Creighton Elementary School District #14
INSURANCE INFORMATION/ ONLINE BENEFITS ENROLLMENT
Welcome to the Creighton Elementary School District! Please review this information regarding your
insurance benefits carefully. Your understanding of our group insurance plans is important in order to
receive the best service from our insurance providers.
INSURANCE INFORMATION
New full time contracted employees become eligible for benefits the first day of the month following
their contract date of employment. Employees choose their benefits for the entire benefit year. The
benefit year runs from July 1st through June 30th. Open enrollment is held annually during the months
of mid April & May with an effective date of July 1st.
While most changes are made during Open Enrollment, life event changes are allowed during the
benefit year. Life event changes include, but are not limited to, the birth of a new child, adoption,
marriage or divorce or loss of coverage. In these cases, changes are permitted within 31 days following
the event with verification of life event.
As a full time employee the Creighton Elementary School District will provide you three (3) medical
HMO options: Silver, Gold, Platinum.
The district will pay 100% of employee premium for the Silver AETNA HMO Plan, dental coverage with
Employers Dental Services and life insurance valued at one times your annual salary with Hartford Life
Insurance. This means no deductions taken from your paycheck for premiums. Dependent coverage is
offered at an additional cost to you through payroll deductions. Refer to the rate sheet to determine
monthly cost.
The District also offers the following voluntary plans, which you can purchase:
 Gold or Platinum HMO Medical Plans with Aetna
 Delta Dental Indemnity Plan
 Short Term Disability Insurance (If selected you must download form, complete and return to
District Office)
 Flexible medical and/or dependent spending accounts (FSA) (If selected you must download
form, complete and return to District Office)
 Supplemental Life Insurance (If selected you must download form, complete and return to
District Office)
Creighton Elementary School District #14
INSURANCE INFORMATION/ ONLINE BENEFITS ENROLLMENT
Employee Insurance Benefits Package
Medical Care:
The Creighton Elementary School District will offer three HMO plans Silver, Gold or Platinum under
Aetna US Healthcare. The district will pay 100% of the HMO premium for eligible employees electing
the HMO Silver plan.
Aetna HMO Silver Plan
*Employee premium paid by
District
Aetna HMO Gold Plan
Employee will pay $42.12 per
month
Aetna HMO Platinum Plan
Employee will pay $82.18 per
month
$500 Deductible
or $1000 for family
$0 Deductible
$0 Deductible
Max out of pocket $2500 or
$5000 for family
Max out of pocket $2500 or
$5000 for family
Max out of pocket $1500 or
$3000 for family
$25 copay for Primary Care
$40 copay for Specialist
$25 copay for Primary Care
$40 copay for Specialist
$25 copay for Primary Care
$35 copay for Specialist
Coinsurance 90%
Coinsurance 90%
Coinsurance 0%
ER 10% after $100 copay
ER 10% after $100 copay
ER $100 copay
Inpatient 10% after $200 copay
per admission
Inpatient 10% after $200 copay
per admission
Inpatient $200 copay
Outpatient 10% after $100 copay
Outpatient 10% after $100 copay
Outpatient $100 copay
Rx $15/$25/$40
Rx $10/$20/$40
Rx $10/$20/$40
Aetna Silver Plan
Employee premium paid 100% by
District
Aetna Gold Plan
Employee Cost
Aetna Platinum Plan
Employee Cost
$42.12
$82.18
Employee + 1 Dependent $515.54 Employee + 1 Dependent $595.65
1 Dependent
$431.42
2 or more Dependents
Employee + 2 or more
$797.97 Dependents
$917.98
(Employee cost reflects a credit
of $431.42)
Employee + 2 or more
Dependents
$1032.14
(Employee cost reflects a credit
of $431.42)
Creighton Elementary School District #14
INSURANCE INFORMATION/ ONLINE BENEFITS ENROLLMENT
Dental Coverage
The Creighton Elementary School District offers Employers Dental Services as the prepaid dental plan
and Delta Dental as the indemnity plan. The district will pay 100% of the eligible employee rate with
Employers Dental Services. Employees electing Delta Dental shall pay the difference of the EDS and
Delta Dental premiums. Monthly rates and coverage information for the plan are as follows:
Employers Dental Services Monthly Rates
Employee Rate
$9.00 Paid by District
One dependent
$ 8.91
Two or more dependents
$15.40
No deductibles, no yearly maximums. You must choose from any of EDS’s participating primary care
dentist.
Delta Dental Monthly Rates
$27.56 (reflects a credit of $9.00)
Employee additional premium
Employee + One dependent $62.20
Employee + Two or more Dep.
$92.44
Calendar year deductible $50 per person, $150. per family. Calendar year benefit maximum $1,000.
Routine services covered at 80%, Basic Services covered at 80%, major service (become a benefit
following a 6 months continuous coverage of the individual under the plan) covered at 50%.
Information regarding specific services and applicable coverage can be found in summary of benefits.
Voluntary Short Term Disability
The Creighton Elementary School District’s voluntary short-term disability program is offered through
Fortis Benefits Insurance Company. Short term disability benefits are payable for up to 6 months for
injury or sickness during a continuous period of disability. Income received from salary continuation or
accumulated sick leave plans will not be deducted from your gross disability benefit. You may
participate in the plan under any one of the benefit levels outlined in the rate schedule, provided the
monthly disability benefit level does not exceed 66 2/3 of your regular monthly salary. You are eligible
for benefits on the 6th day of disability due to injury or illness. Short-term disability also offers
maternity benefits. Short-term disability will not cover any disabilities caused by or resulting from an
occupational sickness or injury. Refer to rate sheet for cost, specific exclusions and limitations.
*If selected you must download form, complete and return to District Office
Voluntary Flexible Spending Account
The flexible spending account (FSA) allows you to pay eligible out of pocket medical, dental and child
care expenses not covered by your health insurance with pre tax dollars. Under an FSA, you designate
an amount of money (up to $3,000 per year for uncovered medical/ dental expenses and/or $5,000 for
dependent care) to be deducted in equal installments from your paycheck. This amount is sent to a
third party administrator, Aetna Insurance Company. You pay the eligible health care or childcare
provider out of pocket and forward the receipt to Aetna for reimbursement from your account. Monies
left in the account as of the end of June will not be reimbursed. While FSA funding can be used for a
variety of eligible expenses, the IRS rules place some severe restrictions on these programs. Refer to
list of services that can be reimbursed on providers plan summary.
*If selected you must download form, complete and return to District Office
Creighton Elementary School District #14
INSURANCE INFORMATION/ ONLINE BENEFITS ENROLLMENT
Voluntary Group Term Life
The Creighton Elementary School District offers a voluntary life insurance option for employees and
their families through Aetna Life Insurance. Employees can purchase additional life insurance in
$10,000. units up to three times their annual salary. Spouses can be insured for a maximum of $25,000
and children can be insured for a maximum of $10,000. Refer to rate sheet for cost, specific exclusions
and limitations.
*If selected you must download form, complete and return to District Office
Long Term Disability
All employees working 20 hours or more per week are covered by long-term disability. The Arizona
State Retirement System provides a long-term disability program for participants through Fortis
Insurance. Employee is eligible for benefits on the 6th month of their onset of disability. For benefit
duration and other specific information, consult the plan documents or Arizona State Retirement
System at 602-240-2000.
Group Life & Accidental Death & Dismemberment (AD&D)
Benefits under the Creighton Elementary School District Group Life & Accidental Death &
Dismemberment are with Hartford Insurance Company. The cost of this program is paid by the district.
Contract employees are insured at one times their annual salary. The AD&D benefit is a percentage of
the principal sum based on the type of loss.
If you have any questions or need assistance, don’t hesitate to call or e-mail Rosalinda Varvel (Benefits
Specialist) at 602-381-6000 or rvarvel@creightonschools.org.
Creighton Elementary School District #14
INSURANCE INFORMATION/ ONLINE BENEFITS ENROLLMENT
ONLINE BENEFITS ENROLLMENT
You must select your benefits online at www.creightonschools.org.
Click on Staff Resources and scroll to Infinite Visions (iVisions) portal.
Click Log in with your user name and password (this is the same as your e-mail account).
Click on Employee Resources and scroll down to Benefits Enrollment.
You are ready to begin your benefits selection. You will need to complete all fields.
You will need the following information to complete your benefits online.

Name, date of birth and social security number of your life insurance beneficiary.
Beneficiary Name: __________________________________________________
Date of Birth: ______________________________________________________
Social Security Number: _____________________________________________

Know what medical plan you will be selecting: Silver, Gold or Platinum Plan.

The District will provide you with dental coverage with Employers Dental Services. You will
need to select a dentist on EDS Plan. Find your Dentist at www.mydentalplan.net and write
down the Dental Office ID number.
Dentist: __________________________________________________________
Dental Office ID number: ____________________________________________

You will have the option to select Delta Dental, instead of EDS. Delta Dental premiums will be
$27.56 per month, employee only. You do not need to select a dentist on this plan.

If you are insuring your dependents, you will need name, date of birth and social security
numbers for all dependents.
Dependent Name: __________________________________________________
Date of Birth: ______________________________________________________
Social Security Number: _____________________________________________

You will need a current Arizona address.
Address: _________________________________________________________
_________________________________________________________________

In the event of an emergency, please provide contact information.
Emergency Contact Name: ___________________________________________
Phone: ___________________________________________________________