Your Medical Plan Options (Open Enrollment 2025)

Each employee's needs are different — that's why Duke offers five different medical plans to meet the needs of you and your family. Eligibility for each plan is based on the employee's permanent home zip code:

• Duke Select – available only to employees living in ZIP codes beginning with 272, 273, 275, 276 and 277. This plan uses a health care provider network unique to Duke. Since this network is unique, we encourage you to carefully review the provider listing. Out-of-network care is only covered for emergency or urgent care, and limited to 20 visits and 20 days for behavioral health or substance use disorder when out-of-network.
• Duke Basic – available only to employees living in ZIP codes beginning with 272, 273, 275, 276 and 277. This plan uses a health care provider network unique to Duke. Since this network is unique, we encourage you to carefully review the provider listing. Out-of-network care is only covered for emergency or urgent care, and limited to 20 visits and 20 days for behavioral health or substance use disorder when out-of-network. Premiums are lower than Duke Select, but out-of-pocket costs are higher.
• Blue Care (Blue Cross Blue Shield of North Carolina) HMO – available only to employees living in North Carolina. Participants must use a statewide network of providers. Out-of-network care is only covered for emergency or urgent care, and limited to 20 visits and 20 days for behavioral health or substance use disorder when out-of-network.
• Duke Options (Blue Cross Blue Shield of North Carolina) PPO – includes a worldwide network of health care providers and hospitals, and provides access to full out-of-network benefits, including out-of-network behavioral health and substance use disorder benefits. If you live within a zip code beginning with 272, 273, 275, 276 or 277 but have dependents who reside outside of North Carolina (including dependents attending college outside of North Carolina), Duke Options is the medical plan that will provide comprehensive coverage for you and your dependents.
• Duke USA (Blue Cross Blue Shield of North Carolina) PPO – New for 2024! – available to any employee who lives outside of a zip code beginning with 272, 273, 275, 276, or 277. This plan uses the same worldwide network of health care providers and hospitals as the Duke Options PPO plan. Premiums are lower than Duke Options but out-of-pocket costs (such as deductibles, coinsurance, and out-of-pocket maximums) are higher. Additionally, certain benefits covered on the Duke Options plan, such as bariatric surgery and comprehensive infertility coverage, are not covered under the Duke USA plan. If you are in need of these benefits, you should elect a different plan.

Each medical plan includes both pharmacy and behavioral health benefits. Please refer to the Medical Plans Comparison Chart. Pharmacy benefits are covered through Express Scripts. Behavioral Health is administered by Aetna or Blue Cross Blue Shield of North Carolina depending on the medical plan in which you are enrolled. A complete description of coverage under each plan is available online. All of our medical plans will comply with the provisions of the Patient Protection and Affordable Care Act.

Please refer to the following for further details:

• Medical Plans Comparison Chart
• 2025 Medical Premiums
• For Employees Who Travel Internationally on Duke Business
• Tobacco Use Surcharge (Fee)
• Duke Basic Reimbursement Account Contribution
• Important Information Related to Your Health Plan
• Questions to Ask: Making Your Medical Plan Decisions

For Employees Who Travel Internationally on Duke Business

Duke provides supplemental health insurance at no additional cost for full-time, benefits-eligible employees traveling internationally for a period of time not to exceed six months on Duke business. You must have health insurance from Duke or another company in order to be eligible for this coverage.

This coverage, called Cigna Medical Benefits Abroad (MBA), offers eligible employees and their spouses or registered same-sex partners and dependents up to age 26 who are traveling with them, supplemental medical insurance coverage for unexpected injuries and illnesses while traveling abroad on Duke business. This coverage supplements Duke's regular health insurance plan or the employee's other health insurance coverage. The coverage also includes up to seven days of personal travel when taken in conjunction with a covered business trip.

For more information, including coverage limits and eligibility requirements, visit the Medical Benefits Abroad website.

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 the Tobacco Cessation website for more information.

Duke Basic Reimbursement Account Contribution

To help offset the higher out-of-pocket expenses under the Duke Basic health plan, Duke Basic members will receive an annual contribution to a Health Care Reimbursement Account based on the level of coverage selected:

• $200 for Employee
• $300 for Employee/Child
• $400 for Employee/Children
• $400 for Employee/Spouse*
• $500 for Family (includes Spouse*)

PLEASE NOTE: Duke will not make additional contributions to the Health Care Reimbursement Account for Duke Basic participants if dependents are added during the year due to a qualifying event such as a birth or marriage. If you terminate coverage in Duke Basic during 2025 then re-enroll in coverage later in the year, you will not receive a second contribution to a Health Care Reimbursement Account. Also, if you or your spouse are enrolled in a Health Savings Account (HSA), please contact the HR Information Center at (919) 684-5600 before enrolling in Duke Basic. Duke does not offer a high deductible health plan. If you have an HSA from a previous employer, you cannot contribute to your HSA while you are covered under a Duke medical plan.

*Reimbursement account plans are governed by Internal Revenue Code guidelines that limit the reimbursement of either health care expenses or dependent care expenses to a spouse and legal dependents.

Important Information Related to Your Health Plan

Check to Know

Before you use your health plan be sure to check the following:

• Check that your doctor, hospital or other healthcare provider is in the network – even if you have been referred by an in-network provider.
• Check your member guide to ensure that your service is covered.
• Check to determine if the service needs a prior authorization or prior approval before you have the procedure. If you reside outside of North Carolina, it is your responsibility to make sure prior authorization has been received.
• Check Medical Insurance for additional information about your health plan. 

What is Prior Authorization?

Many services, procedures, tests and medications require a prior authorization. (i.e., must be precertified).

• This means that the services must be evaluated to assess the medical necessity and cost of care before the service is authorized.
• Generally, the physician will obtain the prior authorization but ultimately it is your responsibility to ensure that the service has been authorized.
• If this is not done, you may be responsible for the full cost of the service.
• Under the Duke Options plan and Duke USA plan, if you see a provider outside of North Carolina (including an in-network provider) or go to an out-of-network provider in North Carolina, you are responsible for ensuring that prior authorization from Blue Cross Blue Shield of North Carolina has been received. For questions regarding the prior authorization process or services requiring prior authorization, contact the appropriate medical vendor (Aetna for Duke Select or Duke Basic; Blue Cross Blue Shield of North Carolina for Blue Care, Duke Options, or Duke USA).

Services that require prior authorization vary by plan and may include inpatient hospital services (surgeries and transplants), outpatient surgeries, radiology imaging (such as MRI, CT, and PET scans), residential treatment centers, rehabilitation facility services, skilled nursing, applied behavioral therapy (ABT), durable medical equipment, certain tests (such as EEGs,

ECGs, genetic testing, sleep studies), home health care, infertility, infusion services, radiation therapy, and other services listed in the Member Guide. For questions regarding the prior authorization process or services requiring prior authorization, contact the appropriate medical vendor (Aetna for Duke Select or Duke Basic; Blue Cross Blue Shield of North Carolina for Blue Care, Duke Options, or Duke USA).

Emergency Services generally do not require prior authorization.

Questions to Ask: Making Your Medical Plan Decisions

When comparing Duke's medical plans, it is important to compare the cost of out-of-pocket expenses as well as premiums. Here are some questions to ask yourself in choosing a medical plan that matches the needs of you and your family. For specific coverage information, please refer to the Medical Plans Comparison Chart.