Documents & Contacts
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UHC Participants
Summary
Telehealth Information
UHC Members - FAQ
UHC Members - Informational Video


Kaiser Participants:
For all Kaiser Permanente plans, cost sharing (deductibles, copayments and coinsurance) will be reduced to zero dollars ($0.00) for medically necessary screening and testing for COVID-19 including the visit, associated lab testing, and radiology services in a plan hospital, emergency or urgent care setting, or medical office. This cost sharing reduction will apply to all Kaiser Permanente and other plan (participating) providers. If a member is diagnosed with COVID-19, all treatment including but not limited to hospital, transportation and pharmacy services will be covered in accordance with the terms and conditions set forth in the coverage document for the member’s health plan.
General
Document
Eligibility Definitions & Required Documents
UHC Bronze Plan
Document Vendor Internal Contact
Summary of Benefits & Coverage UnitedHealthCare | myuhc.com
877-468-0979 | Group: 704025		 benefits@jackinthebox.com
OOA Summary of Benefits & Coverage See above See above
Summary Plan Description See above See above
OOA Summary Plan Description See above See above
UHC Silver Plan
Document Vendor Internal Contact
Summary of Benefits & Coverage See above See above
OOA Summary of Benefits & Coverage See above See above
Summary Plan Description See above See above
OOA Summary Plan Description See above See above
UHC Gold Plan
Document Vendor Internal Contact
Summary of Benefits & Coverage See above See above
OOA Summary of Benefits & Coverage See above See above
Summary Plan Description See above See above
OOA Summary Plan Description See above See above
UHC General
Document Vendor Internal Contact
Preventive Medications UnitedHealthCare | myuhc.com
877-468-0979 | Group: 704025		 benefits@jackinthebox.com
UHC Virtual Visits Information See above See above
UHC Health4Me App See above See above
Kaiser Plan
Document Vendor Internal Contact
Kaiser SBC Kaiser | kp.org
800-464-4000 | Group: 704104971-01		 benefits@jackinthebox.com
Kaiser Wellness Resources Kaiser | kp.org
800-464-4000 | Group: 704104971-01		 benefits@jackinthebox.com
Dental
Document Vendor Internal Contact
Dental Plan Summary MetLife | metlife.com/mybenefits
800-942-0854 | Group: 304081		 benefits@jackinthebox.com
Vision
Document Vendor Internal Contact
Vision Plan Summary VSP | vsp.com
800-877-7195 | Group: 00103013		 benefits@jackinthebox.com
Wellness
Document Vendor Internal Contact
Real Appeal Guide Real Appeal | support.realappeal.com benefits@jackinthebox.com
Kaiser Wellness Resources Kaiser | kp.org
800-464-4000 | Group: 704104971-01		 benefits@jackinthebox.com
Compliance Documents
Document
Notice of Electronic Disclosure
Compliance Notice
Summary of Annual Report
Marketplace Coverage Options
California Marketplace Formulary Disclosure
Form 5500 Plan 565
401(k)
Document Vendor Internal Contact
Program Guide Charles Schwab | workplace.schwab.com
800-724-7526/877-905-2553 (Spanish)		 retirement.team@jackinthebox.com
Program Guide (Spanish) N/A
Enrollment Flyer N/A
Schwab Rollover Form N/A
Form 5500 N/A
Summary Annual Report N/A
EDCP
Document Vendor Internal Contact
EDCP Plan Highlights Newport Group | newportgroup.com
800-230-3950		 retirement.team@jackinthebox.com
Income Protection Plans
Document Vendor Internal Contact
Basic Life Insurance Reliance Standard | reliancestandard.com
800-351-7500 | Group: 157804 GL		 benefits@jackinthebox.com
Supplemental Life Insurance See above See above
Evidence of Insurability Form See above See above
AD&D Plan See above See above
Short-Term Disability See above | Policy # VPS327500 See above
Long-Term Disability
(Admin not in other classes)		 See above | Policy #129068 See above
Long-Term Disability (Over $100K) See above | Policy #129068 See above
Long-Term Disability (Over $300K) See above | Policy #129068 See above
Flexible Spending Account
Document Vendor Internal Contact
Flexible Spending User Guide UnitedHealthCare | myuhc.com
877-468-0979 | Group: 908484		 benefits@jackinthebox.com
Flexible Spending
Limited Purpose Care User Account		 See above See above
Flexible Spending
Dependent Care User Account		 See above See above
FSA Eligible Expenses See above See above
Health Savings Account
Document Vendor Internal Contact
Health Savings Account User Guide Optum Bank | optumbank.com
866-234-8913, Option 1 | Policy: 704025		 benefits@jackinthebox.com
HSA Qualified Expenses See above See above
HSA Schedule of Fees See above See above
MetLaw Legal Plans
Document Vendor Internal Contact
MetLaw Legal Plans Brochure MetLaw Legal Plans | legalplans.com
800-821-6400 | Low Code: 9902525, High Code: 9902523		 benefits@jackinthebox.com
Pension
Document Vendor Internal Contact
Annual Funding Notice Pension N/A retirement.team@jackinthebox.com
Retirement Plan Form 5500 N/A See above
Paid Time Off
Document Internal Contact
Corporate Vacation Policy totalrewards@jackinthebox.com
Corporate Sick Leave Policy See above.
FY 2020 Calendar: AM/RMs
FY 2020 Calendar: Corporate		 See above.
Jury and Witness Duty Policy See above.
Bereavement Pay Policy See above.
Employee Discounts
Document Vendor Internal Contact
PerkSpot Employee Discount Information PerkSpot | jib.perkspot.com totalrewards@jackinthebox.com
Leave of Absence
Document Vendor Internal Contact
How to File an FMLA Claim Matrix | matrixabsence.com
877-202-0055 		benefits@jackinthebox.com
Employee Assistance Program
Document Vendor Internal Contact
ComPsych EAP Brochure ComPsych | guidanceresources.com, ID: jibeap
866-735-0703 		benefits@jackinthebox.com
In the event of any conflict between the content contained herein and the Summary Plan Description (SPD), the provisions of the Summary Plan Description (SPD) shall prevail.
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