Medical Coverage.

Plan Choices

UnitedHealthcare
The UHC Gold, Silver, and Bronze Plans are consumer driven health plans (CDHP) with a combined savings opportunity. Rather than paying higher premiums each pay period, you can pay less, and put the rest into your HSA. JACK will also put money into your HSA through bi-weekly contributions and wellness incentives. You can then spend the money in your HSA account on qualified medical expenses or save for the future – it’s your choice!

Kaiser
The Kaiser Permanente HMO Plan is only available to employees who live in Southern CA. With the HMO, you must use a provider in the Kaiser network. You pay a copay for almost all of your health care services – if you use services outside of the Kaiser network, you will not be covered unless it’s an emergency.

Important Things to Know

Preventive Care
Preventive care services are covered 100% and are not subject to the plan deductible if performed on an outpatient basis at a physician’s office, an alternate facility or hospital. Preventive care includes routine health exams, screenings, and immunizations that are safe and effective in the early detection and prevention of disease and other health problems. Make sure to ask your health care provider if the services you need are preventive.

Medical ID Card
When you enroll in the UHC or Kaiser plans, you will receive a Medical ID card that is used for both medical and prescription drug benefits. Your card(s) should arrive in the mail within 5-7 business days of your effective date of coverage. For your convenience, within 24 hours of your effective date of coverage, you can also download their app to view/print your digital ID card on the UHC and Kaiser websites.

In-Network Benefits	UHC Bronze	UHC Silver	UHC Gold	Kaiser
Preventive Care	Plan pays 100%	Plan pays 100%	Plan pays 100%	Plan pays 100%
Annual Deductible	$3,500 (I) / $7,000 (F)	$2,800 (I) / $5,600 (F)	$1,900 (I) / $3,800 (F)	None
Out-of-Pocket Max	$6,550 (I) / $13,100 (F)	$5,000 (I) / $10,000 (F)	$3,500 (I) / $7,000 (F)	$2,500 (I) / $5,000 (F)
Coinsurance	You Pay 40%	You Pay 25%	You Pay 20%	Copay $25 Doctor visit $35 Specialist visit
Company HSA Contribution	$500 (I) / $1,000 (F)	$500 (I) / $1,000 (F)	$500 (I) / $1,000 (F)
Max 2020 HSA Contribution	$3,600 (I) / $7,200 (F) $1,000 catch-up for those 55+	$3,600 (I) / $7,200 (F) $1,000 catch-up for those 55+	$3,600 (I) / $7,200 (F) $1,000 catch-up for those 55+	N/A
Bi-Weekly Premium Employee-Only Employee + Spouse/DP Employee + Child(ren) Employee + Family	$50 $115 $96 $158	$63 $145 $121 $199	$103 $238 $199 $327	$115 $264 $219 $366
Rx Retail & Mail Order Generic Preferred Brand Non-Specialty Brand & Specialty	You pay 20% You pay 40% You pay 50%	You pay 20% You pay 40% You pay 50%	You pay 20% You pay 40% You pay 50%	Refer to Summary of Benefits & Coverage (SBC)

I = Individual F = Family (yourself + 1 or more dependents)
For the Gold Plan, Individual Annual Deductibles and Individual Out-of-Pocket Maximums apply to Employee-Only coverage level.
DP = Domestic Partner
Mail Order only for In-Network

To view Out-of-Network Benefits, click here
To view important information about deductibles and out-of-pocket maximums for the UHC plans, click here

Medical Coverage.

Out-of-Network Benefits	UHC Bronze	UHC Silver	UHC Gold	Kaiser
Preventive Care	Plan pays 100%	Plan pays 100%	Plan pays 100%	Plan pays 100%
Annual Deductible	$7,000 (I) / $14,000 (F)	$5,400 (I) / $10,800 (F)	$3,600 (I) / $7,200 (F)	None
Out-of-Pocket Max	$13,100 (I) / $26,200 (F)	$10,000 (I) / $20,000 (F)	$7,000 (I) / $14,000 (F)	$2,500 (I) / $5,000 (F)
Coinsurance	You Pay 50%	You Pay 50%	You Pay 50%	Copay $25 Doctor visit $35 Specialist visit
Company HSA Contribution	$500 (I) / $1,000 (F)	$400 (I) / $800 (F)	$300 (I) / $600 (F)	N/A
Max 2020 HSA Contribution	$3,550 (I) / $7,100 (F) $1,000 catch-up for those 55+	$3,550 (I) / $7,100 (F) $1,000 catch-up for those 55+	$3,550 (I) / $7,100 (F) $1,000 catch-up for those 55+	N/A
Bi-Weekly Premium Employee-Only Employee + Spouse/DP Employee + Child(ren) Employee + Family	$50 $115 $96 $158	$63 $145 $121 $199	$99 $228 $190 $313	$100 $230 $191 $319
Rx Retail & Mail Order Generic Preferred Brand Non-Specialty Brand & Specialty	You pay 20% You pay 40% You pay 50%	You pay 20% You pay 40% You pay 50%	You pay 20% You pay 40% You pay 50%	Refer to Summary of Benefits & Coverage (SBC)

I= Individual; F=Family (any coverage level other than Employee-Only)
For the Gold Plan, Individual Annual Deductibles and Individual Out-of-Pocket Maximums apply to Employee-Only coverage level.
DP = Domestic Partner
Mail Order only for In-Network

To view important information about deductibles and out-of-pocket maximums for the UHC plans, click here

UHC Plans, Important Info.

Click here to view important documents.

Item	UHC Bronze & UHC Silver Plans “Embedded”	UHC Gold Plan “Non-Embedded”
	Per Person AND Family Deductible and Out-of-Pocket Maximum	Employee-Only OR Family Deductible and Out-of-Pocket maximum
Deductible	Once a Person meets the Individual deductible, co-insurance applies for that person, even if the Family deductible has not been met. Once the Family deductible is met (by two or more family members), co-insurance applies for all family members.	For Employee-Only coverage, once the employee-only deductible is met, co-insurance applies. For Family coverage, once the family deductible is met (by one or more family members), co-insurance applies for all family members.
Out-of-Pocket Maximum	Once a Person meets the Individual Out-of-Pocket maximum, the plan pays 100% for that person, even if the Family Out-of-Pocket maximum has not been met. Once the Family Out-of-Pocket maximum is met (by two or more family members), the plan pays 100% for all family members.	For Employee-Only coverage, once the employee-only Out-of-Pocket maximum is met, the plan pays 100%. For Family coverage, once the family Out-of-Pocket maximum is met (by one or more family members), the plan pays 100% for all family members.

Extra Medical Programs.

Click here to view important documents.

Virtual Visits

For UHC Members Only

What if you didn’t have to leave the house when you were sick? With Virtual Visits, you can talk to a nurse or doctor from the comfort of your own home or from wherever you happen to be when you need care. And it’s simple!

How it works

✓ Answer a few questions about your health habits and fill out a brief medical history

✓ Request a Virtual Visit and provide a few details about how you're feeling

✓ Talk to a doctor by phone or video and get a prescription if necessary

Get started

2nd.MD

For UHC Members Only

2nd.MD is a great benefit that gives you the opportunity to get second opinions on medical diagnosis and treatment for you and your dependents.

Through the 2nd.MD website you will be connected via face-to-face online video or phone consultation with board-certified, leading doctors for an expert medical second opinion.

Benefit Features

✓ Gives you a 2nd opinion on diagnosis and treatment options

✓ 2nd.MD does all the heavy lifting, like collecting records and imaging

✓ It's free!

Get started

Prescription Drug Coverage.

Click here to view important documents.

Type	UHC Plan	Kaiser Plan
Pharmacy	Retail: 31 days Mail-Order: 90 days	Retail: 30 days	Mail-Order: 90 days
Generic	You pay 20% after deductible	You pay $10/prescription	You pay $20/prescription
Preferred Brand Name	You pay 40% after deductible	You pay $30/prescription	You pay $60/prescription
Non-Preferred Brand Name	You pay 50% after deductible	You pay $30/prescription	You pay $60/prescription
Specialty	You pay 50% after deductible and are partnered with a Patient Care Coordinator	You pay 20%, up to $150	N/A

Wellness Programs.

Click here to view important documents.

Naturally Slim

For UHC Members Only

Ever wonder how some people can eat all their favorite foods and not gain weight? Naturally Slim is an online program that will teach you how.

JACK is giving you the chance to learn how to eat the foods you love while reducing your risk of developing serious conditions, like diabetes or heart disease.

Benefit Features

✓ Learn new skills to change your relationship with food. Complete lessons on your computer or smart phone when it's convenient for you.

✓ Apply your new skills to your everyday life while still eating what and where you want. All you do is change when and how.

✓ And so much more!

Get started

Rally

For UHC Members Only

Rally is designed to help you make changes to your daily routine, set smart goals and track your progress. You’ll get personalized recommendations to help you move more, eat better and improve your health - and have fun doing it.

Plus, on Rally there are lots of ways to earn Rally Coins, which you can use for chances to win rewards.

Benefit Features

✓ Get your Rally Age

✓ Build healthy habits

✓ Win cool stuff

Get started

Maternity Support

For UHC and Kaiser Members

To promote a healthy pregnancy and birth of your child, JACK will give you up to $300 for completing important milestones in the maternity support program offered by UHC and Kaiser.

These programs provide education, resources, and individualized support throughout pregnancy and are available to pregnant employees and their spouses/DP on our medical plans….and at no extra cost!

Topics Include

✓ The importance of making and attending appointments

✓ Preventive Care

✓ Referrals to community-based resources

Dental Coverage.

Click here to view important documents.

Coverage Type	In-Network	Out-of-Network
Type A: Preventive Cleanings, Exams, X-rays	100%, no deductible	100% of R&C, no deductible
Type B: Basic Restorative Fillings, Extractions, TMJ	80%, after deductible	80% of R&C, after deductible
Type C: Major Restorative Bridges, Dentures, TMJ	50%, after deductible	50% of R&C, no deductible
Type D: Orthodontia	50%, after deductible	50% of R&C, after deductible
Deductible Individual / Family	$50/$150	$50/$150
Annual Maximum Benefit	$2,500 per person	$2,500 per person
Orthodontia Lifetime Maximum	$1,500 per person	$1,500 per person

Tier	Bi-Weekly Premium
Employee-Only	$8
Employee+Spouse/Domestic Partner	$17
Employee+Child(ren)	$14
Employee+Family	$23

Regular dental care is just as important as regular medical care and that is why JACK offers you a comprehensive dental plan. Our dental plans through Ameritas provide coverage for preventive services and pay a portion of more expensive dental procedures such as fillings, root canals, crowns, bridges and orthodontia.

Under the dental plan, you are free to go to any licensed dental provider you choose – but if you go to a dentist who is a member of Ameritas' network, you can reduce your Out-of-Pocket costs. There is no dental ID card necessary. When you need dental care, you have two options:

Network Dentists
This option is your best value for dental care. Network dentists are a select group of providers in the Ameritas network that have agreed to provide service to plan members at discounted rates.

Out-of-Network Dentists
If you use a dentist who is not in the Ameritas network, the plan will pay only up to the reasonable and customary (R&C) charges for a particular service in a particular area. If your out-of-network dentist charges are more than the R&C charge, you will have to pay the difference.

Preventive and diagnostic services (such as teeth cleanings, oral exams, fluoride, sealants and bitewing x-rays) are not subject to the deductible and are paid at 100%.

Employees enrolled in a JACK medical plan can enroll eligible spouses and dependents in dental coverage, even if the spouse and dependents are not enrolled in a JACK medical plan

To find a network dentist, visit ameritas.com and select FIND A PROVIDER and then DENTAL.

Vision Coverage.

Click here to view important documents.

The VSP Choice vision plan helps reduce the cost of vision exams, eyeglasses, contact lenses and other vision services. If you use a VSP network provider, you receive high quality vision care at the lowest Out-of-Pocket costs, and receive allowances or discounted rates on other services.

To find a VSP provider, visit their website at vsp.com or call (800) 877-7195. Once you enroll, make an appointment with your provider and let the provider know that you have VSP Choice insurance coverage. They will verify your coverage and eligibility before you arrive for your appointment. There is no vision ID card necessary.

Employees enrolled in a JACK medical plan can enroll eligible spouses and dependents in vision coverage, even if the spouse and dependents are not enrolled in a JACK medical plan.

To find a VSP provider, visit their website at vsp.com or call (800) 877-7195.

Benefit	In-Network	Frequency
WellVision Exam	$25 copay	Every 12 months
Prescription Glasses	$30 copay for lenses and/or frames; $160 allowance	Frames: Every 24 months Lenses: Every 12 months
Contacts (Instead of glasses)	$160 allowance	Every 12 months
Lens Enhancements	$0-$175 depending on service	Every 12 months
Diabetic Eyecare Plus	$20 copay	As needed

Tier	Bi-Weekly Premium
Employee-Only	$2.13
Employee+ Spouse/Domestic Partner	$2.84
Employee+Child(ren)	$3.35
Employee+Family	$5.35

Terms to Know.

Term	Definition
Beneficiary	Person or persons you name to receive benefits in the event of your death.
Benefit Plan Year	October 1 through September 30.
COBRA	Stands for Consolidated Budget Omnibus Reconciliation Act, which is the federal law that requires employers to allow for continued coverage through a group health plan for up to 18 months after losing eligibility in the group plan, on a self-pay basis.
Coinsurance	Percentage of eligible health care expenses you pay after your deductible has been met.
Consumer Driven Health Plan (CDHPs)	Health insurance plan with lower premiums and higher deductibles, that is typically combined with a tax-advantaged Health Savings Account (HSA) that can be used to pay for eligible health care expenses. CDHPs give employees more control over their health care options.
Copay	Fixed dollar amount you pay for a covered health care service at the time the service is provided; applies to Kaiser Plan.
Covered Service	Health care services that the plan will cover in part or in full based on plan documents.
Deductible	Amount you pay each plan year for covered health care services before the plan begins to pay benefits.
Eligibility Date	Date you are eligible to participate in JACK benefits and enroll online through MyUltiStuff.
Effective Date	Date your benefit coverage begins.
Evidence of Insurability (EOI)	Application process in which you provide information on the condition of your health or your dependent’s health to get certain types of insurance coverage.
Health Maintenance Organization (HMO)	Managed health care program where services are coordinated by a primary care physician (PCP), including referrals to specialists within the HMO network (i.e. the Kaiser Plan).
Health Savings Account (HSA)	Type of tax-advantaged savings account where you can contribute tax-free money to pay for qualified medical expenses.
In-Network Provider	Any licensed doctors, hospital, lab, or other health care provider that has contracted to provide members with comprehensive services at discounted rates.
Out-of-Network Provider	Any licensed doctors, hospital, lab, or other health care provider that is not part of a provider network. Rates are typically higher than in-network providers.
Out-of-Pocket Maximum	Maximum amount you will have to pay Out-of-Pocket in a plan year for covered health care services, including prescriptions. Once you reach the Out-of-Pocket maximum, the plan pays 100% of covered services.
Qualified Life Event (QLE)	A change in your life status such as marriage/divorce, having/adopting a baby, losing/gaining health coverage, that qualifies you to be eligible for a special enrollment period where you can enroll in health coverage outside of the Annual Open Enrollment period. You have 30 days after the event occurs to make benefit changes.
Premium	Amount you pay for your selected benefit plans each bi-weekly pay period.
Preventive Care	Routine health care, including screenings, check-ups, and patient counseling to prevent or discover illness, disease, or other health problems.
Reasonable & Customary (R&C)	Maximum amount the plan will pay for a service, based on what providers in that geographic area charge for similar services or supplies.
Formulary	List of prescription drugs covered by the health insurance plan and which coverage tier they fall under (i.e. generic, preferred, non-preferred).
Generic Drug	Prescription drug that is equivalent to a brand-name drug with the same active (main) ingredients and is subject to the same FDA standards for quality, strength and purity. Generic drugs almost always cost less than brand-name drugs, although not all brand-name drugs have generic equivalents.
Preferred Brand Drug	Prescription drug that is considered a “preferred choice” based on its effectiveness and cost.
Non-Preferred Brand & Specialty Drug	Prescription drug that isn’t on the Plan’s preferred list.

Stock Awards.

The Basics

Employees in Director level positions and above typically receive an annual grant of Restricted Stock Units (RSUs) in November or December. At times, the Company may elect to award grants below the Director level.

The monetary value of the RSU award at grant varies by position level. RSU awards vest over a three-year period from the grant date.

Awards are subject to approval by the Company’s Board of Directors and to the terms and provisions of the 2004 Stock Incentive Plan and the Time-Vesting Restricted Stock Unit Award Agreement.

More about Grants and Vesting

New Grants:
The first time you receive an award, an E*Trade account will be established on your behalf and you will be required to activate your account. Additionally, each time you receive a grant you will need to accept the terms of the award agreement within your Employee Stock Plan Account.

Award Vesting:
When an award vests, you will receive shares of Jack in the Box Inc. common stock. The income and required tax withholdings related to the transaction will be reported on your W2 as income and taxes withheld.

See additional FAQs related to RSUS here:
RSU FAQs →

Our Vendor

The Company uses E*Trade as its exclusive broker for employee stock plan transactions.

www.etrade.com
Participant Support: 1-800-838-0908

Allowances & Reimbursements.

Communications Allowances - The Basics

Mobile Device Allowance

If you work primarily in the corporate office (CSC/IC) and your job requires you to be accessible when traveling outside the office or outside of regular business hours, you may receive a $20 allowance each bi-weekly pay period.

For text messaging, restaurant managers may receive a $4.62 allowance each bi-weekly pay period.

or

Home-Based Allowance

If you work out of your home (a home-based employee), you may receive a $40 allowance each bi-weekly pay period.

Vehicle Reimbursement

The Basics

If your position requires that you regularly travel 5,000 or more miles per year using your personal vehicle for business purposes, you are eligible to participate in the vehicle reimbursement program.

The reimbursement consists of a fixed monthly reimbursement for the cost of using your personal vehicle, and a variable rate reimbursement for actual business miles traveled.

Reimbursements qualify for 100% tax-free status if you comply with program requirements (refer to the Motus Driver Brochure).

Helpful Documents

Motus (the program administrator) calculates fair and accurate reimbursement rates for the business use of your personal vehicle; rates vary based on costs and other considerations of your specific geographic location.

JIB Motus Driver Brochure →
JIB Vehicle Reimbursement Program Policy →

Our Vendor

www.motus.com

Member Services:
888-801-6714
memberservices@motus.com

Rewards and Recognition.

The Basics

Recognition for Corporate Employees (Including DMs):

RAVE, a digital, web-based platform hosted by Achievers, is used for employee recognition and career celebration at the corporate level.

Employees can publicly recognize others for varying degrees of achievement and contributions in two ways:

RAVE for Recognition – Continuous and frequent appreciation without points

RAVE for Rewards – Points based recognition to reward desired behaviors or outcomes

You also receive points when you meet significant career milestones (i.e 1 yr, 3 yrs, 5 yrs, 10 yrs, 15, yrs, etc.).

You can redeem your points to purchase things that are meaningful to you, such as gift cards, electronics, vacation excursions and so much more!

RAVE Program FAQs →

Our Vendor

Contact the Member Experience group at Achievers for questions about point redemptions.

Mobile App: Search for Achievers
Participant Support: 1-888-676-4687
jackintheboxinc.achievers.com

Your Items

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Health & Wellness

Medical Plans

UHC Bronze

UHC Silver

UHC Gold

Kaiser

Prescription Drug

UHC Plans

Kaiser Plan (Retail)

Wellness Programs

Dental Plan

Now with Ameritas!

In-Network

Out-of-Network

Vision Plan

Highlights