The Patient Protection and Affordable Care Act, or ACA, requires non-grandfathered plans to include preventive care coverage at 100% for certain screenings, medicines, supplements, counseling services, and immunizations.
Duke Select HMO and Duke Basic HMO
Toll-free (800) 385-3636
Blue Care HMO and Duke Options PPO
Blue Cross Blue Shield of North Carolina
Toll-free (877) 275-9787
Need to Find a Provider?
At Find a Network Provider page, you will find:
- A directory of participating health care providers, and
- Mobile apps for our medical plans.
Each employee's needs are different — that's why Duke offers four different medical plans to meet the needs of you and your family:
- 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 at 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 at 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 is the only medical plan provided by Duke that has full out-of-network benefits, including out-of-network behavioral health and substance use disorder benefits, available. Duke Options is the only medical plan option that covers ABA therapy and transgender surgery. It is also the only plan option that provides access to international care.
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
- 2022 Medical Premiums
- For Employees Who Travel Internationally on Duke Business
- Tobacco Use Surcharge (Fee)
- Duke Basic Reimbursement Account Contribution
- Questions to Ask: Making Your Medical Plan Decisions
- New Medical Plan Provisions for 2022
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.
To help offset the higher out-of-pocket expenses 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 2022 then re-enroll in coverage later in the year, you will not receive a second contribution to a Health Care Reimbursement Account. Also, if your spouse is enrolled in a Health Savings Account (HSA), please contact the HR Information Center at (919) 684-5600 before enrolling in Duke Basic.
*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.
Beginning January 1, 2022, Duke's medical plans will fully comply with the Patient Protection and Affordable Care Act, commonly referred to as the ACA. Since the initial passing of the ACA, Duke has each year enhanced coverage in our plans to meet the many requirements of this act while keeping coverage affordable to all of our members.
This year, our plans have expanded to include full coverage for Preventive Care for all members, including adults. Each plan also has an annual maximum out of pocket limit that will protect members from the financial impact of healthcare expenses.
Preventive Care Coverage for Adults, Children, and Infants
Preventive care coverage helps members to stay safe and healthy, and to identify potential issues before your health may be compromised. Preventive care services include an annual routine physical exam, screenings, and counseling, all designed to help you proactively manage your health.
As long as you see an in-network primary care provider and your doctor files the visit as a preventive care visit, your visit will be covered at 100% (no copay applied) under Duke Select, Duke Basic, Blue Care, and Duke Options. Each member will have one annual visit covered at no charge, unless your provider diagnoses a health problem or provides medical treatment. If that occurs, your visit would be considered diagnostic and a co-payment would apply. Preventive care visits are not covered if you see an out-of-network provider.
A complete description of preventive care coverage under each plan is available online at hr.duke.edu/benefits/medical.
Out of Pocket Limit
Another enhanced feature of our Duke Select, Duke Basic, Blue Care, and Duke Options plans is the addition of an Out of Pocket Limit. This maximum limit protects an individual or family financially by establishing a maximum amount that a member could pay in a year for covered services.
If you are an individual enrolled in one of Duke's medical plans in 2022, the most that you will be responsible for paying for covered medical services in-network is $3,000. This includes the combined amounts that you spend on your medical and pharmacy co-payments, deductibles, and coinsurance. Health care premiums deducted from our paychecks are not included in the Out of Pocket Limit.
If you are covering your spouse, children, or family on your medical plans, the most that you will be responsible for paying for covered medical services in-network is $6,000. Each family member is responsible for meeting his or her own Out of Pocket Limit until the overall family Out of Pocket Limit is met.
Once an individual or family meets the Out of Pocket Limit, the cost of any additional covered medical or pharmaceutical services is 100% covered under the plan.
If you are in need of a revision of a previous bariatric surgical procedure, you meet the required medical criteria for the revision, and you are enrolled in a plan that covers bariatric surgery (Duke Select, Blue Care, or Duke Options), your revision will be a covered benefit. You will be responsible for the $2,500 co-payment.
Private Duty Nursing
Blue Care and Duke Options provide a Private Duty Nursing benefit as a short-term solution for individuals transitioning from an acute care setting to the home setting. This benefit does not provide long-term permanent or custodial care, and must be medically necessary and pre-certified. Effective January 1, 2022, this benefit is limited to 60 days per calendar year.
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.
|Duke Select (HMO)||Duke Basic (HMO)||Blue Care
Blue Cross NC (HMO)
(Blue Cross Blue Shield PPO)
|Can I select any doctor I wish?||No||No||No||No||Yes|
|Will my child's pregnancy be covered?||Prenatal care only (labor and delivery are excluded)||Prenatal care only (labor and delivery are excluded)||Yes||Yes||No|
|Will my dependent children who live in a different location be covered?||Emergency/urgent care only. No follow-up care.||Emergency/urgent care only. No follow-up care.||Yes, if within NC and in-network - otherwise, emergency care only||Yes, worldwide listing of doctors||Yes|
|Since I travel a lot, can I see doctors in other locations around the world?||Emergency/urgent care only. No follow-up care.||Emergency/urgent care only. No follow-up care.||Emergency/urgent care only. No follow-up care.||Yes, worldwide listing of doctors||Yes|
|Can I participate in the DukeWELL care management program?||Yes, if you have certain medical conditions||Yes, if you have certain medical conditions||No||No||No|
|Are there out-of network benefits?||20 visits/20 days out-of-network limit for behavioral health. Emergency/ urgent care out- of-network||20 visits/20 days out-of-network limit for behavioral health. Emergency/ urgent care out- of-network||20 visits/20 days out-of-network limit for behavioral health. Emergency/ urgent care out- of-network||Yes, under out-of-network benefits||Yes|
|Must I meet an annual deductible?||No||Yes, for some services||No||Yes, for some services||Yes|
|Do all plans cover the same services?||Special Services include: Bariatric and Infertility||No special services covered||Special Services include: Bariatric and dependent pregnancy||Special Services include: ABA Therapy, Bariatric, Infertility, International health services, Transgender surgery, and dependent pregnancy||Special Services include: ABA Therapy, International health services, Transgender surgery, and dependent pregnancy|
|What is the most I could pay for covered services in a year?||$3,000 person/ $6,000 family||$3,000 person/ $6,000 family||$3,000 person/ $6,000 family||$3,000 person/ $6,000 family||$6,000 person/ $12,000 family|