When Can I Enroll?
Since your premiums for medical, dental, and vision insurance and reimbursement accounts are pre-tax, federal law limits when you can change your elections for these benefits.
Changes made outside of the annual Open Enrollment period are allowed only within 30 days of a qualifying life event such as marriage or divorce, birth or death of a dependent, or a change in insurance eligibility due to relocation of residence or work. For more information on qualifying life events, visit Life Events Information.
Who Can I Enroll?
You can enroll the following dependents for medical, dental and vision insurance:
- Your legal spouse
- Same-sex spousal equivalent registered with Duke HR prior to January 1, 2016
- Your children (includes your biological children, stepchildren, adopted children, children of your registered same-sex spousal equivalent, or foster children) or children for whom you are a legal guardian*, up to their 26th birthday. Dependent children do not include grandchildren, siblings or other family members, or children for whom you have legal custody but not guardianship.
- We may request dependent documentation at any time. This documentation includes birth certificates, marriage certificates, and the first page of your tax return.
Update Your Personal Information
During the Open Enrollment period, staff and faculty should review and update their personal data and information in the Duke@Work self-service website. Updated contact information helps ensure that you receive benefits communications throughout the year.
As part of compliance with the Affordable Care Act, Duke must request all employees to provide Social Security numbers for dependents enrolled in medical coverage.
*Legal guardianship obtained outside of NC must meet the NC qualifications.
Medical Plans
The decision to transition to Cigna Healthcare came after a comprehensive review process. Our primary goal was to ensure that we are taking necessary steps to offer a modern and competitive benefits program with affordable premiums, while addressing the diverse needs of our employees who work and live across the country. Cigna was selected for its strong performance in a competitive bidding process and positive feedback from other employers that worked with Cigna.
Because Duke Basic and (Blue) Cigna Care will be sunset in 2027, only current participants in either of these health program options can continue their coverage in them for 2026.
Newer health program choices have been added to the Duke health plan line up since these programs were introduced many years ago, and these two programs are now redundant with other Duke health plan options. Also, they have limited availability based on where our colleagues reside – they do not have national reach.
We wanted to give colleagues enough time to review Duke’s plan options (i.e., 12-months) and reduce the number of changes introduced in one year for our health plan participants.
UNC physicians and facilities remain out-of-network for Duke Basic and Duke Select with limited exceptions, such as UNC Burn Center.
If you are currently enrolled in Blue Care, you and your family members will automatically be enrolled in Cigna Care for 2026.
Provider directories are available on the 2026 open enrollment website. You may verify your provider's status by using these directories or by contacting Cigna at 800-440-DUKE (3853).
Complete and submit the Provider Nomination Form available on the Open Enrollment website. Cigna will then reach out to your provider to invite them to join the Cigna network.
Most active staff will use 9ZKPMVFE. The code for COBRA participants is SW472N82. House Staff should use 7JDTVXGJ.
If you aren't changing your medical plan, you do not have to complete the annual open enrollment. Please keep in mind that if you are enrolled in a Reimbursement Account and would like to be enrolled in that account for 2026, you must enroll or re-enroll during open enrollment.
The cost would be the negotiated rate. Both rates will be reflected on your Explanation of Benefits you will receive for all claims in the plan.
Coinsurance is a type of cost-sharing in the high-deductible health plan (Duke Advantage). It refers to the percentage of medical costs that a patient pays after you have met your deductible. There are no copays in the Duke Advantage plan.
You would be responsible for meeting the deductible or coinsurance percentage owed based on the negotiated rate for services.
Health Savings Accounts
The HSA is only available to you if you enroll in the Duke Advantage high deductible health plan.
No, the HSA does not work like the Reimbursement Account. Elections are made based on a per pay period contribution and not an annual election. Also, the funds are available as they are contributed each payroll. The Duke contribution is made in a lump sum at the start of the year.
Yes you can, however, you must ensure that your combined contributions (employee, employer) for both you and your spouse do not exceed the IRS family limit for the year.
Your HSA contributions can be changed at any time throughout the year in Duke@Work. You can increase or decrease your contribution or choose to start or end contributions as well at anytime.
Reimbursement / Flexible Spending Accounts
Yes, the HCRA will be available in 2026 for those enrolled in Duke Select, Duke Basic, Cigna Care, Duke Options and Duke USA. Duke will also continue to make an annual contribution to the HCRA for those enrolled in Duke Basic for 2026. If you enroll in the Duke Advantage Plan, you will have access to a Health Savings Account and a Limited Purpose Flexible Spending Account (LPFSA).
Your carryover balance will be converted to a Limited Purpose Reimbursement account which can be used to pay for qualified dental and vision expenses.
If you meet the Duke Advantage plan deductible you will have the option to work with Health Equity to convert the LPFSA to a regular health care FSA for the remainder of the year.
Key Terms
Coinsurance: is the percentage of costs that you pay for a service after you meet your benefit period deductible.
Copay or Copayment: is a fixed dollar amount that you must pay for a medical service.
Deductible: the amount you are responsible for paying before your insurance plan begins to pay for covered services.
Health Care Reimbursement Account: can be used for eligible medical, dental, and vision expenses.
Health Savings Account (HSA): a type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses if you are enrolled in the High Deductible Health Plan (Duke Advantage).
High Deductible Health Plan (HDHP): plan with a higher deductible than a traditional insurance plan. The monthly premium is usually lower. A high deductible health plan can be combined with a health savings account (HSA), for you to pay for certain medical expenses.
HMO: a health plan option which typically limits member coverage to medical care provided by doctors, hospitals, and other healthcare providers within its network, except for emergencies and out-of-area urgent care.
In-Network Provider: any healthcare provider (physician, hospital, urgent care or other facility) that is contracted by the insurance administrator to provide health care services.
Limited Purpose Flexible Spending Account (LPFSA): a tax-advantaged savings account that lets you set aside pre-tax money to pay for eligible dental and vision expenses
Out-of-Network Provider: any healthcare provider that does not belong to your insurance company’s preferred provider network. If the Out-of-Network provider charges more for a service than your insurance company agrees to pay, you will need to pay the difference. This payment does not count toward your out-of-pocket limit.
Out-of-Pocket Limit: the maximum dollar amount that a member or family could pay in a year for covered services before the plan pays 100%. Any deductible, copayment, and coinsurance amounts that you pay count towards the out-of-pocket limit.
PPO: a type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost.
Prior Authorization: a requirement that services must be evaluated to assess the medical necessity and cost of care before the service is authorized.