Your Medical Plan Options (Open Enrollment 2026)

*Duke Basic and Cigna Care: These plans are frozen to new enrollments. Current members may keep their current coverage in 2026 or remove dependents from coverage. No other changes may be made.

• Duke Select HMO – plan available only to participants 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 Advantage HDHP (NEW PLAN) – high deductible health plan available to all benefits eligible employees. This plan is paired with a Health Savings Account (HSA) that is administered by Fidelity Investments. Duke provides an HSA contribution to offset higher deductibles. Duke Advantage offers lower monthly premiums and encourages members to make wise healthcare spending choices. The HSA allows you to save pre-tax dollars for qualified medical expenses. This plan includes a national network of health care providers and hospitals and is an option for individuals who prefer lower premium costs and are comfortable managing higher out-of-pocket expenses before the plan begins to share costs.
  • Members must meet the annual deductible before the plan covers most services, including office visits and prescriptions. However, preventive care is covered at 100%, with no deductible required.
• Duke Options PPO – includes a national 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 outside of the Triangle area and need access to certain benefits, such as bariatric surgery and infertility services, and you prefer low deductibles and out-of-pocket limits, Duke Options may be a plan for you to consider.
• Duke USA PPO – available to all benefits eligible employees. This plan uses the same national network of health care providers and hospitals as the Duke Options and Duke Advantage plans. 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.

Please refer to the Medical Plans Comparison Chart for a complete description of coverage under each plan. Pharmacy benefits are covered through Express Scripts. All of Duke’s medical plans comply with the provisions of the Patient Protection and Affordable Care Act.

Please refer to the following for further details:

• Medical Plans Comparison Chart
• 2026 Medical Premiums
• Tobacco Use Surcharge (Fee)
• Duke Advantage HSA Contribution
• Duke Basic Reimbursement Account Contribution

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 for Monthly paid employees and $23 per pay period for Biweekly paid employees. 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 a reasonable 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.

Upon completion of a tobacco cessation program, the surcharge will be removed and you will receive a full refund of all tobacco surcharges paid during the current calendar year.

Visit the Tobacco Cessation website for more information.

Duke Advantage HSA Contribution

To help offset the higher out-of-pocket expenses under the Duke Advantage health plan, Duke Advantage members will receive an annual contribution to a Health Savings Account (HSA) based on the level of coverage selected:

• Individual (Employee) $200
• Family (All other coverage tiers) $500

PLEASE NOTE: If you or your spouse is enrolled in a Health Care Reimbursement Account or Flexible Spending Account, you are not eligible for the HSA.
 

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: 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. Additionally, Duke Basic is frozen to new enrollments. Current members may keep their current coverage in 2026 or remove dependents from coverage. No other changes may be made.

*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.