Open enrollment is your opportunity to review your medical, dental, vision, and reimbursement account benefit elections and make any changes necessary to ensure your choices continue to meet your needs.

If you wish to participate in the Health Care or Dependent Care Reimbursement Accounts for 2025, you must enroll (or re-enroll). Participation in the reimbursement accounts does not automatically continue from year to year.

If you do not make changes to your medical, dental or vision coverage, your current medical, dental and vision coverage elections for 2024 will continue for 2025.

Open Enrollment 2025: Oct. 14 (8 a.m.) to Oct. 25, 2024 (6 p.m.)

Decisions to Make During Open Enrollment

Open Enrollment is the one time of year when benefit eligible employees can enroll in or change their medical, dental and/or vision insurance plans, and enroll in reimbursement accounts. Changes made during open enrollment are effective on January 1, 2025.

Here's what you need to decide this year:

  1. Which medical plan best meets my needs and the needs of my covered family member? Duke offers five different medical plans with eligibility based on the employee's permanent home zip Carefully consider the network available (particularly if your dependents live outside of the Triangle Area), any specific health providers that you see, or a need to cover dependent pregnancy. Note that if you change health plans, your care management may be disrupted and may also need to change. If you live outside of a zip code beginning with 272, 273, 275, 276, or 277 and are ineligible for coverage in Duke's Aetna plans, you will be eligible to participate in the Blue Care, Duke Options, or Duke USA plan. (Note that to be eligible for Blue Care, you must permanently reside in the state of North Carolina.) If you have recently changed your residence and live outside of the state of North Carolina, Duke Options or Duke USA are the medical plans that will provide comprehensive coverage for you and your dependents.
  2. Will you cover yourself and/or dependents for dental and vision insurance? Duke offers three different dental plans and a vision plan that covers eye exams, lenses and frames.
  3. Do you need to add or remove any dependents enrolled in your medical, dental or vision plan? If you missed your opportunity to make a change in coverage for a family member due to a qualifying life event, now is the time to make that change.
  4. How much would you like to save on taxes? During Open Enrollment, you can sign up to participate in a Health Care Reimbursement Account and/or a Dependent Care Reimbursement Account. Both of these accounts allow you to put money aside before taxes to pay for health care costs and child or elder care costs, respectively. Since the money is taken out of your paycheck before taxes are calculated, you save about 30 cents of every dollar you put in the accounts.

Remember: If you take no action during Open Enrollment, the elections you made for 2024 for your medical, dental, and vision coverage will continue for 2025. To continue to use a reimbursement account, you must re-enroll for 2025.

Open Enrollment representatives are available at (919) 684-5600, option 1, during the following times:

  • 8 a.m. - 6 p.m., October 14-25
  • 10 a.m. - 3 p.m., Saturday, October 19

Reminder: Payroll locks Duke@Work from changes during payroll calculations. After payroll unlocks, you may make changes.

2025 Plan Highlights and Changes

Medical Plans

  • Nutritional counseling visits provided as treatment for a behavioral health diagnosis are no longer subject to a six-visit limit. This update is effective January 1, 2023. Plan participants that incurred expenses for nutritional counseling beyond the six-visit limit are encouraged to submit a claim for reimbursement. Please see Medical Insurance or contact us at (919) 684-5600 for more information.
  • Eligibility for fertility services through Duke Select and Duke Options will not require a diagnosis of infertility. This update is effective January 1, 2025. Other eligibility requirements, medical policy criteria, and prior review and certification remain in place.
  • Lastly, coverage for gender affirming surgery, currently available under Duke Options, is extended to participants on Duke's Blue Care and Duke USA programs effective January 1, 2025 subject to applicable copays and deductibles.
  • As a reminder, certain specialty pharmacy drugs are considered non-essential health benefits under the plan, and the cost of these drugs will not be applied toward a member's out-of-pocket maximum. Although the cost of these eligible specialty drugs will not be applied towards the out-of-pocket maximum, these costs will be reimbursed by the manufacturer at no cost to the member. A list of specialty medications eligible for this program is available online.

Dental Plans

  • No change in deductibles or premiums for the dental plans.
  • As a reminder, if you or a dependent are not currently enrolled for dental coverage through Duke and enroll for 2025, the “late entrant” provision will apply (refer to page 10 for more information).

Vision Plan

  • No change in copays, deductibles or premiums for the vision plan.

Reimbursement Accounts

  • Maximum annual contribution for Health Care Reimbursement Account is $3,200 (subject to IRS regulations). Up to $640 of your unused 2025 Health Care Reimbursement Account balance can be carried over to the 2026 plan year.
  • Maximum annual contribution for Dependent Care Reimbursement Account is $5,000 per family. There is no carryover for the Dependent Care Reimbursement Account.

Tobacco Use Surcharge (Fee)

Duke charges employees covered under a Duke medical insurance plan who smoke or use other forms of tobacco an extra $50 per month. The surcharge does not apply to dependents who use tobacco.

“Tobacco user” includes anyone who has used tobacco more than five times in the previous two months. Tobacco use includes smoking and use of snuff, e-cigarettes, or chewing tobacco. The use of a nicotine patch and nicotine gum are not subject to the surcharge.

The monthly surcharge will be removed upon completion of a tobacco cessation program through LIVE FOR LIFE, Duke's employee wellness program. If you think you might be unable to complete the program, you may request to complete an alternative program or meet an alternative standard. Completion of an alternative activity may allow you to avoid the surcharge. Contact us at 919-684-5600 and we will work with you (and, if you wish, with your doctor) to find the best method for achieving your best health.

Visit Tobacco Cessation for more information.

This enrollment guide serves as a summary of material modification to the benefits described in the official summary plan descriptions for these plans. The benefits that you receive are based upon the plan's official plan documents, not this guide or any other written or oral statement. If there is a conflict between this guide and the official plan documents, the official plan documents will govern in all cases. Duke reserves the right at any time to change or terminate these plans.