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Behavioral Health and Substance Abuse Benefits (Open Enrollment 2022)

Personal Assistance Services (PAS)

Duke also offers up to eight visits to Duke employees and their families through the Personal Assistance Services (PAS) at no cost to you. The staff of licensed professionals offer assessment, referrals and a range of other services to assist with personal, work and family matters. For information, call (919) 416-1727.

Duke's coverage for outpatient and inpatient behavioral health and substance abuse benefits will be provided through our regular medical vendors. If you enroll in Duke Select or Duke Basic, your behavioral health and substance abuse benefits will be provided by Aetna. If you enroll in Blue Care or Duke Options, your behavioral health and substance abuse benefits will be provided by Blue Cross Blue Shield.

When evaluating your medical plan options, it may be important to consider:

  • Will anyone in my family need to access ABA therapy for autism spectrum disorders?
  • Does my provider accept insurance, or might I need to see an out-of-network provider?
  • Does my provider allow telephone visits?
  • Are the services I receive covered under the plan?

In order to verify if your provider is in-network, please contact Aetna's Member Service Center at 800-385-3636 and Blue Cross Blue Shield's Member Services at 877-275-9787. Representatives will be happy to assist you in determining whether or not your provider is a participating provider.

Details about behavioral health and substance abuse benefits are outlined below.

  In-Network Care Out-of-Network Care
Outpatient
  • Precertification required for psychological testing, electroshock therapy, and transcranial magnetic stimulation (TMS)
  • Covered in full after $20 co-pay for individual/ family therapy ($25 co-pay for Duke Basic)
  • Precertification required for psychological testing, electroshock therapy, and transcranial magnetic stimulation (TMS)
  • After $650 annual deductible, you pay 30%*
  • Limit of 20 visits per calendar year for Duke Select, Duke Basic, and Blue Care participants (no visit limit applies for Duke Options)
Inpatient
  • Must be precertified prior to admission
  • Co-pay of $600 per admission
  • Must be precertified prior to admission
  • After $900 per admission co-pay and deductible, you pay 30%
  • Limit of 20 days per calendar year for Duke Select, Duke Basic, and Blue Care participants (no day limit applies for Duke Options)

*All payments are based on the allowable charge. You are responsible for charges over the allowable charge when receiving out-of-network services.

Benefits