The Duke Options PPO medical insurance plan does not require that you select a PCP. Duke Options has a national network of physicians and hospitals and a network of international hospitals, so if you or a family member travels often or lives elsewhere, you may want to consider this plan.
If you use a network provider, you will be responsible for a lower portion of the bill than you would if you used an out-of-network provider. Routine, preventive services such as annual physicals, ob/gyn exams, immunizations, and well baby visits are covered with network providers under this plan.
For more information, please see the Duke Options Member Guide.
Comparing Health Plans
Each Duke medical care plan covers both pharmacy and behavioral health benefits. Please refer to the Medical Plans Comparison Chart and Monthly Medical Premiums for details. All of our medical plans will cover pre-existing conditions or covered services.
Need to Find a Provider?
An online directory of participating medical providers by medical plan is available here.
Contact Plan Provider
- Duke Options members:
Blue Cross Blue Shield of NC, select “Blue Options (Group PPO Plan)"
24 Hour Health Advice Line
By calling a health care advice line, faculty and staff can get confidential, up-to-date health information any time of the day or night. Professional staff are available to assist with almost any medical question, offer support, or help patients navigate the health care system.
- Duke Options Members
Duke Options PPO – Frequently Asked Questions (FAQs)
What insurance is available if I relocate outside of North Carolina?
If you move outside of North Carolina and wish to have a medical plan through Duke, you will need to enroll in the Duke Options PPO plan, administered by BlueCross BlueShield of North Carolina. Duke Options is the only plan that provides comprehensive medical coverage outside of North Carolina.
What if I need international coverage?
Duke Options is the only plan offered by Duke that provides medical coverage outside of the United States.
How does the annual deductible work for in-network care?
The annual deductible is the amount you are responsible for paying before your insurance plan begins to pay for covered services. When you have an MRI, CT, PET scan, lab work, or X-rays; or you receive maternity care, inpatient hospitalization services, outpatient services, ambulance services, durable medical equipment, skilled nursing, home health care, or other services that are subject to the annual deductible, you are responsible for the first $130 of costs each year.
What are out of pocket limits?
The plan's out of pocket limit is the maximum dollar amount that a member or family could pay in a year for covered services before the plan pays 100%. Any deductible, copayment, and coinsurance amounts that you pay count towards the out of pocket limit. Under the Duke Options plan, the individual out of pocket limit for in-network services is $3,000 per calendar year and the family out of pocket limit for in-network services is $6,000 per calendar year.
What services have copayments?
Like other medical plans, Duke Options in-network services that are subject to copayments include provider office visits (PCP, specialist, and OB/Gyn exams), mental health/substance abuse, physical and occupational therapy (including speech therapy), chiropractic care, urgent care, emergency care, vision exams, inpatient hospitalization, outpatient services, and other services listed in the Member Guide.
Do copayments apply for preventive care services?
As long as you see an in-network primary care provider and your doctor files the visit as a preventive care visit, your visit will be covered at 100% (no copayment applied). Each member will have one annual visit covered at no charge, unless your provider diagnoses a health problem or provides medical treatment. If that occurs, your visit would be considered diagnostic and a copayment would apply. Preventive care services are not covered if you see an out-of-network provider.
Services, such as diagnostic lab tests, that may be delivered with preventive care service are not considered preventive care. Consult the Member Guide for more details or contact BlueCross BlueShield of North Carolina Member Services at (877) 275-9787 if you have questions related to preventive care services.
When does coinsurance apply?
Under the Duke Options PPO plan, coinsurance (the percentage of costs that you pay for a service after you meet your benefit period deductible) applies when you receive the following in-network services: MRIs, CTs, PET scans, lab work, X-rays, maternity care, inpatient hospitalization, outpatient services, ambulance services, durable medical equipment, skilled nursing, home health care, and other services listed in the Member Guide. For example, if you have an X-ray at an in-network provider, you will be billed your $130 deductible (if it has not yet been met) and 10% of the remaining cost (the in-network coinsurance).
Most out-of-network care is also subject to coinsurance.
What services require prior review and certification?
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 Member Guide. If you see a provider outside of North Carolina or go to an out-of-network provider in North Carolina, you are responsible for ensuring that you or your provider requests prior review by BlueCross BlueShield of North Carolina.
If you are not certain if a service requires prior review and certification, consult your Member Guide or contact BlueCross BlueShield of North Carolina Member Services at (877) 275-9787.
Who is responsible for obtaining prior review and certification?
If you are seeing an in-network provider in North Carolina, the provider is responsible for obtaining prior review and certification. If you are seeing an out-of-network provider in North Carolina, or any provider (either in- or out-of-network) outside the state of North Carolina, you are responsible for making sure that prior review and certification is obtained. Review your Member Guide or the back of your Duke Options ID card for details.
What happens if I do not obtain prior review and certification?
Failure to request prior review and receive certification will result in full denial of benefits.
What if I disagree with a decision my insurance company makes?
If you disagree with a decision by BlueCross BlueShield of North Carolina regarding a benefit or claim, you may be able to file an appeal. Information about the appeals process can be found in the Member Guide.
What is the difference between an in-network and out-of-network provider?
In-network providers are providers, facilities, and suppliers with whom BlueCross BlueShield contracts to provide health care services. Providers, facilities, and suppliers who do not participate in the BlueCross BlueShield network are considered out-of-network providers.
Who should I contact if I believe I have been incorrectly billed for a service?
If you believe you have been wrongly billed by a provider, you should contact BlueCross BlueShield of North Carolina Member Services at (877) 275-9787 for more information.
Who may I contact if I have additional questions about my Duke Options coverage?
For additional information regarding benefits provided under the Duke Options PPO plan, contact Duke's HR Information Center at (919) 684-5600 or BlueCross BlueShield of North Carolina Member Services at (877) 275-9787.