AP-R & Staff BENEFITS - OPEN ENROLLMENT 2018 - Chipotle Benefits
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AP-R & Staff BENEFITS
OPEN ENROLLMENT – 2018
iWHAT TO KNOW FOR 2018
OPEN ENROLLMENT: OCTOBER 30 – NOVEMBER 13
Preventing illness is a lot less expensive — and a lot less painful — than
100% treating it. Don’t forget that all Chipotle medical plan options cover
Covered! preventive screenings at 100% — it costs you nothing but the time it
takes to go to the doctor.
To receive benefits for maintenance drugs — ongoing prescription drugs
including birth control and medication to control conditions such as
high cholesterol or hypertension — you’ll now need to purchase them in
90-day supplies either through the mail-order program, a CVS/Caremark
pharmacy, or take action to continue receiving a 30-day supply at your
local pharmacy.
A Consumer Directed Health Plan will replace the High Deductible
Plan. The benefits are similar, but the new plan has a few important
differences:
• You will be able to open a Health Savings Account (HSA) to set aside
money for out-of-pocket medical expenses now and in the future
• The annual deductible and coinsurance applies to prescription drugs
• If you cover dependents, you must meet the full family deductible
before the plan will pay benefits.
Chipotle Wellness is providing you more ways to earn your wellness
incentive in 2018! See page 5 to learn more.
Save time and money. With LiveHealth Online you can use a mobile app to
talk to a doctor or psychologist anytime, anywhere. In most states, doctors
can even write you a prescription. Visit www.LiveHealthOnline.com for
more information and to download the app.
You’ll enroll through Workday. Visit https://wd5.myworkday.com/chipotle
and check your inbox for an Open Enrollment notification to get started.
For more plan information or details not included in this brochure,
visit the Benefits Hub, https://benefits.unburritable.net.
Para cualquier información sobre los beneficios en español, favor de comunicarse
con el Centro de Servicios para Empleados de Chipotle al (877) 625-1919.
1WHAT DO I NEED TO DO?
1 Review this brochure and learn about what’s new for 2018!
2 Visit the Benefits Hub at https://benefits.unburritable.net
to learn more about available benefits
• Download the 2018 AP-R & Staff Benefits Guide under the Open
Enrollment Section
3 Enroll in your 2018 benefits using Workday
• Log in to https://wd5.myworkday.com/chipotle
-User ID = your employee ID with Leading Zeroes (7 digits total)
-Password = Existing Password
Forgot your password? Use the forgot password link from the Workday login screen.
If you need additional help contact the Employee Service Center via email at
workdayesc@chipotle.com or call 877-625-1919 x Benefits.
• Verify your personal and dependent information
• Review your current benefits and make any changes you want for you
and your family for 2018
• Complete your enrollment by 10pm EST on November 13
• Print your confirmation statement after you finish your enrollment
• Your new benefits will become effective January 1, 2018
• You must make a new election for 2018 Flexible Spending Accounts
Don’t forget
and the Hyatt Legal Plan if you wish to enroll or continue these benefits.
-Current elections for these plans will end with the last paycheck in 2017.
2WELLNESS
Chipotle Wellness aims to create an innovative culture of wellbeing by providing you
physical, financial, emotional and community resources to inspire each individual
employee to live their best life.
COMPLETE THESE 1. Register on www.chipotlewellness.com
STEPS TO EARN $400 2. Get a biometric screening
IN ANNUAL PREMIUM 3. Meet the 2018 Healthy Criteria (or participate in
REDUCTIONS a reasonable alternative)
Continue to participate in wellness programs and
STAY ENGAGED challenges during the year and you’ll be rewarded
THROUGHOUT THE for each activity you complete. Redeem your
YEAR AND EARN $300 rewards for gift cards at your favorite retailers
IN WELLNESS REWARDS and brands or choose to donate your rewards to a
charitable organization.
That’s right. By completing a few easy steps
THAT’S UP TO $700
through the wellness program, you and your
OR $1,400* IN
spouse/partner can put some serious cash back in
WELLNESS REWARDS your pocket in 2018.
*If you and your spouse/partner both enroll in medical coverage and participate in Wellness.
2018 HEALTHY CRITERIA
WELLNESS SCREENING (MEET 3 OUT OF 4)
BODY MASS INDEX (kg/m2)2018 RATES
$
Reduce these premiums by participating in Wellness! See your 2018 Benefits Guide for details.
EMPLOYEE EMPLOYEE EMPLOYEE EMPLOYEE
MEDICAL ONLY + SPOUSE/
PARTNER
+ CHILDREN + FAMILY
PLAN 1: E
PO1 PLAN
BIWEEKLY $76.26 $176.56 $157.23 $251.41
PLAN 2: L
OW DEDUCTIBLE PPO2 PLAN
BIWEEKLY
$67.78 $159.17 $141.12 $225.96
PLAN 3: C
ONSUMER DIRECTED HEALTH
$42.64 $107.64 $93.36 $150.55
PLAN2 (CDHP) BIWEEKLY
1
Exclusive Provider Organization (i.e. In-Network benefits only).
2
Preferred Provider Organization.
EMPLOYEE EMPLOYEE EMPLOYEE EMPLOYEE
DENTAL ONLY + SPOUSE/
PARTNER
+ CHILDREN + FAMILY
BASE PLAN
BIWEEKLY
$5.92 $12.27 $13.08 $20.36
BUY-UP PLAN
$9.74 $24.48 $25.64 $38.88
BIWEEKLY
EMPLOYEE EMPLOYEE EMPLOYEE EMPLOYEE
VISION ONLY + SPOUSE/
PARTNER
+ CHILDREN + FAMILY
BASE PLAN
BIWEEKLY $0.00 $2.44 $1.93 $4.33
BUY-UP PLAN
BIWEEKLY
$4.28 $11.00 $9.63 $16.10
4WHAT’S NEW FOR 2018
+
Beginning January 1, 2018, you will be required to purchase 90-day
90-DAY supplies of maintenance medications (prescription drugs that you
SUPPLY FOR take on a regular basis), such as birth control, or medication to control
MAINTENANCE cholesterol or hypertension. For your convenience, you may fill these
prescriptions through the medical plan’s mail-order drug program or at a
MEDICATIONS
CVS/Caremark pharmacy (including those located in Target stores).
Under all Chipotle medical plans, you’ll save money by purchasing a
90-day supply of your maintenance medication because you’ll get more
medication for lower cost than you would otherwise.
If you wish to opt-out of the 90-day supply requirement, you may call CVS
Customer Care at the number on your prescription drug ID card. After
three fills, if you continue to purchase 30-day supplies of maintenance
medications without contacting CVS Customer Care, the plan will not pay
benefits; you will be responsible for the full cost of your prescription.
The High Deductible PPO Plan will be replaced by the Consumer Directed
NEW MEDICAL Health Plan (CDHP). There are a few differences with the CDHP:
PLAN WITH •• You will be able to open a Health Savings Account (HSA) that can
HEALTH SAVINGS provide tax savings on eligible out-of-pocket medical expenses
ACCOUNT (HSA) •• The annual deductible and coinsurance applies to prescription drugs
•• If you cover dependents, you need to meet the full family deductible
before the plan will pay benefits. Also, you will need to meet the full
family out-of-pocket maximum before the plan will pay benefits at
100% for the rest of the year.
•• Don’t forget: In-network preventive care is still covered at 100%, the
deductible does not apply.
The CDHP works like a PPO plan, except that before the plan begins to
NOTE: If you are pay for services (including prescription drugs) other than preventive care,
currently enrolled in the you must first meet the annual deductible. Once you do, you will pay the
High Deductible PPO 20% coinsurance for all services and the plan will pay 80%.
and don't take action
you will be automatically The CDHP comes with a Health Savings Account (HSA) that you can
enrolled into the CDHP. use to pay for out-of-pocket medical expenses both now and in the
If you wish to enroll in future. You can direct pre-tax payroll contributions into your HSA and,
another plan you must if you wish, you may also make after-tax contributions on your own, up
actively submit your to the maximum allowed by the IRS. For 2018, if you have employee-
elections in Workday. only coverage the maximum contribution is $3,450; if you also cover
dependents, the maximum is $6,900.
If there’s money left in your HSA at the end of the year, it will
automatically roll over into the next year. As long as you are in the
CDHP, you can use the money in your HSA to pay eligible out-of-pocket
expenses for yourself and covered family members. Also, you own the
balance in your HSA, so if you leave Chipotle, you will still have access to
your HSA balance.
5STAY INFORMED!
Benefits Hub
https://benefits.unburritable.net
Enrollment Site
https://wd5.myworkday.com/chipotle
Anthem’s Coverage Advisor
enrollment.anthem.com/ChipotleSalary
Wellness Site
www.chipotlewellness.com
Health Insurance Marketplace
www.mercermarketplace.com/insurance
or www.healthcare.gov
Employee Service Center
(877) 625-1919 x Benefits
workdayesc@chipotle.com
6LEGAL STUFF
Summary of Material Modifications
This guide constitutes a Summary of Material Modifications to the 2018 Chipotle
AP-R & Staff Medical Plan summary plan description (SPD). It is meant to
supplement certain information in the SPD, so retain it for future reference along
with your SPD. Please share these materials with your covered family members.
This guide also provides highlights of Chipotle’s employee benefit plans and
programs. Coverage under any Chipotle employee benefit plan or program
is subject to the rules, conditions, and restrictions that apply pursuant to
the governing plan documents, including the summary plan descriptions
(SPDs) and any applicable insurance policy or certificate. Chipotle reserves
the right to interpret the plans’ provisions. To review the SPDs, go to
https://benefits.unburritable.net.
Summary Plan Descriptions
Individuals entitled to receive benefits under the Chipotle AP-R & Staff Medical
Plan are also entitled to be furnished with certain documents required by
ERISA. Chipotle intends to provide the following documents to you by electronic
delivery via our enrollment website, https://benefits.unburritable.net.
You have a right to request and obtain a paper version of any electronically
transmitted document at no charge. Contact benefits@chipotle.com to request a
paper copy, or visit https://benefits.unburritable.net to download a copy. This
includes the Summary Plan Descriptions (SPDs); the Summary Annual Report
(SAR); and any documents required to be furnished to you. To request a copy of
documents under ERISA Section 104(b), contact benefits@chipotle.com.
HIPAA Special Enrollment Rights Notice
Special enrollment events allow you and your eligible dependents to enroll
for health coverage outside the Open Enrollment period under certain
circumstances if you lose eligibility for other coverage, become eligible for state
premium assistance under Medicaid or the State Children’s Health Insurance
Program (CHIP), or acquire newly eligible dependents. This is required under the
Health Insurance Portability and Accountability Act (HIPAA).
If you decline enrollment in a Chipotle medical plan for you or your dependents
(including your spouse/domestic partner) because of other health insurance
coverage, you or your dependents may be able to enroll in a Chipotle medical
plan without waiting for the next Open Enrollment period if you:
•• Lose other coverage. You must request enrollment within 31 days after the
loss of other coverage.
•• Gain a new dependent as a result of marriage, birth, adoption, or placement
for adoption. You must request enrollment within 31 days after the marriage,
birth, adoption, or placement for adoption.
7•• Lose Medicaid or Children’s Health Insurance Program (CHIP) coverage
because you are no longer eligible or become eligible for a state’s premium
assistance program under Medicaid or CHIP. You must request enrollment
within 60 days after the loss of such coverage or within 60 days of gaining
eligibility for such coverage.
If you request a change due to a special enrollment event within the 30 day
time frame, coverage will be effective the date of birth, adoption or placement
for adoption. For all other events, coverage will be effective the first of the
month following your request for enrollment. Specific restrictions may apply,
depending on federal and state law. If you have questions, or to notify the plan,
email benefits@chipotle.com.
Note: If your dependent becomes eligible for a special enrollment rights, you
may add the dependent to your current coverage or change to another health
plan. Any other currently covered dependents may also switch to the new plan
in which you enroll.
Women’s Health and Cancer Rights Act
Group health plans that cover mastectomies must, under federal law, cover post-
mastectomy reconstructive breast surgery. Specifically, health plans must cover:
reconstruction of the breast on which the mastectomy has been performed,
surgery and reconstruction of the other breast to produce a symmetrical
appearance, and prostheses and physical complications of all stages of a
mastectomy, including lymphedemas.
The Chipotle AP-R & Staff Medical Plan complies with these requirements.
Benefits required by law will be provided in consultation between the patient
and attending physician. These benefits are subject to the plan’s regular
deductibles and/or coinsurance.
The Newborns’ And Mothers’ Health Protection Act
Group health plans and health insurance issuers generally may not, under
federal law, restrict benefits for any hospital length of stay in connection with
childbirth for the mother or newborn child to less than 48 hours following a
vaginal delivery, or less than 96 hours following a cesarean section. However,
federal law generally does not prohibit the mother’s or newborn’s attending
provider, after consulting with the mother, from discharging the mother or
her newborn earlier than 48 hours (or 96 hours as applicable). In any case,
plans and issuers may not, under federal law, require that a provider obtain
authorization from the plan or the issuer for prescribing a length of stay not in
excess of 48 hours (or 96 hours).
8Chipotle Notice of Privacy Practices for Protected Health Information
The Chipotle Group Health Plan for AP-R & Staff Employees (the “Plan”)
provides health benefits to eligible employees of Chipotle Mexican Grill, Inc.
(the “Company”) and their eligible dependents as described in the summary
plan description(s) for the Plan. The Plan creates, receives, uses, maintains and
discloses health information about participating employees and dependents
in the course of providing these health benefits. The Plan is required by law to
provide notice to participants of the Plan’s duties and privacy practices with
respect to covered individuals’ protected health information, and has done so by
providing to Plan participants a Notice of Privacy Practices, which describes the
ways that the Plan uses and discloses protected health information. To receive
a copy of the Plan’s Notice of Privacy Practices you should contact the Benefits
Manager, who has been designated as the Plan’s contact person for all issues
regarding the Plan’s privacy practices and covered individuals’ privacy rights.
You can reach this contact person through the Employee Service Center at:
(877) 625-1919, 1401 Wynkoop St., Suite 500, Denver, Colorado, 80202. You may
also download the full Notice at https://benefits.unburritable.net.
9Chipotle Benefits 1401 Wynkoop St., Suite 500 Denver, CO 80202
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