Open Enrollment for 2026 Benefits

2026 Highlights, Enhancements, and Changes

Deduction Schedule Change

• Health plan premiums for Medical, Dental, and Vision coverage will no longer be collected in the month prior to the coverage date. January premiums will be taken in the January paychecks and not a month ahead in December. As a result, there will not be any premiums deducted from paychecks in December 2025. Beginning in 2026 upon separation from Duke, coverage will end on the last day of the month of separation and no longer on the last day of the month following separation.
• Effective January 2026, Duke is moving to a 26 pay period deduction schedule for health plan coverage for biweekly paid employees. All deductions for medical, dental and vision coverage will be withheld in equal amounts in each paycheck.

Medical Plans

• Effective January 1, 2026, the Duke Health Plan will be partnering with Cigna Healthcare as our new Third-Party Administrator (TPA) for all active medical plans.
• Duke is pleased to introduce a new health plan option known as the Duke Advantage plan. Duke Advantage is a High Deductible Health Plan with a Health Savings Account (HSA) option. You must be enrolled in the Duke Advantage plan to be eligible to open and contribute to the Duke HSA.
• The Duke USA plan will be open for employees in all zip codes effective January 1, 2026.
• Duke Basic and Cigna Care (formerly BCBS Blue Care) medical plans will be phased out at the end of the 2026 plan year. These plans will be frozen for plan year 2026. Current participants can remain in these plans for the 2026 plan year but will not be able to add new dependents. Participants who remain in these plans for 2026 will be able to remove dependents or enroll in one of the other four (4) options available during this Open Enrollment or in the event of a qualifying life event in 2026.
• Behavioral Health benefits are enhanced for outpatient services including partial hospitalization, intensive outpatient services and ABA Therapy. Duke Select and Cigna Care will cover these services at 100% coinsurance. Duke Basic and Duke Options will not require a deductible and the member will be responsible for 10% coinsurance for these outpatient services. Under the Duke Advantage Plan, members will first need to satisfy their annual deductible and then 25% coinsurance will apply to these outpatient services.
• DukeWELL services are now available to employees enrolled in all Duke medical plans.
• Coverage for bariatric procedures will be extended to pediatrics, provided Cigna medical criteria is met and prior authorization is obtained.

Dental Plans

• The Duke Dental Plan will continue to be administered by Ameritas.
• There will be a small increase in the PPO Plan premiums and a slightly higher increase in the Plan A premiums. There will be no change in Plan B premiums or any dental plan deductibles.
• As a reminder, if you or a dependent are not currently enrolled for dental coverage through Duke and enroll for 2026, the “late entrant” provision will apply.

Vision Plan

• The Duke Vision Plan will continue to be administered by UnitedHealthcare.
• No change in copays, deductibles or premiums for the vision plan.

Reimbursement Accounts

• Reimbursement accounts will continue to be administered by HealthEquity.
• Maximum annual contribution for the Health Care Reimbursement Account is $3,300 (subject to IRS regulations). Up to $660 of your unused 2026 Health Care Reimbursement Account balance can be carried over to the 2027 plan year.
• Maximum annual contribution for the Dependent Care Reimbursement Account is $7,500 per family. There is no carryover for the Dependent Care Reimbursement Account.
• Duke is introducing a new Limited Purpose Reimbursement Account/Limited Purpose Flexible Spending Account (LPFSA). The LPFSA will be available to employees enrolled in the Duke Advantage medical plan. The LPFSA is a pre-tax spending account that works alongside a Health Savings Account (HSA) to pay for eligible dental and vision expenses. The LPFSA is subject to the same IRS maximum annual contribution and carryover allowance amount as the general purpose Health Care Reimbursement Account.

Duke Health Savings Account (Duke HSA)

• The Duke Health Savings Account is administered by Fidelity Investments.
• Only participants enrolled in the Duke Advantage plan are eligible for the Duke HSA.
• HSA accounts can be used to pay for qualified medical expenses such as deductibles, coinsurance, prescriptions, dental care, vision care and can be used to reimburse yourself for Medicare premiums once you have turned 65 and are enrolled in Medicare.
• You are ineligible for the Duke HSA if you have other medical coverage through Medicare, Tricare or a plan that is not a high deductible plan such as an HMO or PPO. You are also ineligible if you have received medical benefits from the VA in the previous three (3) months. You may not enroll in the HSA if you or your spouse have coverage with a general purpose Health Care FSA or Health Care Reimbursement Account.
• The maximum combined annual contribution (employer and employee) for the Duke HSA is $4,400 for Individual coverage and $8,750 for Family coverage. Duke will make an annual contribution of $200 for Individual coverage and $500 for Family coverage. Any level of coverage above Employee Only is considered Family coverage.
• Medicare Enrollment: You are ineligible to enroll in an HSA once you are covered by Medicare Part A or B. If Medicare Part A enrollment is delayed after age 65, a 6 month look-back rule will apply and Medicare will be retroactive for 6 months. Therefore, HSA contributions must end 6 months before enrollment in Medicare.

Cigna Healthcare

Beginning January 1, 2026, Cigna Healthcare will provide third-party administrative (TPA) support for Duke University and Duke University Health System’s active employee health plans. The transition from Aetna and BlueCross BlueShield of NC (BCBSNC), Duke’s current carriers, to Cigna as the single carrier is detailed on this website.

What Does This Mean?

• Members enrolled in Duke medical plans will receive new ID cards issued by Cigna Healthcare.
• Existing Duke medical plans will remain in place and you can continue existing coverage in your current plan.
• A new plan option is being introduced. The Duke Advantage Plan is a High Deductible Health Plan with a Health Savings Account (HSA). The HSA will be administered by Fidelity Investments.
• A provider search tool is available to determine if your current providers are in the Cigna network and/or to make a request to add providers to the network.

Cigna Healthcare • Phone: 1-800-440-DUKE (3853) • Website: cignahealthcare.com

Provider Search Directories

Please use the following links to search for providers in the networks for the Duke Health Plans with Cigna:

• Cigna Care: Cigna Health Care Provider Directory
• Duke Select and Duke Basic: DUKE Select and DUKE Basic Custom Directory**
• Duke Options, Duke USA, and Duke Advantage: DUKE Options, DUKE USA, and DUKE Advantage 

If you find that you have a desired provider that is not in the network, you may complete and submit the Provider Nomination Form.

**The Duke Select and Duke Basic medical network is not changing for 2026. UNC is not in-network, and WakeMed is only in-network for Pediatrics, Ob/GYNs, Rehab, and Emergency visits. If you use a non-Duke behavioral health provider, please confirm that provider participates in the Evernorth (Cigna) Behavioral Health Network.

Frequently Asked Questions