Duke Options has a national network of physicians and hospitals. If you or a family member may need coverage in other states, you may want to consider this plan. Duke Advantage is a High Deductible Health Plan (HDHP) with a Health Savings Account (HSA). Some key features of the Duke Advantage plan are:
- Offers lower monthly premiums
- Duke will provide an HSA contribution to offset the higher deductible
- Gives members control of their healthcare spending
- The HSA allows you to make pre-tax contributions into the account for your future medical expenses
Duke Advantage is available to all benefits eligible faculty, staff, and their eligible family members. This plan is paired with a Health Savings Account (HSA) that is administered by Fidelity Investments. Duke provides an HSA contribution to offset higher deductibles. Duke Advantage offers lower monthly premiums and encourages members to make wise healthcare spending choices. The HSA allows you to save pre-tax dollars for qualified medical expenses. This plan is an option for individuals who prefer lower premium costs and are comfortable managing higher out-of-pocket expenses before the plan begins to share costs. Members must meet a higher annual deductible before the plan covers most services, including office visits and prescriptions.
Routine, preventative services such as annual physicals, OB/Gyn exams, immunizations, and well-baby visits are covered at 100% with network providers under this plan. These services may be excluded from coverage if you use an out-of-network provider.
For more information, please see the Duke Advantage Summary of Benefits and Coverage.
MDLive
Members who are enrolled in the Duke Advantage plan have access to a national network of virtual care providers at no cost even before meeting the plan deductible. MDLive makes access to high-quality healthcare more convenient and affordable – for all covered members in Duke Advantage. MDLIVE offers a broad suite of convenient virtual care options (Primary Care, Urgent Care, Dermatology, Behavioral Care)– available by phone or video, in English or Spanish.
Comparing Health Plans
Each Duke medical care plan covers both pharmacy and behavioral health benefits. Please refer to the Medical Plans Comparison Chart and Medical Premiums for details. All of our plans will cover pre-existing conditions or covered services.
Need to Find a Provider
An online directory of participating medical providers for the Duke Advantage plan is available here.
Duke Advantage HDHP Frequently Asked Questions (FAQs)
Duke Advantage is a nationwide plan offering coverage throughout the continental US. If you are enrolled in Duke Advantage, relocating to an area outside of North Carolina won’t be considered a qualifying life event (QLE) that requires or allows you to change your medical plan.
Duke Advantage doesn’t offer coverage outside of the United States.
The annual deductible is the amount you are responsible for paying before your insurance plan begins to pay for covered services.
Under the Duke Advantage Plan, the annual deductible must be paid in full. Once the annual deductible has been met, covered services will be paid at the in-network coinsurance rate of 75%. You will pay the remaining 25%. When receiving services from an in-network provider the annual deductible is $3,000 for individual and $6,000 per family. Please refer to the Medical Plans Comparison Chart for additional information.
The annual deductible is the amount you are responsible for paying before your insurance plan begins to pay for covered services.
Under the Duke Advantage Plan, the annual deductible must be paid in full. Once the annual deductible has been met, covered services will be paid at the in-network coinsurance rate of 55%. You will pay the remaining 45%. When receiving services from an in-network provider the annual deductible is $6,000 for individual and $12,000 per family. Please refer to the Medical Plans Comparison Chart for additional information.
Using an in-network physician or facility can result in substantial savings for you and your family.
As long as you see an in-network provider and your doctor files the visit as a preventative care visit, your visit will be covered at 100%. If your provider diagnoses a health problem or provides medical treatment, then the visit will be considered as diagnostic services and will be applied to the deductible. Preventative services may not be covered if you see an out-of-network provider. Please refer to the Medical Plans Comparison Chart for additional information.
No. The Duke Advantage Plan has no copayments. All claims are applied to the deductible. Once the deductible has been satisfied, claims are paid at the in or out-of-network coinsurance rates.
Coinsurance is the percentage of cost you pay for a service after you meet the benefit period deductible. For example, if you have an X-ray at an in-network provider, and you have previously met your deductible, you will be billed for 25% of the remaining cost.
Under the Duke Advantage Plan, the annual deductible must be paid in full. Once the annual deductible has been met, prescription drugs filled by an in-network pharmacy will be paid at the in-network coinsurance rate of 75%. You will pay the remaining 25%. Coverage for drugs on the HDHP preventive drug list may be provided prior to meeting the plan deductible.
Prescription drugs filled by an out-of-network pharmacy will be paid at the out-of-network coinsurance rate of 55%. You will pay the remaining 45%.
Copays do not apply to prescription drugs in the Duke Advantage plan. Please refer to this preventive drug list for an example of drugs that may not require meeting the deductible before the plan covers the applicable cost sharing amounts without the need to meet the plan deductible first.
The Duke HSA is an individual account used in conjunction with the Duke Advantage Medical plan to cover out-of-pocket qualified medical expenses on a tax-advantaged basis. Dependent on your coverage level, Duke will make an annual contribution to your HSA. This contribution is in addition to any monies you choose to contribute to the account. Your HSA belongs to you, which means you it is yours to keep even if you change employers or retire.
Certain services and medications require prior review and certification in order to be covered. These services include inpatient hospital services (including surgeries and transplants), outpatient surgeries, radiology imaging (such as MRI, CT, and PET scans), residential treatment centers, rehabilitation facility services, skilled nursing, applied behavioral therapy (ABT), durable medical equipment (including hearing aids and prosthetics), dental services, certain tests (such as EEGs, ECGs, genetic testing, sleep studies), home health care, infusion services, radiation therapy, non-emergency air ambulance services, private duty nursing, and other services listed in the Duke Advantage Summary of Benefits and Coverage. If you see an out-of-network provider in, you are responsible for ensuring that you or your provider requests prior review by Cigna.
If you are not certain if a service requires prior review and certification, consult your Duke Advantage Summary of Benefits and Coverage or contact Cigna Member Services at 1-800-440-3853.
Failure to request prior review and receive certification will result in denial of benefits.
If you disagree with a decision made by Cigna regarding a benefit or claim, you may be able to file an appeal. Information regarding the appeals process can be found in the Duke Advantage Summary of Benefits and Coverage.
In-network providers are providers, facilities, and suppliers with whom Cigna contracts to provide health care services. Providers, facilities, and suppliers who do not participate in the Cigna network are considered out-of-network providers.
If you believe you have been wrongly billed by a provider, you should contact Cigna Member Services at (800) 440-DUKE(3853) for more information.
For additional information regarding benefits provided under the Duke Advantage plan, contact Duke's HR Information Center at (919) 684-5600 or Cigna Member Services at (800) 440-DUKE(3853).