Each employee's needs are different — that's why Duke offers five different medical plans to meet the needs of you and your family:
Each medical care plan covers both pharmacy and behavioral health benefits. Please refer to the Medical Plans Comparison Chart for details. All of our medical plans will cover pre-existing conditions for covered services.
Important Updates to Your Health Coverage
The COVID-19 public health emergency (PHE) and national emergency ends on May 11, 2023. Beginning May 12, 2023, the following provisions will apply to Duke's health plans (Duke Select, Duke Basic, Blue Care, Duke Options, Duke USA, and Duke Plus):
- The COVID-19 vaccine and booster shots will continue to be covered at no charge to members when an in-network provider or facility is used. Coverage for the COVID-19 vaccine and booster is also available through your pharmacy coverage.
- COVID-19 at-home test kits or OTC test kits will no longer be covered under the medical or pharmacy benefit. Members will need to pay the retail cost of the test kit when purchasing, but may use funds set aside in a Health Care Flexible Spending Account to pay for or be reimbursed for the cost of the kit.
- COVID-19 lab tests—including rapid diagnostic tests, swab-and-send tests, and tests administered by a provider during the course of an office visit, urgent care, or emergency care—are covered subject to the plan’s standard copay, coinsurance, or deductible charges.
- Surveillance testing is not covered under Duke’s health plans.
Additionally, any COBRA, HIPAA, special enrollment, or benefit claims and appeals deadlines that were extended due to the COVID-19 national emergency have returned to their normal deadlines and timeframes. This includes COBRA election deadlines, COBRA premium due dates, HIPAA special enrollment deadlines, and timeframes for filing claims, appeals, and requests for external reviews.
Health Insurance Coverage for Virtual Visits
A virtual office visit with your regular healthcare provider is covered under your health plan, subject to your regular copay. This includes virtual office visits with your behavioral health provider.
Enrolling/Making Changes
Employees have 30 days from the date of a qualifying life event or 30 days after their hire date to enroll or make changes to their health, dental, vision, and reimbursement accounts.
Your Duke Health Account
Access your My Duke Health patient account to make appointments with your current primary care or specialty provider, view lab results, update information and make payments online. A mobile app is also available in the Apple and Google Play app stores. If you need help finding a provider, review the Duke provider listing online or call the Duke Consultation and Referral Center at 888-ASK-DUKE (275-3853).
Urgent Care
Visiting an Urgent Care facility only requires a $35-$50 co-pay while the co-pay for visiting the emergency room is $250. Urgent Care facilities provide diagnosis, treatment and management of urgent medical conditions and minor trauma when a patient's primary care physician is unavailable.
Duke Urgent Care Facilities
Click here for a list of Duke Urgent Care locations.
Other Urgent Care Facilities
Check your local listings for Urgent Care facilities in your area.
Remember:
Your child does not have to meet IRS definitions of a dependent to be eligible for coverage for medical, dental and vision benefits. Because of national health care reform, Duke offers coverage for children under age 26 for medical, dental and vision benefits regardless of their student status or their marital status. If your covered child lives outside your home, consider which plans offer coverage in that area.
Pharmacy Benefits
Each of our medical plans cover pharmacy benefits, refer to the pharmacy benefits website for details, including links to our formulary and medication pricing tool.
Programs to Support Your Health
Duke offers a variety of programs that emphasize a proactive approach to improving health and preventing disease. Programs include health assessments, gym discounts, tobacco cessation resources, expectant mom support, and even individual consultations with fitness specialists and registered dietitians.
For Employees Who Travel Internationally on Duke Business
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.
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 a month. The surcharge does not apply to dependents who use tobacco.
A "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 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.
Questions to Ask: Making Your Medical Plan Decisions
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.
| Question | Duke Select Aetna (HMO) | Duke Basic Aetna (HMO) | Blue Care Blue Cross NC (HMO) | Duke Options Blue Cross Blue Shield (PPO) In-Network | Duke USA Blue Cross Blue Shield (PPO) In-Network |
|---|---|---|---|---|---|
| Can I select any doctor I wish? | No | No | No | No | No |
| Will my child's pregnancy be covered? | Prenatal care only (labor and delivery are excluded) | Prenatal care only (labor and delivery are excluded) | Yes | Yes | Yes |
| 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/urgent care only | Yes, worldwide listing of doctors | Yes, worldwide listing of doctors |
| 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, worldwide listing of doctors |
| 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/20 days out-of-network limit for behavioral health. Emergency/urgent care out- of-network | 20 visits/20 days out-of-network limit for behavioral health. Emergency/urgent care out- of-network | 20 visits/20 days out-of-network limit for behavioral health. Emergency/ urgent care out- of-network | Yes, under out-of-network benefits | Yes, under out-of-network benefits |
| Must I meet an annual deductible? | No | Yes, for some services | No | Yes, for some services | Yes, for some services |
| 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: Bariatric, infertility, international health services, transgender surgery, and dependent pregnancy | Special Services include: International health services and dependent pregnancy |
| What is the most I could pay for covered services in a year? | $3,000 person/ $6,000 family | $3,000 person/ $6,000 family | $3,000 person/ $6,000 family | $3,000 person/ $6,000 family | $6,800 person/ $13,600 family |