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.
Employees who are verifying participating network providers can contact the Aetna Member Service Center (800-385-3636) or the Blue Cross Blue Shield Open Enrollment Support Line (877-224-3305).
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. Out-of-network care is only covered for emergency or urgent care. There is no annual deductible.
- 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. Premiums are lower than Duke Select, but out-ofpocket 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. There is no annual deductible.
- 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 available.
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 cover pre-existing conditions for covered services.
Please refer to the following for further details:
- Medical Plans Comparison Chart
- 2021 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
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.
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 for 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 ? $400 for Employee/Spouse*
- $300 for Employee/Child ? $500 for Family (includes Spouse*)
- $400 for Employee/Children
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. 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.
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?||No||No||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 out-of-network limit for behavioral health. Emergency/urgent care out-of-network||20 visits out-of-network limit for behavioral health. Emergency/urgent care out-of-network||20 visits 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|