which your Employer participates). If portable coverage ends due to failure to pay required premium, portable coverage cannot be reinstated. PREMIUM RATE CHANGES FOR PORTABLE COVERAGE

Unum may change premium rates for portable coverage at any time for reasons which affect the risk assumed, including those reasons shown below: - changes occur in the coverage levels; - changes occur in the overall use of benefits by all insureds; - changes occur in other risk factors; or - a new law or a change in any existing law is enacted which applies to portable

coverage. The change in premium rates will be made on a class basis according to Unum's underwriting risk studies. Unum will notify the insured in writing at least 31 days before a premium rate is changed.

GLOSSARY-1 (1/1/2010) 42

GLOSSARY

ACCIDENTAL BODILY INJURY means bodily harm caused by accident and not contributed to by any other cause. ACTIVE EMPLOYMENT means you are working for your Employer for earnings that are paid regularly and that you are performing the material and substantial duties of your regular occupation. You must be working at least the minimum number of hours as described under Eligible Group(s) in each plan. Your work site must be: - your Employer's usual place of business; - an alternative work site at the direction of your Employer, including your home; or - a location to which your job requires you to travel. Normal vacation, holiday, weekend or other scheduled non-working day is considered active employment. Temporary and seasonal workers are excluded from coverage. ACTIVITIES OF DAILY LIVING means: - Bathing - the ability to wash oneself either in the tub or shower or by sponge bath with

or without equipment or adaptive devices. - Dressing - the ability to put on and take off all garments and medically necessary

braces or artificial limbs usually worn. - Toileting - the ability to get to and from and on and off the toilet; to maintain a

reasonable level of personal hygiene, and to care for clothing. - Transferring - the ability to move in and out of a chair or bed with or without

equipment such as canes, quad canes, walkers, crutches or grab bars or other support devices including mechanical or motorized devices.

- Continence - the ability to either: - voluntarily control bowel and bladder function; or - if incontinent, be able to maintain a reasonable level of personal hygiene.

- Eating - the ability to get nourishment into the body. A person is considered unable to perform an activity of daily living if the task cannot be performed safely without another person's stand-by assistance or verbal cueing. ANNUAL EARNINGS means your annual income received from your Employer as defined in the plan. ANNUAL ENROLLMENT PERIOD means a period of time before the beginning of each plan year. CHANGE IN STATUS means a change in status as defined in the regulations under Internal Revenue Code section 125, unless your Employer's cafeteria plan document or human resource policy contains more restrictive provisions. In that event, your Employer may restrict the situations where you can change your coverage. COGNITIVELY IMPAIRED means a person has a deterioration or loss in intellectual capacity resulting from injury, sickness, advanced age, Alzheimer's disease or similar

GLOSSARY-2 (1/1/2010) 43

forms of irreversible dementia and needs another person's assistance or verbal cueing for his or her own protection or for the protection of others. COMA means being in a profound stupor or state of complete and total unconsciousness. We will use the Rancho Los Amigos Levels of Cognitive Functioning scale to evaluate the coma. ELIMINATION PERIOD means a period of continuous disability which must be satisfied before you are eligible to have your life premium waived by Unum. EMPLOYEE means a person who is in active employment in the United States with the Employer. EMPLOYER means the Employer/Applicant named in the Application For Participation in the Select Group Insurance Trust, on the first page of the Summary of Benefits and in all amendments. It includes any division, subsidiary or affiliated company named in the Summary of Benefits. EVIDENCE OF INSURABILITY means a statement of your or your dependent's medical history which Unum will use to determine if you or your dependent is approved for coverage. Evidence of insurability will be at Unum's expense. GAINFUL OCCUPATION means an occupation that within 12 months of your return to work is or can be expected to provide you with an income that is at least equal to 60% of your annual earnings in effect just prior to the date your disability began. GRACE PERIOD means the period of time following the premium due date during which premium payment may be made. HEMIPLEGIA means total and irreversible paralysis of both limbs on either side of the body (i.e. the right arm and right leg or the left arm and left leg). HOSPITAL OR INSTITUTION means an accredited facility licensed to provide care and treatment for the condition causing your disability. INJURY means: - for purposes of Portability, a bodily injury that is the direct result of an accident and

not related to any other cause. - for all other purposes, a bodily injury that is the direct result of an accident and not

related to any other cause. Disability must begin while you are covered under the plan.

INSURED means any person covered under a plan. INTOXICATED means that your blood alcohol level equals or exceeds the legal limit for operating a motor vehicle in the state where the accident occurred. LAYOFF or LEAVE OF ABSENCE means you are temporarily absent from active employment for a period of time that has been agreed to in advance in writing by your Employer. Your normal vacation time or any period of disability is not considered a temporary layoff or leave of absence.

GLOSSARY-3 (1/1/2010) 44

LIFE THREATENING CONDITION is a critical health condition that possibly could result in your dependent's loss of life. LOSS OF A FOOT means that all of the foot is cut off at or above the ankle joint. LOSS OF A HAND means that all four fingers are cut off at or above the knuckles joining each to the hand. LOSS OF HEARING means the total and irrecoverable loss of hearing in both ears. LOSS OF SIGHT means the eye is totally blind and that no sight can be restored in that eye. LOSS OF SPEECH means the total and irrecoverable loss of speech. LOSS OF THUMB AND INDEX FINGER means that all of the thumb and index finger are cut off at or above the joint closest to the wrist. PARAPLEGIA means total and irreversible paralysis of both lower limbs. PAYABLE CLAIM means a claim for which Unum is liable under the terms of the Summary of Benefits. PHYSICIAN means: - a person performing tasks that are within the limits of his or her medical license; and - a person who is licensed to practice medicine and prescribe and administer drugs or

to perform surgery; or - a person with a doctoral degree in Psychology (Ph.D. or Psy.D.) whose primary

practice is treating patients; or - a person who is a legally qualified medical practitioner according to the laws and

regulations of the governing jurisdiction.

Unum will not recognize you, or your spouse, children, parents or siblings as a physician for a claim that you send to us. PLAN means a line of coverage under the Summary of Benefits. PRIVATE PASSENGER CAR means a validly registered four-wheel private passenger car (including Employer-owned cars), station wagons, jeeps, pick-up trucks, and vans that are used only as private passenger cars. QUADRIPLEGIA means total and irreversible paralysis of all four limbs. QUALIFIED CHILD is any of your unmarried dependent children under age 25 who, on the date of your death as a result of an accidental bodily injury, was either: - enrolled as a full-time student in an accredited post-secondary institution of higher

learning beyond the 12th grade level; or - at the 12th grade level and enrolls as a full-time student in an accredited post-

secondary institution of higher learning beyond the 12th grade level within 365 days following the date of your death.

GLOSSARY-4 (1/1/2010) 45

Children include your own natural offspring, lawfully adopted children and stepchildren. They also include foster children and other children who are dependent on you for main support and living with you in a regular parent-child relationship. A child will be considered adopted on the date of placement in your home. REGULAR CARE means: - you personally visit a physician as frequently as is medically required, according to

generally accepted medical standards, to effectively manage and treat your disabling condition(s); and

- you are receiving the most appropriate treatment and care which conforms with generally accepted medical standards, for your disabling condition(s) by a physician whose specialty or experience is the most appropriate for your disabling condition(s), according to generally accepted medical standards.

RETAINED ASSET ACCOUNT is an interest bearing account established through an intermediary bank in the name of you or your beneficiary, as owner. SICKNESS means: - for purposes of Portability, an illness, disease or symptoms for which a person, in

the exercise of ordinary prudence, would have consulted a health care provider. - for all other purposes, an illness or disease. Disability must begin while you are

covered under the plan. TOTALLY DISABLED means that, as a result of an injury, a sickness or a disorder, your dependent: - is confined in a hospital or similar institution; - is unable to perform two or more activities of daily living (ADLs) because of a physical

or mental incapacity resulting from an injury or a sickness; - is cognitively impaired; or - has a life threatening condition. TRIPLEGIA means total and irreversible paralysis of three limbs. TRUST means the policyholder trust named on the first page of the Summary of Benefits and all amendments to the policy. UNIPLEGIA means total and irreversible paralysis of one limb. VEGETATIVE STATE means being completely unaware of one's self and the environment with the presence of sleep-awake cycles and at least partial preservation of involuntary brain functions. Such vegetative state must be due to an accidental bodily injury and must begin within 31 days of the date of the accident. WAITING PERIOD means the continuous period of time (shown in each plan) that you must be in active employment in an eligible group before you are eligible for coverage under a plan. WE, US and OUR means Unum Life Insurance Company of America. YOU means an employee who is eligible for Unum coverage.

GLOSSARY-5 (1/1/2010) 46

ADDLSUM-1 (1/1/2010) 47

ERISA

Additional Summary Plan Description Information If this Summary of Benefits provides benefits under a Plan which is subject to the Employee Retirement Income Security Act of 1974 (ERISA), the following provisions apply. These provisions, together with your certificate of coverage, constitute the summary plan description. The summary plan description and the Summary of Benefits constitute the Plan. Benefit determinations are controlled exclusively by the Summary of Benefits, your certificate of coverage and the information contained in this document. Name of Plan:

The Johns Hopkins Health System Corporation / The Johns Hopkins Hospital Plan

Name and Address of Employer: The Johns Hopkins Health System Corporation / The Johns Hopkins Hospital Phipps Bldg 455D 600 North Wolfe Street Baltimore, Maryland 21287

Plan Identification Number: a. Employer IRS Identification #: 52-0591656 b. Plan #: 506

Type of Welfare Plan: Life and Accidental Death and Dismemberment

Type of Administration: The Plan is administered by the Plan Administrator. Benefits are administered by the insurer and provided in accordance with the insurance Summary of Benefits issued to the Plan.

ERISA Plan Year Ends: June 30

Plan Administrator, Name, Address, and Telephone Number:

The Johns Hopkins Health System Corporation/The Johns Hopkins Hospital Phipps Building 600 North Wolfe Street Baltimore, Maryland 21287 (410) 955-3974 The Johns Hopkins Health System Corporation/The Johns Hopkins Hospital is the Plan Administrator and named fiduciary of the Plan, with authority to delegate its duties. The Plan Administrator may designate Trustees of the Plan, in which case the Administrator will advise you separately of the name, title and address of each Trustee.

Agent for Service of Legal Process on the Plan:

ADDLSUM-2 (1/1/2010) 48

The Johns Hopkins Health System Corporation/The Johns Hopkins Hospital Phipps Building 600 North Wolfe Street Baltimore, Maryland 21287 Service of legal process may also be made upon the Plan Administrator, or a Trustee of the Plan, if any.

Funding and Contributions:

The Plan is funded by insurance issued by Unum Life Insurance Company of America, 2211 Congress Street, Portland, Maine 04122 (hereinafter referred to as "Unum") under identification number 573627 012. Contributions to the Plan are made as stated under "WHO PAYS FOR THE COVERAGE" in the Certificate of Coverage.

EMPLOYER'S RIGHT TO AMEND THE PLAN

The Employer reserves the right, in its sole and absolute discretion, to amend, modify, or terminate, in whole or in part, any or all of the provisions of this Plan (including any related documents and underlying policies), at any time and for any reason or no reason. Any amendment, modification, or termination must be in writing and endorsed on or attached to the Plan.

EMPLOYER'S RIGHT TO REQUEST SUMMARY OF BENEFITS CHANGE

The Employer can request a Summary of Benefits change. Only an officer or registrar of Unum can approve a change. The change must be in writing and endorsed on or attached to the Summary of Benefits.

MODIFYING OR CANCELLING THE SUMMARY OF BENEFITS OR A PLAN UNDER THE SUMMARY OF BENEFITS

The Summary of Benefits or a plan under the Summary of Benefits can be cancelled: - by Unum; or - by the Employer. Unum may cancel or modify the Summary of Benefits or a plan if:

- there is less than 100% participation of those eligible employees for an Employer

paid plan; or - there is less than 20% participation of those eligible employees who pay all or part

of the premium for a basic benefit plan; or - the number of employees insured for all additional benefits is less than 10 lives or

20% of those eligible, whichever is greater; or - the number of employees insured under a plan decreases by 20%; or - the Employer does not promptly provide Unum with information that is reasonably

required; or - the Employer fails to perform any of its obligations that relate to the Summary of

Benefits; or - fewer than 10 employees are insured under a plan; or

ADDLSUM-3 (1/1/2010) 49

- the premium is not paid in accordance with the provisions of the Summary of Benefits that specify whether the Employer, the employee, or both, pay the premiums; or

- the Employer does not promptly report to Unum the names of any employees who are added or deleted from the eligible group; or

- Unum determines that there is a significant change, in the size, occupation or age of the eligible group as a result of a corporate transaction such as a merger, divestiture, acquisition, sale, or reorganization of the Employer and/or its employees; or

- the Employer fails to pay any portion of the premium within the 60 day grace period.

If Unum cancels or modifies the Summary of Benefits or a plan, for reasons other than the Employer's failure to pay premium, a written notice will be delivered to the Employer at least 31 days prior to the cancellation date or modification date. The Employer may cancel the Summary of Benefits or plan if the modifications are unacceptable. If any portion of the premium is not paid during the grace period, Unum will either cancel or modify the Summary of Benefits or a plan automatically at the end of the grace period. The Employer is liable for premium for coverage during the grace period. The Employer must pay Unum all premium due for the full period each plan is in force. The Employer may cancel the Summary of Benefits or a plan by written notice delivered to Unum at least 31 days prior to the cancellation date. When both the Employer and Unum agree, the Summary of Benefits or a plan can be cancelled on an earlier date. If Unum or the Employer cancels the Summary of Benefits or a plan, coverage will end at 12:00 midnight standard time at the Employer's address on the last day of coverage. If the Summary of Benefits or a plan is cancelled, the cancellation will not affect a payable claim.

HOW TO FILE A CLAIM

If you wish to file a claim for benefits, you should follow the claim procedures described in your insurance certificate. To complete your claim filing, Unum must receive the claim information it requests from you (or your authorized representative), your attending physician and your Employer. If you or your authorized representative has any questions about what to do, you or your authorized representative should contact Unum directly.

CLAIMS PROCEDURES

If a claim is based on death, a covered loss not based on disability or for the Education Benefit

In the event that your claim is denied, either in full or in part, Unum will notify you in writing within 90 days after your claim was filed. Under special circumstances, Unum is allowed an additional period of not more than 90 days (180 days in total) within which to notify you of its decision. If such an extension is required, you will receive a written notice from Unum indicating the reason for the delay and the date you may expect a final decision. Unum's notice of denial shall include:

ADDLSUM-4 (1/1/2010) 50

- the specific reason or reasons for denial with reference to those Plan provisions on

which the denial is based; - a description of any additional material or information necessary to complete the

claim and why that material or information is necessary; and - a description of the Plan's procedures and applicable time limits for appealing the

determination, including a statement of your right to bring a lawsuit under Section 502(a) of ERISA following an adverse determination from Unum on appeal.

Notice of the determination may be provided in written or electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements.

If a claim is based on your disability

Unum will give you notice of the decision no later than 45 days after the claim is filed. This time period may be extended twice by 30 days if Unum both determines that such an extension is necessary due to matters beyond the control of the Plan and notifies you of the circumstances requiring the extension of time and the date by which Unum expects to render a decision. If such an extension is necessary due to your failure to submit the information necessary to decide the claim, the notice of extension will specifically describe the required information, and you will be afforded at least 45 days within which to provide the specified information. If you deliver the requested information within the time specified, any 30 day extension period will begin after you have provided that information. If you fail to deliver the requested information within the time specified, Unum may decide your claim without that information. If your claim for benefits is wholly or partially denied, the notice of adverse benefit determination under the Plan will: - state the specific reason(s) for the determination; - reference specific Plan provision(s) on which the determination is based; - describe additional material or information necessary to complete the claim and

why such information is necessary; - describe Plan procedures and time limits for appealing the determination, and your

right to obtain information about those procedures and the right to bring a lawsuit under Section 502(a) of ERISA following an adverse determination from Unum on appeal; and

- disclose any internal rule, guidelines, protocol or similar criterion relied on in

making the adverse determination (or state that such information will be provided free of charge upon request).

Notice of the determination may be provided in written or electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements.

APPEAL PROCEDURES

ADDLSUM-5 (1/1/2010) 51

If an appeal is based on death, a covered loss not based on disability or for the Education Benefit If you or your authorized representative appeal a denied claim, it must be submitted within 90 days after you receive Unum's notice of denial. You have the right to: - submit a request for review, in writing, to Unum; - upon request and free of charge, reasonable access to and copies of, all relevant

documents as defined by applicable U.S. Department of Labor regulations; and - submit written comments, documents, records and other information relating to the

claim to Unum. Unum will make a full and fair review of the claim and all new information submitted whether or not presented or available at the initial determination, and may require additional documents as it deems necessary or desirable in making such a review. A final decision on the review shall be made not later than 60 days following receipt of the written request for review. If special circumstances require an extension of time for processing, you will be notified of the reasons for the extension and the date by which the Plan expects to make a decision. If an extension is required due to your failure to submit the information necessary to decide the claim, the notice of extension will specifically describe the necessary information and the date by which you need to provide it to us. The 60-day extension of the appeal review period will begin after you have provided that information. The final decision on review shall be furnished in writing and shall include the reasons for the decision with reference, again, to those Summary of Benefits' provisions upon which the final decision is based. It will also include a statement describing your access to documents and describing your right to bring a lawsuit under Section 502(a) of ERISA if you disagree with the determination. Notice of the determination may be provided in written or electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements. Unless there are special circumstances, this administrative appeal process must be completed before you begin any legal action regarding your claim.

If an appeal is based on your disability You have 180 days from the receipt of notice of an adverse benefit determination to file an appeal. Requests for appeals should be sent to the address specified in the claim denial. A decision on review will be made not later than 45 days following receipt of the written request for review. If Unum determines that special circumstances require an extension of time for a decision on review, the review period may be extended by an additional 45 days (90 days in total). Unum will notify you in writing if an additional 45 day extension is needed. If an extension is necessary due to your failure to submit the information necessary to decide the appeal, the notice of extension will specifically describe the required information, and you will be afforded at least 45 days to provide the specified information. If you deliver the requested information within the time specified, the 45 day extension of the appeal period will begin after you have provided that information. If you fail to deliver the requested information within the time specified, Unum may decide your appeal without that information.

ADDLSUM-6 (1/1/2010) 52

You will have the opportunity to submit written comments, documents, or other information in support of your appeal. You will have access to all relevant documents as defined by applicable U.S. Department of Labor regulations. The review of the adverse benefit determination will take into account all new information, whether or not presented or available at the initial determination. No deference will be afforded to the initial determination. The review will be conducted by Unum and will be made by a person different from the person who made the initial determination and such person will not be the original decision maker's subordinate. In the case of a claim denied on the grounds of a medical judgment, Unum will consult with a health professional with appropriate training and experience. The health care professional who is consulted on appeal will not be the individual who was consulted during the initial determination or a subordinate. If the advice of a medical or vocational expert was obtained by the Plan in connection with the denial of your claim, Unum will provide you with the names of each such expert, regardless of whether the advice was relied upon. A notice that your request on appeal is denied will contain the following information: - the specific reason(s) for the determination; - a reference to the specific Plan provision(s) on which the determination is based; - a statement disclosing any internal rule, guidelines, protocol or similar criterion

relied on in making the adverse determination (or a statement that such information will be provided free of charge upon request);

- a statement describing your right to bring a lawsuit under Section 502(a) of ERISA

if you disagree with the decision; - the statement that you are entitled to receive upon request, and without charge,

reasonable access to or copies of all documents, records or other information relevant to the determination; and

- the statement that "You or your plan may have other voluntary alternative dispute

resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State insurance regulatory agency".

Notice of the determination may be provided in written or electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements. Unless there are special circumstances, this administrative appeal process must be completed before you begin any legal action regarding your claim.

YOUR RIGHTS UNDER ERISA

As a participant in this Plan you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all Plan participants shall be entitled to:

ADDLSUM-7 (1/1/2010) 53

Receive Information About Your Plan and Benefits Examine, without charge, at the Plan Administrator's office and at other specified locations, all documents governing the Plan, including insurance contracts, and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration. Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the Plan, including insurance contracts, and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The Plan Administrator may make a reasonable charge for the copies. Receive a summary of the Plan's annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report.

Prudent Actions by Plan Fiduciaries In addition to creating rights for Plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your Plan, called "fiduciaries" of the Plan, have a duty to do so prudently and in the interest of you and other Plan participants and beneficiaries. No one, including your Employer or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a benefit or exercising your rights under ERISA.

Enforce Your Rights If your claim for a benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules. Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of Plan documents or the latest annual report from the Plan and do not receive them within 30 days, you may file suit in a federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Plan Administrator. If you have a claim for benefits that is denied or ignored, in whole or in part, you may file suit in a state or federal court. If it should happen that Plan fiduciaries misuse the Plan's money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, if, for example, it finds your claim is frivolous.

ADDLSUM-8 (1/1/2010) 54

Assistance with Your Questions If you have any questions about your Plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Plan Administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration.

OTHER RIGHTS

Unum, for itself and as claims fiduciary for the Plan, is entitled to legal and equitable relief to enforce its right to recover any benefit overpayments caused by your receipt of deductible sources of income from a third party. This right of recovery is enforceable even if the amount you receive from the third party is less than the actual loss suffered by you but will not exceed the benefits paid you under the Summary of Benefits. You agree that Unum and the Plan have an equitable lien over such sources of income until any benefit overpayments have been recovered in full.

DISCRETIONARY ACTS

The Plan, acting through the Plan Administrator, delegates to Unum and its affiliate Unum Group discretionary authority to make benefit determinations under the Plan. Unum and Unum Group may act directly or through their employees and agents or further delegate their authority through contracts, letters or other documentation or procedures to other affiliates, persons or entities. Benefit determinations include determining eligibility for benefits and the amount of any benefits, resolving factual disputes, and interpreting and enforcing the provisions of the Plan. All benefit determinations must be reasonable and based on the terms of the Plan and the facts and circumstances of each claim. Once you are deemed to have exhausted your appeal rights under the Plan, you have the right to seek court review under Section 502(a) of ERISA of any benefit determinations with which you disagree. The court will determine the standard of review it will apply in evaluating those decisions.

Long TermDisability Insurance

CC.FP-1 CC.FP-1 (1/1/2010) 1

CERTIFICATE OF COVERAGE Unum Life Insurance Company of America (referred to as Unum) welcomes you as a client. This is your certificate of coverage as long as you are eligible for coverage and you become insured. You will want to read it carefully and keep it in a safe place. Unum has written your certificate of coverage in plain English. However, a few terms and provisions are written as required by insurance law. If you have any questions about any of the terms and provisions, please consult Unum's claims paying office. Unum will assist you in any way to help you understand your benefits. If the terms and provisions of the certificate of coverage (issued to you) are different from the policy (issued to the policyholder), the policy will govern. Your coverage may be cancelled or changed in whole or in part under the terms and provisions of the policy. The policy is delivered in and is governed by the laws of the governing jurisdiction and to the extent applicable by the Employee Retirement Income Security Act of 1974 (ERISA) and any amendments. When making a benefit determination under the policy, Unum has discretionary authority to determine your eligibility for benefits and to interpret the terms and provisions of the policy. For purposes of effective dates and ending dates under the group policy, all days begin at 12:01 a.m. and end at 12:00 midnight at the Policyholder's address.

Unum Life Insurance Company of America 2211 Congress Street Portland, Maine 04122

TOC-1 (1/1/2010) 2

TABLE OF CONTENTS

BENEFITS AT A GLANCE..........................................................................................B@G-LTD-1

LONG TERM DISABILITY PLAN ................................................................................B@G-LTD-1

CLAIM INFORMATION...............................................................................................LTD-CLM-1

LONG TERM DISABILITY ..........................................................................................LTD-CLM-1

GENERAL PROVISIONS ...........................................................................................EMPLOYEE-1

LONG TERM DISABILITY ..........................................................................................LTD-BEN-1

BENEFIT INFORMATION...........................................................................................LTD-BEN-1

OTHER BENEFIT FEATURES ...................................................................................LTD-OTR-1

OTHER SERVICES....................................................................................................SERVICES-1

GLOSSARY ...............................................................................................................GLOSSARY-1

B@G-LTD-1 (1/1/2010) 3

BENEFITS AT A GLANCE

LONG TERM DISABILITY PLAN

This long term disability plan provides financial protection for you by paying a portion of your income while you are disabled. The amount you receive is based on the amount you earned before your disability began. In some cases, you can receive disability payments even if you work while you are disabled. EMPLOYER'S ORIGINAL PLAN EFFECTIVE DATE: January 1, 2003 PLAN YEAR: October 1, 2008 to January 1, 2009 and each following January 1 to January 1. POLICY NUMBER: 573627 011 ELIGIBLE GROUP(S):

All full-time and part-time eligible, non-represented employees of The Johns Hopkins Hospital, The Johns Hopkins Health System Corporation; The Johns Hopkins Home Care Group, Inc.; Johns Hopkins Pharmaquip, Inc., Johns Hopkins Pediatrics At Home Inc., Johns Hopkins Home Health Services, Inc., and the Triad Corporation, including weekend option Nurses, but excluding temporary and seasonal employees, in active employment in the United States with the Employer

MINIMUM HOURS REQUIREMENT:

Employees must be regularly scheduled to work at least 20 hours per week. WAITING PERIOD:

For employees in an eligible group on or before January 1, 2003: None For employees entering an eligible group after January 1, 2003: First of the month following the date you enter an eligible group

WHO PAYS FOR THE COVERAGE:

You pay the cost of your coverage.

ELIMINATION PERIOD:

180 days

Benefits begin the day after the elimination period is completed. MONTHLY BENEFIT:

60% of monthly earnings to a maximum benefit of $8,000 per month. Your payment may be reduced by deductible sources of income and disability earnings. Some disabilities may not be covered or may have limited coverage under this plan.

MAXIMUM PERIOD OF PAYMENT:

Age at Disability Maximum Period of Payment Less than age 60 To age 65, but not less than 5 years Age 60 60 months Age 61 48 months Age 62 42 months Age 63 36 months Age 64 30 months Age 65 24 months Age 66 21 months Age 67 18 months

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Age 68 15 months Age 69 and over 12 months

No premium payments are required for your coverage while you are receiving payments under this plan. REHABILITATION AND RETURN TO WORK ASSISTANCE BENEFIT:

10% of your gross disability payment to a maximum benefit of $1,000 per month. In addition, we will make monthly payments to you for 3 months following the date your disability ends if we determine you are no longer disabled while: - you are participating in the Rehabilitation and Return to Work Assistance program; and - you are not able to find employment.

CHILD CARE EXPENSE BENEFIT:

While you are participating in Unum's Rehabilitation and Return to Work Assistance program, you may receive payments to cover certain child care expenses limited to the following amounts: Child Care Expense Benefit Amount: $250 per month, per child Child Care Expense Maximum Benefit Amount: $1,000 per month for all eligible child care expenses combined

TOTAL BENEFIT CAP:

The total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 100% of your monthly earnings.

OTHER FEATURES:

Continuity of Coverage

Minimum Benefit

Pre-Existing: 3/12

Survivor Benefit

Work Life Assistance Program

The above items are only highlights of this plan. For a full description of your coverage, continue reading your certificate of coverage section.

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CLAIM INFORMATION

LONG TERM DISABILITY

WHEN DO YOU NOTIFY UNUM OF A CLAIM?

We encourage you to notify us of your claim as soon as possible, so that a claim decision can be made in a timely manner. Written notice of a claim should be sent within 30 days after the date your disability begins. However, you must send Unum written proof of your claim no later than 90 days after your elimination period. If it is not possible to give proof within 90 days, it must be given no later than 1 year after the time proof is otherwise required except in the absence of legal capacity. The claim form is available from your Employer, or you can request a claim form from us. If you do not receive the form from Unum within 15 days of your request, send Unum written proof of claim without waiting for the form. You must notify us immediately when you return to work in any capacity.

HOW DO YOU FILE A CLAIM?

You and your Employer must fill out your own sections of the claim form and then give it to your attending physician. Your physician should fill out his or her section of the form and send it directly to Unum.

WHAT INFORMATION IS NEEDED AS PROOF OF YOUR CLAIM?

Your proof of claim, provided at your expense, must show: - that you are under the regular care of a physician; - the appropriate documentation of your monthly earnings; - the date your disability began; - the cause of your disability; - the extent of your disability, including restrictions and limitations preventing you

from performing your regular occupation; and - the name and address of any hospital or institution where you received

treatment, including all attending physicians. We may request that you send proof of continuing disability indicating that you are under the regular care of a physician. This proof, provided at your expense, must be received within 45 days of a request by us. In some cases, you will be required to give Unum authorization to obtain additional medical information and to provide non-medical information as part of your proof of claim, or proof of continuing disability. Unum will deny your claim, or stop sending you payments, if the appropriate information is not submitted.

TO WHOM WILL UNUM MAKE PAYMENTS?

Unum will make payments to you.

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WHAT HAPPENS IF UNUM OVERPAYS YOUR CLAIM?

Unum has the right to recover any overpayments due to: - fraud; - any error Unum makes in processing a claim; and - your receipt of deductible sources of income. You must reimburse us in full. We will determine the method by which the repayment is to be made. Unum will not recover more money than the amount we paid you.

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GENERAL PROVISIONS

WHAT IS THE CERTIFICATE OF COVERAGE?

This certificate of coverage is a written statement prepared by Unum and may include attachments. It tells you: - the coverage for which you may be entitled; - to whom Unum will make a payment; and - the limitations, exclusions and requirements that apply within a plan.

WHEN ARE YOU ELIGIBLE FOR COVERAGE?

If you are working for your Employer in an eligible group, the date you are eligible for coverage is the later of: - the plan effective date; or - the day after you complete your waiting period.

WHEN DOES YOUR COVERAGE BEGIN?

You pay 100% of the cost of your coverage. Coverage will begin at 12:01 a.m. on the latest of: - the date you are eligible for coverage, if you apply for insurance on or before that

date or within 31 days after your eligibility date; or - the date Unum approves your application, if evidence of insurability is required.

WHEN CAN YOU APPLY FOR COVERAGE IF YOU DECLINED COVERAGE WHEN YOU FIRST BECAME ELIGIBLE OR IF YOU VOLUNTARILY CANCELLED YOUR COVERAGE AND ARE REAPPLYING?

You can apply for coverage only during an annual enrollment period. Evidence of insurability is required. Unum and your Employer determine when the annual enrollment period begins and ends. Your coverage will begin at 12:01 a.m. on the later of. - first day of the next plan year; or - the date Unum approves your application.

WHAT IF YOU ARE ABSENT FROM WORK ON THE DATE YOUR COVERAGE WOULD NORMALLY BEGIN?

If you are absent from work due to your injury, sickness, temporary layoff or leave of absence, your coverage will begin on the date you return to active employment.

ONCE YOUR COVERAGE BEGINS, WHAT HAPPENS IF YOU ARE TEMPORARILY NOT WORKING?

If you are on a temporary layoff, and if premium is paid, you will be covered through the end of the month that immediately follows the month in which your temporary layoff begins.

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If you are on a leave of absence, and if premium is paid, you will be covered through the end of the month that immediately follows the month in which your leave of absence begins.

WHAT HAPPENS TO AN EMPLOYEE'S COVERAGE UNDER THIS POLICY WHILE HE OR SHE IS ON A FAMILY AND MEDICAL LEAVE OF ABSENCE?

We will continue the employee's coverage in accordance with the policyholder's Human Resource policy on family and medical leaves of absence if premium payments continue and the policyholder approved the employee's leave in writing. Coverage will be continued until the end of the later of: 1. the leave period required by the federal Family and Medical Leave Act of 1993

and any amendments; or 2. the leave period required by applicable state law. If the policyholder's Human Resource policy doesn't provide for continuation of an employee's coverage during a family and medical leave of absence, the employee's coverage will be reinstated when he or she returns to active employment. We will not: - apply a new waiting period; - apply a new pre-existing conditions exclusion; or - require evidence of insurability.

WHEN WILL CHANGES TO YOUR COVERAGE TAKE EFFECT?

Once your coverage begins, any increased or additional coverage will take effect immediately if you are in active employment or if you are on a covered layoff or leave of absence. If you are not in active employment due to your injury or sickness, any increased or additional coverage will begin on the date you return to active employment. Any decrease in coverage will take effect immediately but will not affect a payable claim that occurs prior to the decrease.

WHEN DOES YOUR COVERAGE END?

Your coverage under the policy or a plan ends on the earliest of: - the date the policy or a plan is cancelled; - the date you no longer are in an eligible group; - the date your eligible group is no longer covered; - the last day of the period for which you made any required contributions; or - the last day you are in active employment except as provided under the covered

layoff or leave of absence provision. Unum will provide coverage for a payable claim which occurs while you are covered under the policy or plan.

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WHAT ARE THE TIME LIMITS FOR LEGAL PROCEEDINGS?

You can start legal action regarding your claim 60 days after proof of claim has been given and up to 3 years from the time proof of claim is required, unless otherwise provided under federal law.

HOW CAN STATEMENTS MADE IN YOUR APPLICATION FOR THIS COVERAGE BE USED?

Unum considers any statements you or your Employer make in a signed application for coverage a representation and not a warranty. If any of the statements you or your Employer make are not complete and/or not true at the time they are made, we can: - reduce or deny any claim; or - cancel your coverage from the original effective date. We will use only statements made in a signed application as a basis for doing this. If the Employer gives us information about you that is incorrect, we will: - use the facts to decide whether you have coverage under the plan and in what

amounts; and - make a fair adjustment of the premium.

HOW WILL UNUM HANDLE INSURANCE FRAUD?

Unum wants to ensure you and your Employer do not incur additional insurance costs as a result of the undermining effects of insurance fraud. Unum promises to focus on all means necessary to support fraud detection, investigation, and prosecution. It is a crime if you knowingly, and with intent to injure, defraud or deceive Unum, or provide any information, including filing a claim, that contains any false, incomplete or misleading information. These actions, as well as submission of materially false information, will result in denial of your claim, and are subject to prosecution and punishment to the full extent under state and/or federal law. Unum will pursue all appropriate legal remedies in the event of insurance fraud.

DOES THE POLICY REPLACE OR AFFECT ANY WORKERS' COMPENSATION OR STATE DISABILITY INSURANCE?

The policy does not replace or affect the requirements for coverage by any workers' compensation or state disability insurance.

DOES YOUR EMPLOYER ACT AS YOUR AGENT OR UNUM'S AGENT?

For purposes of the policy, your Employer acts on its own behalf or as your agent. Under no circumstances will your Employer be deemed the agent of Unum.

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LONG TERM DISABILITY

BENEFIT INFORMATION

HOW DOES UNUM DEFINE DISABILITY?

You are disabled when Unum determines that: - you are limited from performing the material and substantial duties of your

regular occupation due to your sickness or injury; and - you have a 20% or more loss in your indexed monthly earnings due to the same

sickness or injury. After 24 months of payments, you are disabled when Unum determines that due to the same sickness or injury, you are unable to perform the duties of any gainful occupation for which you are reasonably fitted by education, training or experience.

The loss of a professional or occupational license or certification does not, in itself, constitute disability. We may require you to be examined by a physician, other medical practitioner and/or vocational expert of our choice. Unum will pay for this examination. We can require an examination as often as it is reasonable to do so. We may also require you to be interviewed by an authorized Unum Representative.

HOW LONG MUST YOU BE DISABLED BEFORE YOU ARE ELIGIBLE TO RECEIVE BENEFITS?

You must be continuously disabled through your elimination period. Unum will treat your disability as continuous if your disability stops for 30 days or less during the elimination period. The days that you are not disabled will not count toward your elimination period.

Your elimination period is 180 days. During your elimination period you will be considered disabled if: - you are limited from performing the material and substantial duties of your regular

occupation due to your sickness or injury; and - you are under the regular care of a physician. You are not required to have a 20% or more loss in your indexed monthly earnings due to the same injury or sickness to be considered disabled during the elimination period.

CAN YOU SATISFY YOUR ELIMINATION PERIOD IF YOU ARE WORKING?

Yes. If you are working while you are disabled, the days you are disabled will count toward your elimination period.

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WHEN WILL YOU BEGIN TO RECEIVE PAYMENTS?

You will begin to receive payments when we approve your claim, providing the elimination period has been met. We will send you a payment monthly for any period for which Unum is liable.

HOW MUCH WILL UNUM PAY YOU IF YOU ARE DISABLED?

We will follow this process to figure your payment:

1. Multiply your monthly earnings by 60%. 2. The maximum monthly benefit is $8,000. 3. Compare the answer from Item 1 with the maximum monthly benefit. The lesser

of these two amounts is your gross disability payment. 4. Subtract from your gross disability payment any deductible sources of income. The amount figured in Item 4 is your monthly payment.

WILL UNUM EVER PAY MORE THAN 100% OF MONTHLY EARNINGS?

The total benefit payable to you on a monthly basis (including all benefits provided under this plan) will not exceed 100% of your monthly earnings.

WHAT ARE YOUR MONTHLY EARNINGS?

All Non-Union Employees of JHHSC/JHH and Class 2 Employees "Monthly Earnings" means your gross monthly income from your Employer in effect just prior to your date of disability. It includes your total income before taxes plus shift differential pay. It is prior to any deductions made for pre-tax contributions to a qualified deferred compensation plan, Section 125 plan, or flexible spending account. It does not include income received from commissions, bonuses, overtime pay or any other extra compensation, or income received from sources other than your Employer.

All Employees of Johns Hopkins Community Physicians "Monthly Earnings" means your gross monthly income from your Employer in effect just prior to your date of disability. It includes your total income before taxes plus shift differential and geographical differential pay. It is prior to any deductions made for pre-tax contributions to a qualified deferred compensation plan, Section 125 plan, or flexible spending account. It does not include income received from commissions, bonuses, overtime pay or any other extra compensation or income received from sources other than your Employer.

WHAT WILL WE USE FOR MONTHLY EARNINGS IF YOU BECOME DISABLED DURING A COVERED LAYOFF OR LEAVE OF ABSENCE?

If you become disabled while you are on a covered layoff or leave of absence, we will use your monthly earnings from your Employer in effect just prior to the date your absence begins.

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HOW MUCH WILL UNUM PAY YOU IF YOU ARE DISABLED AND WORKING?

We will send you the monthly payment if you are disabled and your monthly disability earnings, if any, are less than 20% of your indexed monthly earnings, due to the same sickness or injury. If you are disabled and your monthly disability earnings are from 20% through 80% of your indexed monthly earnings, due to the same sickness or injury, Unum will figure your payment as follows: During the first 12 months of payments, while working, your monthly payment will not be reduced as long as disability earnings plus the gross disability payment does not exceed 100% of indexed monthly earnings. 1. Add your monthly disability earnings to your gross disability payment. 2. Compare the answer in Item 1 to your indexed monthly earnings. If the answer from Item 1 is less than or equal to 100% of your indexed monthly earnings, Unum will not further reduce your monthly payment. If the answer from Item 1 is more than 100% of your indexed monthly earnings, Unum will subtract the amount over 100% from your monthly payment. After 12 months of payments, while working, you will receive payments based on the percentage of income you are losing due to your disability. 1. Subtract your disability earnings from your indexed monthly earnings. 2. Divide the answer in Item 1 by your indexed monthly earnings. This is your

percentage of lost earnings. 3. Multiply your monthly payment by the answer in Item 2. This is the amount Unum will pay you each month. Unum may require you to send proof of your monthly disability earnings at least quarterly. We will adjust your payment based on your quarterly disability earnings. As part of your proof of disability earnings, we can require that you send us appropriate financial records which we believe are necessary to substantiate your income. After the elimination period, if you are disabled for less than 1 month, we will send you 1/30 of your payment for each day of disability.

HOW CAN WE PROTECT YOU IF YOUR DISABILITY EARNINGS FLUCTUATE?

If your disability earnings routinely fluctuate widely from month to month, Unum may average your disability earnings over the most recent 3 months to determine if your claim should continue. If Unum averages your disability earnings, we will not terminate your claim unless the average of your disability earnings from the last 3 months exceeds 80% of indexed monthly earnings.

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We will not pay you for any month during which disability earnings exceed 80% of indexed monthly earnings.

WHAT ARE DEDUCTIBLE SOURCES OF INCOME?

Unum will subtract from your gross disability payment the following deductible sources of income: 1. The amount that you receive or are entitled to receive under:

- a workers' compensation law. - an occupational disease law. - any other act or law with similar intent.

2. The amount that you receive or are entitled to receive as disability income payments under any: - state compulsory benefit act or law. - other group insurance plan. - governmental retirement system as a result of your job with your Employer.

3. The amount that you, your spouse and your children receive or are entitled to receive as disability payments because of your disability under: - the United States Social Security Act. - the Canada Pension Plan. - the Quebec Pension Plan. - any similar plan or act.

4. The amount that you receive as retirement payments or the amount your spouse and children receive as retirement payments because you are receiving retirement payments under: - the United States Social Security Act. - the Canada Pension Plan. - the Quebec Pension Plan. - any similar plan or act.

5. The amount that you: - receive as disability payments under your Employer's retirement plan. - voluntarily elect to receive as retirement payments under your Employer's retirement plan. - receive as retirement payments when you reach the later of age 62 or normal retirement age, as defined in your Employer's retirement plan. Disability payments under a retirement plan will be those benefits which are paid due to disability and do not reduce the retirement benefit which would have been paid if the disability had not occurred. Retirement payments will be those benefits which are based on your Employer's contribution to the retirement plan. Disability benefits which reduce the retirement benefit under the plan will also be considered as a retirement benefit.

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Regardless of how the retirement funds from the retirement plan are distributed, Unum will consider your and your Employer's contributions to be distributed simultaneously throughout your lifetime. Amounts received do not include amounts rolled over or transferred to any eligible retirement plan. Unum will use the definition of eligible retirement plan as defined in Section 402 of the Internal Revenue Code including any future amendments which affect the definition.

6. The amount that you receive under Title 46, United States Code Section 688 (The Jones Act).

With the exception of retirement payments, Unum will only subtract deductible sources of income which are payable as a result of the same disability. We will not reduce your payment by your Social Security retirement income if your disability begins after age 65 and you were already receiving Social Security retirement payments.

WHAT ARE NOT DEDUCTIBLE SOURCES OF INCOME?

Unum will not subtract from your gross disability payment income you receive from, but not limited to, the following:

- 401(k) plans - profit sharing plans - thrift plans - tax sheltered annuities - stock ownership plans - non-qualified plans of deferred compensation - pension plans for partners - military pension and disability income plans - credit disability insurance - franchise disability income plans - a retirement plan from another Employer - individual retirement accounts (IRA) - individual disability income plans - no fault motor vehicle plans - salary continuation or accumulated sick leave plans

WHAT IF SUBTRACTING DEDUCTIBLE SOURCES OF INCOME RESULTS IN A ZERO BENEFIT? (Minimum Benefit)

The minimum monthly payment is the greater of: - $100; or - 10% of your gross disability payment. Unum may apply this amount toward an outstanding overpayment.

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WHAT HAPPENS WHEN YOU RECEIVE A COST OF LIVING INCREASE FROM DEDUCTIBLE SOURCES OF INCOME?

Once Unum has subtracted any deductible source of income from your gross disability payment, Unum will not further reduce your payment due to an increase in social security income or a cost of living increase from another source.

WHAT IF UNUM DETERMINES YOU MAY QUALIFY FOR DEDUCTIBLE INCOME BENEFITS?

When we determine that you may qualify for benefits under Item(s) 1, 2 and 3 in the deductible sources of income section, we will estimate your entitlement to these benefits. We can reduce your payment by the estimated amounts if such benefits: - have not been awarded; and - have not been denied; or - have been denied and the denial is being appealed. Your Long Term Disability payment will NOT be reduced by the estimated amount if you: - apply for the disability payments under Item(s) 1, 2 and 3 in the deductible

sources of income section and appeal your denial to all administrative levels Unum feels are necessary; and

- sign Unum's payment option form. This form states that you promise to pay us any overpayment caused by an award.

If your payment has been reduced by an estimated amount, your payment will be adjusted when we receive proof: - of the amount awarded; or - that benefits have been denied and all appeals Unum feels are necessary have

been completed. In this case, a lump sum refund of the estimated amount will be made to you.

If you receive a lump sum payment from any deductible sources of income, the lump sum will be pro-rated on a monthly basis over the time period for which the sum was given. If no time period is stated, we will use a reasonable one.

HOW LONG WILL UNUM CONTINUE TO SEND YOU PAYMENTS?

Unum will send you a payment each month up to the maximum period of payment. Your maximum period of payment is based on your age at disability as follows:

Age at Disability Maximum Period of Payment Less than age 60 To age 65, but not less than 5 years Age 60 60 months Age 61 48 months Age 62 42 months Age 63 36 months Age 64 30 months Age 65 24 months Age 66 21 months

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Age 67 18 months Age 68 15 months Age 69 and over 12 months

WHEN WILL PAYMENTS STOP?

We will stop sending you payments and your claim will end on the earliest of the following:

- during the first 24 months of payments, when you are able to work in your regular

occupation on a part-time basis but you choose not to; - after 24 months of payments, when you are able to work in any gainful occupation

for which you are reasonably fitted by education, training or experience on a part-time basis but you choose not to;

- if you are working and your monthly disability earnings exceed 80% of your indexed monthly earnings, the date your earnings exceed 80%;

- the end of the maximum period of payment; - the date you are no longer disabled under the terms of the plan, unless you are

eligible to receive benefits under Unum's Rehabilitation and Return to Work Assistance program;

- the date you fail to cooperate or participate in Unum's Rehabilitation and Return to Work Assistance program;

- the date you fail to submit proof of continuing disability; - after 12 months of payments if you are considered to reside outside the United

States or Canada. You will be considered to reside outside these countries when you have been outside the United States or Canada for a total period of 6 months or more during any 12 consecutive months of benefits;

- the date you die. WHAT DISABILITIES HAVE A LIMITED PAY PERIOD UNDER YOUR PLAN?

Disabilities, due to a sickness or injury, which are primarily based on self-reported symptoms, and disabilities due to mental illness, alcoholism or drug abuse have a limited pay period up to 24 months. Unum will continue to send you payments beyond the 24 month period if you meet one or both of these conditions: 1. If you are confined to a hospital or institution at the end of the 24 month period,

Unum will continue to send you payments during your confinement. If you are still disabled when you are discharged, Unum will send you payments

for a recovery period of up to 90 days. If you become reconfined at any time during the recovery period and remain

confined for at least 14 days in a row, Unum will send payments during that additional confinement and for one additional recovery period up to 90 more days.

2. In addition to Item 1, if, after the 24 month period for which you have received

payments, you continue to be disabled and subsequently become confined to a hospital or institution for at least 14 days in a row, Unum will send payments during the length of the reconfinement.

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Unum will not pay beyond the limited pay period as indicated above, or the maximum period of payment, whichever occurs first. Unum will not apply the mental illness limitation to dementia if it is a result of: - stroke; - trauma; - viral infection; - Alzheimer's disease; or - other conditions not listed which are not usually treated by a mental health

provider or other qualified provider using psychotherapy, psychotropic drugs, or other similar methods of treatment.

WHAT DISABILITIES ARE NOT COVERED UNDER YOUR PLAN?

Your plan does not cover any disabilities caused by, contributed to by, or resulting from your:

- intentionally self-inflicted injuries. - active participation in a riot. - loss of a professional license, occupational license or certification. - commission of a crime for which you have been convicted under state or federal

law. - pre-existing condition.

Your plan will not cover a disability due to war, declared or undeclared, or any act of war.

Unum will not pay a benefit for any period of disability during which you are incarcerated.

WHAT IS A PRE-EXISTING CONDITION?

You have a pre-existing condition if:

- you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines in the 3 months just prior to your effective date of coverage; and

- the disability begins in the first 12 months after your effective date of coverage. For employees covered under the prior carrier's plan: When determining if you have a pre-existing condition under this plan, we will credit the time you were previously covered under your Employer's prior group disability insurance policy if your coverage was continuous prior to the effective date of your coverage under this plan.

WHAT HAPPENS IF YOU RETURN TO WORK FULL TIME AND YOUR DISABILITY OCCURS AGAIN?

If you have a recurrent disability, Unum will treat the disability as recurrent and as part of your prior claim and you will not have to complete another elimination period if:

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- you were continuously insured under the plan for the period between your prior claim and your recurrent disability; and

- your recurrent disability occurs within 6 months of the end of your prior claim. Your recurrent disability will be subject to the same terms of the plan and maximum period of payment as your prior claim. Any disability which occurs after 6 months from the date your prior claim ended, or is due to a different cause than your prior disability, will be treated as a new claim. The new claim will be subject to all of the policy provisions. If you become entitled to payments under any other group long term disability plan, you will not be eligible for payments under the Unum plan.

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LONG TERM DISABILITY

OTHER BENEFIT FEATURES WHAT BENEFITS WILL BE PROVIDED TO YOUR FAMILY IF YOU DIE? (Survivor Benefit)

When Unum receives proof that you have died, we will pay your eligible survivor a lump sum benefit equal to 3 months of your gross disability payment if, on the date of your death: - your disability had continued for 180 or more consecutive days; and - you were receiving or were entitled to receive payments under the plan. If you have no eligible survivors, payment will be made to your estate, unless there is none. In this case, no payment will be made.

However, we will first apply the survivor benefit to any overpayment which may exist on your claim.

WHAT IF YOU ARE NOT IN ACTIVE EMPLOYMENT WHEN YOUR EMPLOYER CHANGES INSURANCE CARRIERS TO UNUM? (Continuity of Coverage)

When the plan becomes effective, Unum will provide coverage for you if: - you are not in active employment because of a sickness or injury; and - you were covered by the prior policy. Your coverage is subject to payment of premium. Your payment will be limited to the amount that would have been paid by the prior carrier. Unum will reduce your payment by any amount for which your prior carrier is liable.

WHAT IF YOU HAVE A DISABILITY DUE TO A PRE-EXISTING CONDITION WHEN YOUR EMPLOYER CHANGES INSURANCE CARRIERS TO UNUM? (Continuity of Coverage)

Unum may send a payment if your disability results from a pre-existing condition if, you were: - in active employment and insured under the plan on its effective date; and - insured by the prior policy at the time of change. In order to receive a payment you must satisfy the pre-existing condition provision under: 1. the Unum plan; or 2. the prior carrier's plan, if benefits would have been paid had that policy remained

in force. If you do not satisfy Item 1 or 2 above, Unum will not make any payments.

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If you satisfy Item 1, we will determine your payments according to the Unum plan provisions. If you only satisfy Item 2, we will administer your claim according to the Unum plan provisions. However, your payment will be the lesser of: a. the monthly benefit that would have been payable under the terms of the prior

plan if it had remained inforce; or b. the monthly payment under the Unum plan. Your benefits will end on the earlier of the following dates: 1. the end of the maximum benefit period under the plan; or 2. the date benefits would have ended under the prior plan if it had remained in

force.

HOW CAN UNUM'S REHABILITATION AND RETURN TO WORK ASSISTANCE PROGRAM HELP YOU RETURN TO WORK?

Unum has a vocational Rehabilitation and Return to Work Assistance program available to assist you in returning to work. We will determine whether you are eligible for this program, at our sole discretion. In order to be eligible for rehabilitation services and benefits, you must be medically able to engage in a return to work program. Your claim file will be reviewed by one of Unum's rehabilitation professionals to determine if a rehabilitation program might help you return to gainful employment. As your file is reviewed, medical and vocational information will be analyzed to determine an appropriate return to work program. If we determine you are eligible to participate in a Rehabilitation and Return to Work Assistance program, you must participate in order to receive disability benefits. We will make the final determination of your eligibility for participation in the program. We will provide you with a written Rehabilitation and Return to Work Assistance plan developed specifically for you. You must comply with the terms of the Rehabilitation and Return to Work Assistance plan in order to receive disability benefits. The rehabilitation program may include at our sole discretion, but is not limited to, the following services and benefits:

- coordination with your Employer to assist you to return to work; - adaptive equipment or job accommodations to allow you to work; - vocational evaluation to determine how your disability may impact your

employment options; - job placement services; - resume preparation; - job seeking skills training; or - education and retraining expenses for a new occupation.

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WHAT ADDITIONAL BENEFITS WILL UNUM PAY WHILE YOU PARTICIPATE IN A REHABILITATION AND RETURN TO WORK ASSISTANCE PROGRAM?

We will pay an additional disability benefit of 10% of your gross disability payment to a maximum benefit of $1,000 per month. This benefit is not subject to policy provisions which would otherwise increase or reduce the benefit amount such as Deductible Sources of Income. However, the Total Benefit Cap will apply. In addition, we will make monthly payments to you for 3 months following the date your disability ends if we determine you are no longer disabled while:

- you are participating in the Rehabilitation and Return to Work Assistance program;

and - you are not able to find employment. This benefit payment may be paid in a lump sum.

WHEN WILL REHABILITATION AND RETURN TO WORK ASSISTANCE BENEFITS END?

Benefit payments will end on the earliest of the following dates:

- the date Unum determines that you are no longer eligible to participate in Unum's Rehabilitation and Return to Work Assistance program; or

- any other date on which monthly payments would stop in accordance with this plan.

WHAT ADDITIONAL BENEFIT IS AVAILABLE FOR CHILD CARE EXPENSES IF YOU ARE PARTICIPATING IN UNUM'S REHABILITATION AND RETURN TO WORK ASSISTANCE PROGRAM?

When you are disabled and incurring child care expenses for your dependent child(ren) and participating continuously in Unum's Rehabilitation and Return to Work Assistance program, we will pay the Child Care Expense Benefit Amount. The payment of the Child Care Expense Benefit Amount will begin immediately after you start Unum's rehabilitation program. CHILD CARE EXPENSE BENEFIT AMOUNT

Our payment of the Child Care Expense Benefit Amount will: 1. be $250 per month, per child; and 2. not exceed $1,000 per month for all eligible child care expenses combined. CHILD CARE EXPENSE BENEFIT RULES

The Child Care Expense Benefit will be provided to reimburse your expenses incurred for providing care for your dependent children who are: 1. under the age of 15; or 2. incapable of providing their own care on a daily basis due to their own physical

handicap or mental retardation.

LTD-OTR-4 (1/1/2010) 22

To receive this benefit, you must provide satisfactory proof that: 1. you are incurring expenses for child care while participating in Unum's

rehabilitation program; and 2. payments for child care have been made to the child care provider. Child Care Expense Benefits will end on the earlier of the following: 1. the date the dependent child(ren) attain the age of 15; 2. if the dependent child(ren) are mentally retarded or physically handicapped, the

date they are no longer: a. incapacitated; or b. requiring daily care;

3. the date a charge is no longer made by the child care provider; 4. the date you no longer participate in Unum's rehabilitation program; or 5. any other date payments would stop in accordance with this plan.

SERVICES-1 (1/1/2010) 23

OTHER SERVICES

These services are also available from us as part of your Unum Long Term Disability plan. IS THERE A WORK LIFE ASSISTANCE PROGRAM AVAILABLE WITH THE PLAN?

We do provide you and your dependents access to a work life assistance program designed to assist you with problems of daily living. You can call and request assistance for virtually any personal or professional issue, from helping find a day care or transportation for an elderly parent, to researching possible colleges for a child, to helping to deal with the stress of the workplace. This work life program is available for everyday issues as well as crisis support. This service is also available to your Employer. This program can be accessed by a 1-800 telephone number available 24 hours a day, 7 days a week or online through a website. Information about this program can be obtained through your plan administrator.

HOW CAN UNUM HELP YOUR EMPLOYER IDENTIFY AND PROVIDE WORKSITE MODIFICATION?

A worksite modification might be what is needed to allow you to perform the material and substantial duties of your regular occupation with your Employer. One of our designated professionals will assist you and your Employer to identify a modification we agree is likely to help you remain at work or return to work. This agreement will be in writing and must be signed by you, your Employer and Unum. When this occurs, Unum will reimburse your Employer for the cost of the modification, up to the greater of: - $1,000; or - the equivalent of 2 months of your monthly benefit. This benefit is available to you on a one time only basis.

HOW CAN UNUM'S SOCIAL SECURITY CLAIMANT ADVOCACY PROGRAM ASSIST YOU WITH OBTAINING SOCIAL SECURITY DISABILITY BENEFITS?

In order to be eligible for assistance from Unum's Social Security claimant advocacy program, you must be receiving monthly payments from us. Unum can provide expert advice regarding your claim and assist you with your application or appeal. Receiving Social Security benefits may enable: - you to receive Medicare after 24 months of disability payments; - you to protect your retirement benefits; and - your family to be eligible for Social Security benefits. We can assist you in obtaining Social Security disability benefits by:

SERVICES-2 (1/1/2010) 24

- helping you find appropriate legal representation; - obtaining medical and vocational evidence; and - reimbursing pre-approved case management expenses.

GLOSSARY-1 (1/1/2010) 25

GLOSSARY

ACTIVE EMPLOYMENT means you are working for your Employer for earnings that are paid regularly and that you are performing the material and substantial duties of your regular occupation. You must be working at least the minimum number of hours as described under Eligible Group(s) in each plan. Your work site must be: - your Employer's usual place of business; - an alternative work site at the direction of your Employer, including your home; or - a location to which your job requires you to travel. Normal non-work days such as vacations, weekends, holidays and personal days are considered active employment. Temporary and seasonal workers are excluded from coverage. ANNUAL ENROLLMENT PERIOD means a period of time before the beginning of each plan year. DEDUCTIBLE SOURCES OF INCOME means income from deductible sources listed in the plan which you receive or are entitled to receive while you are disabled. This income will be subtracted from your gross disability payment. DISABILITY EARNINGS means the earnings which you receive while you are disabled and working, plus the earnings you could receive if you were working to your maximum capacity. ELIMINATION PERIOD means a period of continuous disability which must be satisfied before you are eligible to receive benefits from Unum. EMPLOYEE means a person who is in active employment in the United States with the Employer. EMPLOYER means the Policyholder, and includes any division, subsidiary or affiliated company named in the policy. EVIDENCE OF INSURABILITY means a statement of your medical history which Unum will use to determine if you are approved for coverage. Evidence of insurability will be at Unum's expense. GAINFUL OCCUPATION means an occupation for which you are reasonably fitted by education, training or experience, that is or can be expected to provide you with an income within 12 months of your return to work, that exceeds: 80% of your indexed monthly earnings, if you are working; or 60% of your indexed monthly earnings, if you are not working. GRACE PERIOD means the period of time following the premium due date during which premium payment may be made. GROSS DISABILITY PAYMENT means the benefit amount before Unum subtracts deductible sources of income and disability earnings.

GLOSSARY-2 (1/1/2010) 26

HOSPITAL OR INSTITUTION means an accredited facility licensed to provide care and treatment for the condition causing your disability. INDEXED MONTHLY EARNINGS means your monthly earnings adjusted on each anniversary of benefit payments by the lesser of 10% or the current annual percentage increase in the Consumer Price Index. Your indexed monthly earnings may increase or remain the same, but will never decrease. The Consumer Price Index (CPI-W) is published by the U.S. Department of Labor. Unum reserves the right to use some other similar measurement approved by the Insurance Commissioner of Maryland if the Department of Labor changes or stops publishing the CPI-W. Indexing is only used to determine your percentage of lost earnings while you are disabled and working. INJURY means a bodily injury that is the direct result of an accident and not related to any other cause. Disability must begin while you are covered under the plan. INSURED means any person covered under a plan. LAW, PLAN OR ACT means the original enactments of the law, plan or act and all amendments. LAYOFF or LEAVE OF ABSENCE means you are temporarily absent from active employment for a period of time that has been agreed to in advance in writing by your Employer. LIMITED means what you cannot or are unable to do. MATERIAL AND SUBSTANTIAL DUTIES means duties that: - are normally required for the performance of your regular occupation; and - cannot be reasonably omitted or modified. MAXIMUM CAPACITY means, based on your restrictions and limitations: - during the first 24 months of disability, after your elimination period, the greatest

extent of work you are able to do in your regular occupation, that is reasonably available.

- beyond 24 months of disability, the greatest extent of work you are able to do in any occupation, that is reasonably available, for which you are reasonably fitted by education, training or experience.

MAXIMUM PERIOD OF PAYMENT means the longest period of time Unum will make payments to you for any one period of disability. MENTAL ILLNESS means a psychiatric or psychological condition classified in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM), published by the American Psychiatric Association, most current as of the start of a disability. Such disorders include, but are not limited to, psychotic, emotional or behavioral disorders, or disorders relatable to stress or to substance abuse or dependency. If the DSM is

GLOSSARY-3 (1/1/2010) 27

discontinued or replaced, these disorders will be those classified in the diagnostic manual then used by the American Psychiatric Association as of the start of a disability. MONTHLY BENEFIT means the total benefit amount for which an employee is insured under this plan subject to the maximum benefit. MONTHLY EARNINGS means your gross monthly income from your Employer as defined in the plan. MONTHLY PAYMENT means your payment after any deductible sources of income have been subtracted from your gross disability payment. PART-TIME BASIS means the ability to work and earn between 20% and 80% of your indexed monthly earnings. PAYABLE CLAIM means a claim for which Unum is liable under the terms of the policy. PHYSICIAN means: - a person performing tasks that are within the limits of his or her medical license; and - a person who is licensed to practice medicine and prescribe and administer drugs or

to perform surgery; or - a person with a doctoral degree in Psychology (Ph.D. or Psy.D.) whose primary

practice is treating patients; or - a person who is a legally qualified medical practitioner according to the laws and

regulations of the governing jurisdiction.

Unum will not recognize you, or your spouse, children, parents or siblings as a physician for a claim that you send to us. PLAN means a line of coverage under the policy. PRE-EXISTING CONDITION means a condition for which you received medical treatment, consultation, care or services including diagnostic measures, or took prescribed drugs or medicines for your condition during the given period of time as stated in the plan. RECURRENT DISABILITY means a disability which is: - caused by a worsening in your condition; and - due to the same cause(s) as your prior disability for which Unum made a Long Term

Disability payment. REGULAR CARE means: - you personally visit a physician as frequently as is medically required, according to

generally accepted medical standards, to effectively manage and treat your disabling condition(s); and

- you are receiving the most appropriate treatment and care which conforms with generally accepted medical standards, for your disabling condition(s) by a physician whose specialty or experience is the most appropriate for your disabling condition(s), according to generally accepted medical standards.

GLOSSARY-4 (1/1/2010) 28

REGULAR OCCUPATION means the occupation you are routinely performing when your disability begins. Unum will look at your occupation as it is normally performed in the national economy, instead of how the work tasks are performed for a specific employer or at a specific location. RETIREMENT PLAN means a defined contribution plan or defined benefit plan. These are plans which provide retirement benefits to employees and are not funded entirely by employee contributions. Retirement Plan includes but is not limited to any plan which is part of any federal, state, county, municipal or association retirement system. SALARY CONTINUATION OR ACCUMULATED SICK LEAVE means continued payments to you by your Employer of all or part of your monthly earnings, after you become disabled as defined by the Policy. This continued payment must be part of an established plan maintained by your Employer for the benefit of all employees covered under the Policy. Salary continuation or accumulated sick leave does not include compensation paid to you by your Employer for work you actually perform after your disability begins. Such compensation is considered disability earnings, and would be taken into account in calculating your monthly payment. SELF-REPORTED SYMPTOMS means the manifestations of your condition which you tell your physician, that are not verifiable using tests, procedures or clinical examinations standardly accepted in the practice of medicine. Examples of self-reported symptoms include, but are not limited to headaches, pain, fatigue, stiffness, soreness, ringing in ears, dizziness, numbness and loss of energy. SICKNESS means an illness or disease. Disability must begin while you are covered under the plan. SURVIVOR, ELIGIBLE means your spouse, if living; otherwise your children through the end of the calendar year in which they turn age 25. WAITING PERIOD means the continuous period of time (shown in each plan) that you must be in active employment in an eligible group before you are eligible for coverage under a plan. WE, US and OUR means Unum Life Insurance Company of America. YOU means an employee who is eligible for Unum coverage.

ADDLSUM-1 (1/1/2010) 29

ERISA

Additional Summary Plan Description Information If this policy provides benefits under a Plan which is subject to the Employee Retirement Income Security Act of 1974 (ERISA), the following provisions apply. These provisions, together with your certificate of coverage, constitute the summary plan description. The summary plan description and the policy constitute the Plan. Benefit determinations are controlled exclusively by the policy, your certificate of coverage and the information contained in this document. Name of Plan:

The Johns Hopkins Health System Corporation / The Johns Hopkins Hospital Plan

Name and Address of Employer: The Johns Hopkins Health System Corporation / The Johns Hopkins Hospital Phipps Bldg 455D 600 North Wolfe Street Baltimore, Maryland 21287

Plan Identification Number: a. Employer IRS Identification #: 52-0591656 b. Plan #: 506

Type of Welfare Plan: Disability

Type of Administration: The Plan is administered by the Plan Administrator. Benefits are administered by the insurer and provided in accordance with the insurance policy issued to the Plan.

ERISA Plan Year Ends: June 30

Plan Administrator, Name, Address, and Telephone Number:

The Johns Hopkins Health System Corporation/The Johns Hopkins Hospital Phipps Building 600 North Wolfe Street Baltimore, Maryland 21287 (410) 955-3974 The Johns Hopkins Health System Corporation/The Johns Hopkins Hospital is the Plan Administrator and named fiduciary of the Plan, with authority to delegate its duties. The Plan Administrator may designate Trustees of the Plan, in which case the Administrator will advise you separately of the name, title and address of each Trustee.

Agent for Service of Legal Process on the Plan:

ADDLSUM-2 (1/1/2010) 30

The Johns Hopkins Health System Corporation/The Johns Hopkins Hospital Phipps Building 600 North Wolfe Street Baltimore, Maryland 21287 Service of legal process may also be made upon the Plan Administrator, or a Trustee of the Plan, if any.

Funding and Contributions:

The Plan is funded by insurance issued by Unum Life Insurance Company of America, 2211 Congress Street, Portland, Maine 04122 (hereinafter referred to as "Unum") under policy number 573627 011. Contributions to the Plan are made as stated under "WHO PAYS FOR THE COVERAGE" in the Certificate of Coverage.

EMPLOYER'S RIGHT TO AMEND THE PLAN

The Employer reserves the right, in its sole and absolute discretion, to amend, modify, or terminate, in whole or in part, any or all of the provisions of this Plan (including any related documents and underlying policies), at any time and for any reason or no reason. Any amendment, modification, or termination must be in writing and endorsed on or attached to the Plan.

EMPLOYER'S RIGHT TO REQUEST POLICY CHANGE

The Employer can request a policy change. Only an officer or registrar of Unum can approve a change. The change must be in writing and endorsed on or attached to the policy.

MODIFYING OR CANCELLING THE POLICY OR A PLAN UNDER THE POLICY

The policy or a plan under the policy can be cancelled: - by Unum; or - by the Policyholder. Unum may cancel or modify the policy or a plan if:

- there is less than 75% participation of those eligible employees who pay all or part

of their premium for a plan; or - there is less than 100% participation of those eligible employees for a Policyholder

paid plan; - the Policyholder does not promptly provide Unum with information that is

reasonably required; - the Policyholder fails to perform any of its obligations that relate to the policy; - fewer than 10 employees are insured under a plan; - the premium is not paid in accordance with the provisions of this policy that specify

whether the Policyholder, the employee, or both, pay(s) the premiums; - the Policyholder does not promptly report to Unum the names of any employees

who are added or deleted from the eligible group; - Unum determines that there is a significant change, in the size, occupation or age

of the eligible group as a result of a corporate transaction such as a merger,

ADDLSUM-3 (1/1/2010) 31

divestiture, acquisition, sale, or reorganization of the Policyholder and/or its employees; or

- the Policyholder fails to pay any portion of the premium within the 60 day grace period.

If Unum cancels or modifies the policy or a plan for reasons other than the Policyholder's failure to pay premium, a written notice will be delivered to the Policyholder at least 31 days prior to the cancellation date or modification date. The Policyholder may cancel this policy or a plan if the modifications are unacceptable. If any portion of the premium is not paid during the grace period, Unum will either cancel or modify the policy or plan automatically at the end of the grace period. The Policyholder is liable for premium for coverage during the grace period. The Policyholder must pay Unum all premium due for the full period each plan is in force. The Policyholder may cancel the policy or a plan by written notice delivered to Unum at least 31 days prior to the cancellation date. When both the Policyholder and Unum agree, the policy or a plan can be cancelled on an earlier date. If Unum or the Policyholder cancels the policy or a plan, coverage will end at 12:00 midnight on the last day of coverage. If the policy or a plan is cancelled, the cancellation will not affect a payable claim.

HOW TO FILE A CLAIM

If you wish to file a claim for benefits, you should follow the claim procedures described in your insurance certificate. To complete your claim filing, Unum must receive the claim information it requests from you (or your authorized representative), your attending physician and your Employer. If you or your authorized representative has any questions about what to do, you or your authorized representative should contact Unum directly.

CLAIMS PROCEDURES

Unum will give you notice of the decision no later than 45 days after the claim is filed. This time period may be extended twice by 30 days if Unum both determines that such an extension is necessary due to matters beyond the control of the Plan and notifies you of the circumstances requiring the extension of time and the date by which Unum expects to render a decision. If such an extension is necessary due to your failure to submit the information necessary to decide the claim, the notice of extension will specifically describe the required information, and you will be afforded at least 45 days within which to provide the specified information. If you deliver the requested information within the time specified, any 30 day extension period will begin after you have provided that information. If you fail to deliver the requested information within the time specified, Unum may decide your claim without that information. If your claim for benefits is wholly or partially denied, the notice of adverse benefit determination under the Plan will: - state the specific reason(s) for the determination; - reference specific Plan provision(s) on which the determination is based;

ADDLSUM-4 (1/1/2010) 32

- describe additional material or information necessary to complete the claim and why such information is necessary;

- describe Plan procedures and time limits for appealing the determination, and your

right to obtain information about those procedures and the right to bring a lawsuit under Section 502(a) of ERISA following an adverse determination from Unum on appeal; and

- disclose any internal rule, guidelines, protocol or similar criterion relied on in

making the adverse determination (or state that such information will be provided free of charge upon request).

Notice of the determination may be provided in written or electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements.

APPEAL PROCEDURES

You have 180 days from the receipt of notice of an adverse benefit determination to file an appeal. Requests for appeals should be sent to the address specified in the claim denial. A decision on review will be made not later than 45 days following receipt of the written request for review. If Unum determines that special circumstances require an extension of time for a decision on review, the review period may be extended by an additional 45 days (90 days in total). Unum will notify you in writing if an additional 45 day extension is needed. If an extension is necessary due to your failure to submit the information necessary to decide the appeal, the notice of extension will specifically describe the required information, and you will be afforded at least 45 days to provide the specified information. If you deliver the requested information within the time specified, the 45 day extension of the appeal period will begin after you have provided that information. If you fail to deliver the requested information within the time specified, Unum may decide your appeal without that information. You will have the opportunity to submit written comments, documents, or other information in support of your appeal. You will have access to all relevant documents as defined by applicable U.S. Department of Labor regulations. The review of the adverse benefit determination will take into account all new information, whether or not presented or available at the initial determination. No deference will be afforded to the initial determination. The review will be conducted by Unum and will be made by a person different from the person who made the initial determination and such person will not be the original decision maker's subordinate. In the case of a claim denied on the grounds of a medical judgment, Unum will consult with a health professional with appropriate training and experience. The health care professional who is consulted on appeal will not be the individual who was consulted during the initial determination or a subordinate. If the advice of a medical or vocational expert was obtained by the Plan in connection with the denial of your claim, Unum will provide you with the names of each such expert, regardless of whether the advice was relied upon. A notice that your request on appeal is denied will contain the following information: - the specific reason(s) for the determination;

ADDLSUM-5 (1/1/2010) 33

- a reference to the specific Plan provision(s) on which the determination is based; - a statement disclosing any internal rule, guidelines, protocol or similar criterion

relied on in making the adverse determination (or a statement that such information will be provided free of charge upon request);

- a statement describing your right to bring a lawsuit under Section 502(a) of ERISA

if you disagree with the decision; - the statement that you are entitled to receive upon request, and without charge,

reasonable access to or copies of all documents, records or other information relevant to the determination; and

- the statement that "You or your plan may have other voluntary alternative dispute

resolution options, such as mediation. One way to find out what may be available is to contact your local U.S. Department of Labor Office and your State insurance regulatory agency".

Notice of the determination may be provided in written or electronic form. Electronic notices will be provided in a form that complies with any applicable legal requirements. Unless there are special circumstances, this administrative appeal process must be completed before you begin any legal action regarding your claim.

YOUR RIGHTS UNDER ERISA

As a participant in this Plan you are entitled to certain rights and protections under the Employee Retirement Income Security Act of 1974 (ERISA). ERISA provides that all Plan participants shall be entitled to:

Receive Information About Your Plan and Benefits Examine, without charge, at the Plan Administrator's office and at other specified locations, all documents governing the Plan, including insurance contracts, and a copy of the latest annual report (Form 5500 Series) filed by the Plan with the U.S. Department of Labor and available at the Public Disclosure Room of the Employee Benefits Security Administration. Obtain, upon written request to the Plan Administrator, copies of documents governing the operation of the Plan, including insurance contracts, and copies of the latest annual report (Form 5500 Series) and updated summary plan description. The Plan Administrator may make a reasonable charge for the copies. Receive a summary of the Plan's annual financial report. The Plan Administrator is required by law to furnish each participant with a copy of this summary annual report.

ADDLSUM-6 (1/1/2010) 34

Prudent Actions by Plan Fiduciaries In addition to creating rights for Plan participants, ERISA imposes duties upon the people who are responsible for the operation of the employee benefit plan. The people who operate your Plan, called "fiduciaries" of the Plan, have a duty to do so prudently and in the interest of you and other Plan participants and beneficiaries. No one, including your Employer or any other person, may fire you or otherwise discriminate against you in any way to prevent you from obtaining a benefit or exercising your rights under ERISA.

Enforce Your Rights If your claim for a benefit is denied or ignored, in whole or in part, you have a right to know why this was done, to obtain copies of documents relating to the decision without charge, and to appeal any denial, all within certain time schedules. Under ERISA, there are steps you can take to enforce the above rights. For instance, if you request a copy of Plan documents or the latest annual report from the Plan and do not receive them within 30 days, you may file suit in a federal court. In such a case, the court may require the Plan Administrator to provide the materials and pay you up to $110 a day until you receive the materials, unless the materials were not sent because of reasons beyond the control of the Plan Administrator. If you have a claim for benefits that is denied or ignored, in whole or in part, you may file suit in a state or federal court. If it should happen that Plan fiduciaries misuse the Plan's money, or if you are discriminated against for asserting your rights, you may seek assistance from the U.S. Department of Labor, or you may file suit in a federal court. The court will decide who should pay court costs and legal fees. If you are successful, the court may order the person you have sued to pay these costs and fees. If you lose, the court may order you to pay these costs and fees, if, for example, it finds your claim is frivolous.

Assistance with Your Questions If you have any questions about your Plan, you should contact the Plan Administrator. If you have any questions about this statement or about your rights under ERISA, or if you need assistance in obtaining documents from the Plan Administrator, you should contact the nearest office of the Employee Benefits Security Administration, U.S. Department of Labor, listed in your telephone directory or the Division of Technical Assistance and Inquiries, Employee Benefits Security Administration, U.S. Department of Labor, 200 Constitution Avenue N.W., Washington, D.C. 20210. You may also obtain certain publications about your rights and responsibilities under ERISA by calling the publications hotline of the Employee Benefits Security Administration.

ADDLSUM-7 (1/1/2010) 35

OTHER RIGHTS

Unum, for itself and as claims fiduciary for the Plan, is entitled to legal and equitable relief to enforce its right to recover any benefit overpayments caused by your receipt of deductible sources of income from a third party. This right of recovery is enforceable even if the amount you receive from the third party is less than the actual loss suffered by you but will not exceed the benefits paid you under the policy. Unum and the Plan have an equitable lien over such sources of income until any benefit overpayments have been recovered in full.

DISCRETIONARY ACTS

The Plan, acting through the Plan Administrator, delegates to Unum and its affiliate Unum Group discretionary authority to make benefit determinations under the Plan. Unum and Unum Group may act directly or through their employees and agents or further delegate their authority through contracts, letters or other documentation or procedures to other affiliates, persons or entities. Benefit determinations include determining eligibility for benefits and the amount of any benefits, resolving factual disputes, and interpreting and enforcing the provisions of the Plan. All benefit determinations must be reasonable and based on the terms of the Plan and the facts and circumstances of each claim. Once you are deemed to have exhausted your appeal rights under the Plan, you have the right to seek court review under Section 502(a) of ERISA of any benefit determinations with which you disagree. The court will determine the standard of review it will apply in evaluating those decisions.