Document
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Purpose
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1400 Hour Plan Summary Plan Description (1.1 MB PDF)
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Describes the plan’s eligibility rules, covered services and expenses, exclusions, claims review and claims determination procedures.
JBT Medical and other plan benefits are described in detail.
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1400 Hour Plan SMM—2010 (32 KB PDF)
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Distributed in January 2010, this document provides amendments to the 1400 Hour Plan Summary Plan Description. This document is a companion to the 1400 Hour Plan Summary Plan Description.
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Non-1400 Hour Plan Summary Plan Description
Contact the JBT Administrative office at 1-800-JBT-HELP (1-800-528-4357) to request a copy.
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Describes the plan’s eligibility rules, covered services and expenses, exclusions, claims review and claims determination procedures.
JBT Medical and other plan benefits are described in detail.
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Non-1400 Hour Plan SMM—2010 (32 KB PDF)
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Distributed in January 2010, this document provides amendments to the Non-1400 Hour Plan Summary Plan Description. This document is a companion to the Non-1400 Hour Plan Summary Plan Description.
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JBT Notice of Privacy Practices (254 KB PDF)
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This notice describes participants’ rights under the HIPAA privacy rule.
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Medical Plans
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Medical Plan Comparison Chart (32 KB PDF)
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Provides a high-level summary and comparison of the JBT-sponsored medical plans, including the JBT Medical plan, Kaiser Permanente HMO and PacifiCare HMO.
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Kaiser Permanente HMO Evidence of Coverage (496 KB PDF)
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Serves as the official plan documentation for the Kaiser Permanente HMO plan, explaining eligibility, coverage levels, exclusions, claims review and claims determination procedures.
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PacifiCare HMO Evidence of Coverage booklets and Plan summaries for Medical and Prescription Drug Coverage:
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Serves as the official plan documentation for the PacifiCare HMO plan, explaining eligibility, coverage levels, exclusions, claims review and claims determination procedures.
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Mammogram Network Provider List (20 KB PDF)

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Lists the radiology providers who agree to accept JBT’s payment in full for mammogram services (available to JBT Medical plan participants only). You will incur no out-of-pocket expense for a mammogram if you visit a provider on this list.
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Dental
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Table of Dental Allowances (44 KB PDF)
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Shows the maximum charges allowed by the plan for dental care.
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Participating Dentist Network Brochure (40 KB PDF)
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Lists the dental providers who participate in the JBT plan’s network. You’ll receive a higher level of benefits when you visit a network provider.
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Mental Health
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MHN Evidence of Coverage Booklet
Contact MHN at 1-800-528-0646 to request a copy.
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Explains eligibility, coverage levels, exclusions, claims review and claims determination procedures for eligible participants’ mental health care services, provided through MHN.
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Life Insurance
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Group Life Insurance Evidence of Coverage:
- JBT Life Insurance Evidence of Coverage
- JBT Life Insurance Evidence of Coverage Rider Notice
Contact Prudential at 1-800-524-0542 to request copies of these documents.
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Serves as the official plan document for the JBT life insurance plan, explaining eligibility, coverage levels, exclusions, claims review and claims determination procedures.

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myhealthIQ Program
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Sample myhealthIQ Health Risk Report (212 KB PDF)
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Shows sample results from the myhealthIQ screening.
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