Effective January 1, 2026, Duke’s active employee health programs transitioned to Cigna as the new plan administrator.  Duke Human Resources and Cigna are committed to this partnership to advance the health of plan participants while providing access to critical benefits and world-class care.

This page will provide updates on the transition as questions arise, as well as useful resources for members.

Common concerns that members could encounter as part of the transition to Cigna may include:

Confusion regarding member copays

In certain cases, an individual’s copay is not being accurately reflected within the Duke Health system when a provider uses the verification platform in the electronic medical record to confirm benefits. This is a known issue and will be resolved with the release of a new interface on March 20. In the interim, providers should confirm benefits by using the Cigna portal, contacting Cigna Healthcare, or by using the member’s ID card. Members should always bring their Cigna ID cards to their healthcare appointments. If a copay cannot be confirmed at the time of service, Duke Health’s Patient Revenue Management Organization (PRMO) will bill the member after the visit.

Important Contact Information

Cigna Healthcare Customer Service for Duke University Health

MyCigna.com – access your health plan benefits and Cigna ID card

Duke Human Resource Information Center (HRIC)

Differences in medical policy criteria

In most cases, Cigna’s medical policy and clinical criteria aligns with that of our previous health plan administrators. However, some differences may occur that require additional documentation by your medical provider. Reach out to Cigna Healthcare if you encounter an issue with medical policy.

Service requirements for certain benefits

Certain benefits, such as infertility and bariatric surgery, require two years of continuous service before a member is eligible for services. Reach out to the HR Information Center (919-684-5600) if you believe you have met this requirement but are unable to access services.

Prior authorization (PA) status

In some cases (e.g., infusions and other pharmaceuticals administered through the medical plan), prior authorization (PA) from the previous health plan administrator did not fully transfer and additional documentation was needed for Cigna Healthcare to verify treatment needs. Prior authorizations have been updated, member claims have been adjusted, and ongoing issues should not occur. If you have questions related to prior authorizations, reach out to Cigna Healthcare. (Note: Duke’s prescription drug coverage through Express Scripts did not change).

Transition of Care/Continuity of Care

Members currently undergoing a course of treatment for a medical or behavioral health issue may be able to request Transition of Care to avoid a disruption to their treatment. Pregnancy, cancer, trauma, transplant, and behavioral health are examples of conditions that may qualify for continuity of care. Submit the Transition of Care request form to Cigna Healthcare if you feel you may qualify for continuity of care. (Note: members seeing an-out-of-network behavioral health care provider have been automatically granted continuity of care through March 31, 2026).

Access to Duke Health System providers

Members enrolled in Duke Select and Duke Basic have a health care provider network unique to Duke. All Duke Health System medical and behavioral health providers participate in the Duke custom network, though we are still working through the set-up of certain providers (e.g., audiology, lactation services). Reach out to the HR Information Center (919-684-5600) if you have questions regarding your Duke provider’s network status.

Behavioral Health Care

Some members may be seeing a behavioral health provider who does not participate in the Evernorth Behavioral Health network. Invitations to join the network to partner with Duke and Cigna are ongoing, and members may continue to nominate their providers for participation by submitting a request to Cigna Healthcare. All Duke plans include access to out-of-network behavioral health care, though some plans have day/visit limits that apply when out-of-network care is used.

Care Management Services

Care management services are provided at no additional cost through DukeWELL and Cigna Healthcare. Members may self-refer to either group to gain assistance navigating complex medical conditions, coordinating care, and understanding treatment options. Contact DukeWELL at 919-660-WELL (9355) or Cigna Healthcare to request care management services.

Personal Health Coaching and Wellness Services

Wellness services such as health assessments, nutrition and fitness consultations, and other health support are provided through LIVE FOR LIFE and Duke CarePath Coaching (administered by Evernorth). Members may self-refer to either group, and most services are provided at no additional cost. Contact LiveForLife at 919-684-3136 opt. 1 and Duke CarePath Coaching at 919-339-2066.