When comparing Duke's medical plans, it is important to compare the cost of out-of-pocket expenses as well as premiums. Please refer to the comparison charts below to help you choose the best plan to fit your and/or your family's needs. The Cigna Easy Choice Tool can also help you choose the medical plan that is right for you. Note that all plans include access to behavioral health and pharmacy coverage.
| Duke Select (HMO) Zip code requirement | Duke Options (PPO) In-Network | Duke Options (PPO) Out-Network | Duke USA (PPO) In-Network | Duke USA (PPO) Out-Network | Duke Advantage (HDHP) In-Network | Duke Advantage (HDHP) Out-Network | |
|---|---|---|---|---|---|---|---|
| Annual Deductible | |||||||
| Individual | None | $130 | $650 | $2,000 | $6,000 | $3,000 | $6,000 |
| Family | None | $390 | $1,950 | $6,000 | $12,000 | $6,000* | $12,000* |
| Coinsurance | |||||||
| Member Cost Share | 0% | 10% | 30% | 20% | 40% | 25% | 45% |
| Out of Pocket Limit | |||||||
| Individual | $3,000 | $3,000 | $6,000 | $6,800 | $13,600 | $7,500 | $15,000 |
| Family | $6,000 | $6,000 | $12,000 | $13,600 | $27,200 | $15,000 | $30,000 |
| Physician Office Visit | |||||||
| PCP | $20 copay | $20 copay | 30% after deductible | $25 copay | 40% after deductible | 25% after deductible | 45% after deductible |
| Specialist | $55 copay | $55 copay | 30% after deductible | $55 copay | 40% after deductible | 25% after deductible | 45% after deductible |
| MRI, CT, PET Scan | $150 copay | 10% after deductible | 30% after deductible | 20% after deductible | 40% after deductible | 25% after deductible | 45% after deductible |
| Lab & Other X-Ray | Covered in full | 10% after deductible | 30% after deductible | 20% after deductible | 40% after deductible | 25% after deductible | 45% after deductible |
| Annual Preventive Visit | Covered in full | Covered in full | 30% after deductible | Covered in full | Not covered | Covered in full | Not covered |
| Maternity Care | $20 copay primary care or $55 copay specialist first visit | $20 copay primary care or $55 copay specialist first visit | 30% after deductible | $25 copay primary care or $55 copay specialist first visit | 40% after deductible | 25% after deductible for each visit, physician’s charges, labor and delivery charges, and facility charges | 45% after deductible for each visit, physician’s charges, labor and delivery charges, and facility charges |
| Urgent Care | $35 copay | $35 copay | $35 copay | $50 copay | $50 copay | 25% after deductible | 25% after deductible |
| Hospital Care | |||||||
| Inpatient | $600 per admission copay | 10% after $600 or $700 per admission copay and deductible | 30% after $900 per admission copay and deductible | 20% after $600 or $700 per admission copay and deductible | 40% after $900 per admission copay and deductible | 25% after deductible | 45% after deductible |
| Outpatient | $250 copay | 10% after deductible | 30% after deductible | 20% after deductible | 40% after deductible | 25% after deductible | 45% after deductible |
| Emergency Care | $250 copay | $250 copay | $250 copay | $250 copay | $250 copay | 25% after deductible | 25% after deductible |
| Behavioral Health and Substance Abuse | |||||||
| Outpatient - Physician's Office | $20 copay | $20 copay | 30% coinsurance after deductible | $25 copay | 40% coinsurance after deductible | 25% coinsurance after deductible | 454% coinsurance after deductible |
| Outpatient - All Other Services | No charge | 10% coinsurance (deductible waived) | 30% coinsurance after deductible | 20% coinsurance (deductible waived) | 40% coinsurance after deductible | 25% coinsurance after deductible | 45% coinsurance after deductible |
| Inpatient | $600 copay per admission | $600 or $700 per admission copay, then 10% after deductible | $900 per admission copay, then 30% after deductible | $600 or $700 per admission copay, then 20% after deductible | $900 per admission copay, then 40% after deductible | 25% after deductible | 45% after deductible |
| Other Services | |||||||
| Infertility | Provided only at the Duke Fertility Center for employees with two years of service; limits apply | Provided only at the Duke Fertility Center for employees residing in NC with two years of service; limits apply. Out of state employees may access a Cigna in-network provider. | Not covered | Coverage will be provided for the treatment of an underlying medical condition up to the point an infertility condition is diagnosed. Services will be covered as any other illness in-network. | Coverage will be provided for the treatment of an underlying medical condition up to the point an infertility condition is diagnosed. Services will be covered as any other illness out-of-network. | Coverage will be provided for the treatment of an underlying medical condition up to the point an infertility condition is diagnosed. Services will be covered as any other illness in-network. | Coverage will be provided for the treatment of an underlying medical condition up to the point an infertility condition is diagnosed. Services will be covered as any other illness out-of-network. |
| Physical Therapy (PT) Occupational Therapy (OT) Speech Therapy | $20 copay; visit limits apply | $55 copay; limits apply | 30% after deductible; limits apply | $55 copay; limits apply | 40% after deductible; limits apply | 25% after deductible; limits apply | 45% after deductible; limits apply |
| Vision Exam (Duke Eye Center only) | $55 copay | $55 copay | Not covered | $55 copay | Not covered | 25% after deductible | Not covered |
| Bariatric Surgery | $2,500 surgical copay | $2,500 surgical copay | Not covered | Not covered | Not covered | Not covered | Not covered |
| Gender Affirmation Surgery | Not covered | 10% after $600 or $700 per admission copay and deductible | 30% after $900 per admission copay and deductible | 20% after $600 or $700 per admission copay and deductible | 40% after $900 per admission copay and deductible | 25% after deductible | 45% after deductible |
*An individual cannot have claims covered under the plan coinsurance until the total family deductible has been satisfied.
Duke Basic & Cigna Care
(plans are frozen and closed to new enrollments)
| Duke Basic (HMO) | Cigna Care (HMO) | |
|---|---|---|
| Annual Deductible | ||
| Individual | $600 | None |
| Family | $1,800 | None |
| Out of Pocket Limit | ||
| Individual | $3,000 | $3,000 |
| Family | $6,000 | $6,000 |
| Physician Office Visit | ||
| PCP | $25 copay | $20 copay |
| Specialist | $75 copay | $55 copay |
| MRI, CT, PET Scan | $150 copay | Covered in full |
| Lab & Other X-Ray | Covered in full | Covered in full |
| Annual Preventive Visit | Covered in full | Covered in full |
| Maternity Care | $25 copay primary care or $75 copay specialist first visit | $20 copay primary care or $55 copay specialist first visit |
| Hospital Care | ||
| Inpatient | 10% after deductible | $600 or $700 per admission copay |
| Outpatient | 10% after deductible | $250 copay |
| Emergency Care | $250 copay, waived if admitted | $250 copay, waived if admitted |
| Other Services | ||
| Infertility | Coverage will be provided for the treatment of an underlying medical condition up to the point an infertility condition is diagnosed. Services will be covered as any other illness. | Coverage will be provided for the treatment of an underlying medical condition up to the point an infertility condition is diagnosed. Services will be covered as any other illness. |
| Physical Therapy (PT) Occupational Therapy (OT) | $75 copay; limits apply | $55 copay, limits apply |
| Vision Exam (Duke Eye Center only) | $55 copay | $55 copay |
| Bariatric Surgery | Not covered | $2,500 surgical copay |
| Gender Affirmation Surgery | Not covered | $600 or $700 per admission copay |
| Behavioral Health and Substance Abuse | ||
| Outpatient - Physician's Office | $25 copay | $20 copay |
| Outpatient - All Other Services | 10% coinsurance (deductible waived) | No change |
| Inpatient | 10% after deductible | $600 copay per admission |