Important documents/forms/notices
Guides
- 2021 Northwell Benefit Guide for Non Union Employees
- 2021 Northwell Benefit Guide for Residents
- 2021 Northwell Benefit Guide for Physicians and Executives
- 2021 Northwell Benefit Guide for Peconic Residents
- 2021 Northwell Benefit Guide for Peconic Physicians and Executives
- 2021 Northwell Benefit Guide for Peconic Non-Union
- 2021 Part Time and Per-Diems Guide
Health and welfare summary plan descriptions (SPDs)
- SMM for 2020 Covid-19 Changes
- 2020 Non-Union SPD - Welcome and Intro
- 2020 Non-Union SPD - Coverage Ends
- 2020 Non-Union SPD - Important Information
- 2020 Non-Union SPD - Legal Information
- 2020 Non-Union SPD - Notices
- 2020 Non-Union SPD - Appeals and General
- 2020 Non-Union SPD - Medical - Buy Up Plan
- 2020 Non-Union SPD - Medical- Buy Up OOA Plan
- 2020 Non-Union SPD - Medical - Value Plan
- 2020 Non-Union SPD - Medical - Value OOA Plan
- 2020 Non-Union SPD - Medical - UHC High Deductible Health Plan
- 2020 Non-Union SPD - Medical - Perdiem, Part Time, Temporary Medical Plan
- 2020 Non-Union SPD - Medical - Glossary
- 2020 Non-Union SPD - Prescription
- 2020 Non-Union SPD - Flexible Spending Accounts
- 2020 Non-Union SPD - Dental Plan
- 2020 Non-Union SPD - Vision Plan
- 2020 Non-Union SPD - Life Insurance Plan
- 2020 Non-Union SPD - Disability Plan
Medical - forms/documents
- HSA Contribution Change Form
- HSA Transfer Request Form
- MagnaCare - Infant Formula Claims Submission Guidelines
- MagnaCare - Infant Formula Claim
- MagnaCare - Disabled Dependent Application
- MagnaCare - Disabled Dependent Determination Form
- UHC - Disabled Dependent
- UnitedHealthcare - Behavioral Health
- UnitedHealthcare - Infant Formula Claim
- UnitedHealthcare - Infant Formula Claims Submission Guidelines
- Vivo Health - Direct Member Reimbursement Compound Prescription Form
- Vivo Health - Direct Member Reimbursement Form
- Vivo Health - Formulary Exclusions and Alternatives
- Vivo Health - Formulary Print Q1
- Vivo Health - Preferred Drug List
- Vivo Health - Prior Authorization Form
- PayFlex Claim form Health and Dep care
- UnitedHealthcare - Foreign Claim Form
- UnitedHealthcare - Foreign Coverage Directions
- UnitedHealthcare Claim Reimbursement
Medical - notices/legal disclosures
- 2019 HSA Custodial Agreement
- CHIP_Medicaid Notice
- Exchange Notice Non Union
- Health Savings Acount Fee Schedule
- Northwell Nondiscrimination Notice
- SAR - Peconic Health
- SMM for Northwell Health and Welfare Flex Benefit Program
- Health and Welfare legal notices
- Affordable Care Act (ACA)
- CHIP Notice
- Cobra Notice
- Disclaimer
- HIPAA Notice
- Michelles Law
- Newborns and Mothers protection
- Northwell Health Disclaimer
- Northwell Health Nondiscrimination Notice
- Northwell Health Solutions Notice
- Notice of Credible Coverage
- Notice Regarding Northwell Healths Annual The Well-being Credit Program
- PPACA Notice
- Privacy Notice
- Protected Health Information (PHI) Notice
- Protections From Disclosure of Medical Information
- WHRCA Notice
Voluntary Plans 2021
- Aflac - Critical Illness Flyer
- Aflac - Accident Insurance Flyer
- Aflac - Group Hospital Indemnity Flyer
- LegalEase - Legal Insurance Flyer
- LegalEase - Legal Insurance FAQ
- Norton LifeLock Flyer
- NortonLifeLock Member Expectations Guide
- Norton LifeLock Product Features Flyer
- Trans$ure - Whole Life Insurance Flyer (NY)
- Trans$ure - Whole Life Insurance Flyer (TX)
Dental
- Cigna - Oral Health Integration Program Coverage Flyer
- Cigna - Oral Health Integration Program Registration Form
- Cigna- Claim Form
- DHMO Schedule of fees
Dental - notices/legal disclosures
Vision
- Davis Vision - Out Of Network Claim
- Davis Vision Brochure
- Davis Vision Contact Information
- Lasik Services Flyer
Leave of absence
The Well-being Credit Program
- Completing HRA through Virgin Pulse
- Completing the Feinstein GaP Wellness Action
- Tobacco Cessation Program Action
- Living Healthy with Diabetes Program Action
Retirement - plan documents
- Northwell Health 401(k) Plan Document
- Northwell Health 401(k) Plan - Amendment No. 1
- Northwell Health 401(k) Plan - Amendment No. 2
- Northwell Health 403(b) Plan Document
- Northwell Health 403(b) Plan - Amendment No. 1
- Northwell Health 403(b) Plan - Amendment No. 2
- Northwell Health 457b Plan Document
- Northwell Health System 457(b) Plan - Amendment No. 1
- Northwell Health System 457(b) Plan - Amendment No. 2
- Northwell Health System 457(b) Plan - Amendment No. 3
- Northwell Health 409A Plan Document
- Northwell Health 409A Plan - Amendment No. 1
- Northwell Cash Balance Plan (2020)
- 2020 Benefit Guide for Retirees Post 2020
Retirement - notices
- Annual Funding Notice - Northwell Health Cash Balance Plan
- Cash Balance Plan 2019 5500
- Northwell 403b Plan 2019 5500
- Northwell 401k Plan 2019 5500
- 2020 Universal Coverage Notice Final
Retirement - documents
- Instructions to run a pension estimate
- Instructions to update a beneficiary
- Pension request form
- Planning your retirement guide
Documents & notices
- Overnight Virtual Emergency Care
- 2018 Summary Annual Report Final
- 2020 Plan Maximums Final
- Central Suffolk Hospital Employee Dental Plan 5500
- Central Suffolk Hospital Employee Medical Plan 5500
- Central Suffolk Hospital Life Insurance Plan 501 5500
- Franklin General BCBS Health Plan LIJMC 5500
- Group Travel Accident Northwell Health 5500
- HUNTG Major Medical Hospitalization Dental Vision Prescription Drug 5500
- LENOX MANHATTAN Eye Ear Throat Hospital Group 5500
- Major Medical Plan PHELPS 5500
- Northern Westchester 5500
- Northwell Health Flex Benefit Plan 5500
- NSUH Contributory LTD Plan 5500
- Qualified Health Plan Northwell Health 5500
- Retiree Hospital Major Medical Northwell Health 5500