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Behavioral Health and Substance Abuse Benefits (Open Enrollment 2021)

Beginning January 1, 2021, 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.

Your benefits are not changing. Instead, you will be able to access behavioral health care through your medical ID card and you will have a single insurance provider to deliver a comprehensive approach to treating your physical, mental and emotional needs. Your medical and behavioral health providers will be able to work together to identify the best care for you. Both Aetna and Blue Cross Blue Shield offer a suite of online tools that work in conjunction with their medical platforms to maximize the support you need.

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 Open Enrollment Support Line at 877-224-3305. Representatives will be happy to assist you in determining whether or not your provider is a participating provider.

Duke also offers up to eight visits to Duke employees and their immediate family members through the Personal Assistance Service (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.

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)
  • For Duke Options, the deductible and co-insurance maximum will be consolidated with medical claims

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

Benefits