Cultivate Health

Dental

Regular dental exams are an important part of maintaining your overall health. Chipotle provides a Base Plan option as well as a Buy-Up option with richer coverage including adult orthodontia.

Dental Plan Comparison Chart

Plan Details

Dental Base Plan
In-Network

Dental Buy-Up Plan
In-Network

Annual Deductible

$50 individual
$150 family

$25 individual
$75 family

Dental Maximum Benefit

$1,500 per covered individual

$5,000 per covered individual

Preventive

No charge

No charge

Basic

You pay 20% after deductible

You pay 20% after deductible

Major

You pay 50% after deductible

You pay 50% after deductible

Orthodontia

Covered children up to age 19:
Covers 100% up to lifetime maximum of $1,500 when using in-network services
‍Adults: Not covered

Covered children up to age 19:
Covers 100% up to lifetime maximum of $1,500 when using in-network services
‍Adults: Not covered

Your Bi-Weekly Cost for Coverage

You

$7.78

$11.56

You + Spouse/Domestic Partner

$16.18

$29.62

You + Child(ren)

$17.29

$31.10

You + Family

$26.46

$46.85

For additional information including out-of-network coverage, visitCultivateMe.

Anthem

Carrier Name:

Policy Group:

Company Code:

Phone: 855-653-4066
CA Residents:
Email:
Web: anthem.com
EDUCATION
ENGAGEMENT
CHIPLINKS

Looking for full benefits details? Visit the Cultivate Me portal for additional details, plan documents, resources, and more.

This guide provides a summary of our benefits plans. Official plan and insurance documents govern your rights and benefits under each plan. For more details about your benefits, including covered expenses, exclusions, and limitations, please refer to the individual Summary Plan Description (SPD), plan document, or certificate of coverage for each plan. If any discrepancy exists between this guide and the official plan documents or contracts, the plan documents and contracts will prevail.


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