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Coverage & Eligibility

Preventive Care

Preventive care plays an important role in reducing health care expenses. In many cases, more expensive treatments and procedures can be avoided through regular visits to your Primary Care Physician (PCP), a healthy diet, and exercise. LIVE FOR LIFE, Duke's employee wellness program also offers a wide range of health checks and fitness opportunities for faculty, staff, and their families.

Levels of Coverage

When making your medical, dental, and vision benefit selections, you may choose from among the following levels of coverage:

  • Employee
  • Employee/Child
  • Employee/Children — only available for medical and vision care*
  • Employee/Spouse or Employee/Same-Sex Partner
  • Family

*Dental care coverage does not include an Employee/Children option. You may cover any number of children in the dental plan by choosing the Family option.

Your premium for coverage - including your contribution and Duke's contribution- will vary, depending on which level of coverage you select. Your Personal Information Fact Sheet ("My Info") provides you with the premium amounts for each level.

Who Are My Eligible Dependents?

The following dependents are eligible for enrollment:

  • Your legal spouse or same-sex spousal equivalent.
  • Your children (includes natural children, stepchildren, adopted children, foster children), or children for whom you are a legal guardian up to 26th birthday. Dependent children do not include grandchildren, siblings, or other family members, or children of whom you have legal custody.
  • Your children who are intellectually or physically disabled and incapable of self-support after age 26, as long as their disability began before they turned age 26, and they were covered under a Duke medical plan prior to age 26. Duke reserves the right to request an annual review of those dependents' health status.

Coverage of Disabled Dependent Children

In order to continue coverage of an intellectually or physically disabled dependent child beyond the 26th birthday, all of the following criteria must be met:

  • The parent must apply for the waiver on or prior to the child's 26th birthday;
  • The intellectually or physical handicap must be significant and render the child incapable of independent living and self-sustaining employment, and must be supported by medical records;
  • The condition must exist on or prior to the 26th birthday;
  • The parent must remain eligible;
  • The parent must provide annual evidence of continued incapacity;
  • There must not be a break in coverage after the 26th birthday under the parental policy.

Please Note: Under no circumstances may an employee enroll a sibling, cousin, parent or other dependent relative as a dependent. Duke reserves the right to verify the eligibility of dependents covered by one of Duke's health plans to ensure compliance with plan provisions and the appropriate payment of legitimate health claims. This supports Duke's continued efforts to manage the increasing cost of health care.  The verification may include a request for a birth certificate, marriage certificate, and/or the first two pages of your tax return.

Benefits