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2023 Medical Care Plans Comparison Chart

The following chart gives an overview of the differences between the four medical plans.

  Duke Select (HMO) Duke Basic (HMO) Blue Care Blue Cross NC (HMO) Duke Options
Blue Cross Blue Shield (PPO)
In-Network Out-of- Network
Annual Deductible
Individual None $6001 None $1301 $650
Family None $1,8001 None $3901 $1,950
Out of Pocket Limit2
Individual $3,000 $3,000 $3,000 $3,000 $6,000
Family $6,000 $6,000 $6,000 $6,000 $12,000
Physician Office Visit
PCP $20 co-pay $25 co-pay $20 co-pay $20 co-pay You pay 30% after deductible3
Specialist $55 co-pay $75 co-pay $55 co-pay $55 co-pay You pay 30% after deductible3
MRI, CT, PET Scan $150 co-pay $150 co-pay Covered in full You pay 10% after deductible You pay 30% after deductible3
Lab & Other X-Ray Covered in full Covered in full Covered in full You pay 10% after deductible You pay 30% after deductible3
Annual Preventive Visit Covered in full Covered in full Covered in full Covered in full Not covered
Mammogram Covered in full Covered in full Covered in full Covered in full You pay 30% after deductible3
Colonoscopy Covered in full Covered in full Covered in full Covered in full You pay 30% after deductible3
OB/GYN Exams $20 co-pay primary care
$55 co-pay specialist		 $25 co-pay primary care
$75 co-pay specialist		 $20 co-pay primary care
$55 co-pay specialist		 $20 co-pay primary care
$55 co-pay specialist		 Well visits not covered; you pay 30% after deductible3 for PAP smear, mammogram, and sick visits
Well Baby / Well Child Visits Covered in full Covered in full Covered in full Covered in full Not covered
Maternity Care $20 co-pay primary care or $55 co-pay specialist first visit, then professional services covered in full $75 co-pay specialist first visit, then professional services covered in full $20 co-pay first visit, then professional services covered in full $20 co-pay primary care or $55 co-pay specialist first visit, then professional services covered in full You pay 30% after deductible3 for professional services
Hospital Care
Inpatient $600 per admission co-pay4, then covered in full Subject to $600 annual deductible; you pay 10% co-insurance $600 or $700 per admission co-pay5, then covered in full After $600 or $700 per admission co-pay5 and deductible, you pay 10% co-insurance 70% after $900 per admission co-pay and deductible3
Outpatient $250 co-pay You pay 10% after deductible $250 co-pay You pay 10% after deductible You pay 30% after deductible3
Emergency Care $250 co-pay, waived if admitted $250 co-pay, waived if admitted $250 co-pay, waived if admitted $250 co-pay, waived if admitted $250 co-pay, waived if admitted
Urgent Care $35 co-pay $50 co-pay $35 co-pay $35 co-pay $35 co-pay
Ambulance Covered in full when medically necessary You pay 20% after deductible Covered in full when medically necessary You pay 10% after deductible when medically necessary You pay 10% after deductible when medically necessary
Other Services
Infertility Provided only at the Duke Fertility Center7 for employees with two years of service; limits apply6 Not covered Does not include COH, IVF, or other types of artificial conception6 Provided only at the Duke Fertility Center7 for employees with two years of service; limits apply6 Not covered
Infertility Testing and Treatment, Subject to Precertification Fixed price; precertification required; limits apply6 Not covered $20 co-pay primary care; $55 co-pay specialist; covered in full for testing6 Fixed price; precertification required; limits apply6,7 Not covered
Skilled Nursing Facility Covered in full when authorized by doctor; 60-day annual maximum Covered in full when authorized by doctor; 60-day annual maximum Covered in full when authorized by doctor; 60-day annual maximum You pay 10% after deductible when authorized after $250 per admission co-pay; 60-day annual maximum You pay 30% after deductible3 when authorized after $250 per admission co-pay; 60-day annual maximum
Home Health Care Covered in full when authorized by doctor; up to 100 visits per calendar year $25 co-pay per visit when authorized by doctor; up to 100 visits per calendar year Covered in full when authorized by doctor; up to 100 visits per calendar year You pay 10% after deductible when authorized; 100 combined in- and out-of-network visits per calendar year You pay 30% after deductible3 when medically necessary; 100 combined in- and out-of-network visits per calendar year
Hospice Care Covered in full when authorized by doctor Covered in full when authorized by doctor Covered in full when authorized by doctor You pay 10% after deductible You pay 30% after deductible3
Durable Medical Equipment You pay 10% You pay 20% after deductible Covered in full You pay 10% after deductible You pay 30% after deductible3
Prosthetics You pay 10% You pay 20% after deductible Covered in full You pay 10% after deductible You pay 30% after deductible3
Physical Therapy (PT)
Occupational Therapy (OT)		 $20 co-pay; 40 visits per calendar year for combined PT and OT8 $75 co-pay; 40 visits per calendar year for combined PT and OT $55 co-pay for PT and OT; 40 visits per calendar year for combined PT and OT8 $55 co-pay; 40 visits per calendar year for combined PT, OT, and chiropractic in- and out-of-network8 You pay 30% after deductible; 40 visits per calendar year for combined PT, OT, and chiropractic in- and out-of-network3
Chiropractic Care $55 co-pay $75 co-pay $55 co-pay; 20 visits per calendar year $55 co-pay; 40 visits per calendar year for combined PT, OT, and chiropractic in- and out-of-network You pay 30% after deductible3; 40 visits per calendar year for combined PT, OT, and chiropractic in- and out-of-network
Nutrition $20 co-pay; 6 visits per calendar year $25 co-pay; 6 visits per calendar year Covered in full up to 6 visits per calendar year Covered in full up to 6 visits per calendar year Not covered
Speech Therapy $20 co-pay; 20 visits per calendar year; precertification required8 $75 co-pay; 20 visits per calendar year; precertification required $55 co-pay; 20 visits per calendar year8 $55 co-pay; 20 visits per calendar year for combined in- and out-of-network8 You pay 30% after deductible3; 20 visits per calendar year for combined in- and out-of-network
Vision Exam $55 co-pay; limit 1 per calendar year $75 co-pay; limit 1 per calendar year $20 co-pay; limit 1 per calendar year; 30% lens and frame discount at point of purchase; 15% disposable contacts discount at point of purchase $55 co-pay; limit 1 per calendar year; 30% lens and frame discount at point of purchase; 15% disposable contacts discount at point of purchase Not covered
Bariatric Surgery9 $2,500 surgical co-pay Not covered $2,500 surgical co-pay $2,500 surgical co-pay10 Not covered
Behavioral Health and Substance Abuse
Outpatient $20 co-pay for individual/family therapy11 $25 co-pay for individual/family therapy11 $20 co-pay for individual/family therapy11 $20 co-pay for individual/family therapy11 You pay 30% after $650 annual deductible3; no visit limit applies
Inpatient $600 per admission co-pay applies; must be pre-certified12 $600 per admission co-pay applies; must be pre-certified12 $600 per admission co-pay applies; must be pre-certified12 $600 per admission co-pay applies; must be pre-certified12 You pay 30% after $900 per admission co-pay and deductible3; no day limit applies

 

  1. Deductible does not apply to office visits for primary care and specialist.
  2. Includes the combined amounts that you spend on your medical and pharmacy copayments, deductibles, and co-insurance. Premiums, balance-billed charges, and charges the plan does not cover are excluded. Infertility Benefits and SaveOnSP prescription medications do not count towards a member's Out of Pocket Limit.
  3. All payments are based on the allowable charge. You are liable for charges over the allowable charge when receiving out-of-network services.
  4. Wake Med is considered in-network for only certain services including OBGYN, Pediatrics, Rehabilitation, and ER.
  5. $600 per admission co-pay for Duke Hospital, Duke Regional Hospital, and Duke Raleigh Hospital facilities and $700 for all others in-network.
  6. See the Member Guide and Summary of Benefits and Coverage for details.
  7. For members with a permanent home address outside of the state of North Carolina, access to a provider other than a Duke Fertility provider is covered, as long as the member meets the eligibility requirements and medical policy criteria. Prior authorization may be required.
  8. For children under 18 with significant disability, the plan will pay 100 percent for in-network benefits after appropriate co-pay per visit to an annual maximum of $10,000 in charges for employees hired prior to January 1, 1997. After $10,000 in charges, the plan pays 75 percent. Treatment must be received at Duke Hospital and its outpatient clinics.
  9. For qualified patients only. See Summary of Benefits and Coverage for details.
  10. For members with a permanent home address outside of the state of North Carolina, access to a provider other than a Duke provider is covered, as long as the member meets the eligibility requirements and medical policy criteria. Prior authorization is required.
  11. Out-of-network benefits limited to 20 visits per calendar year for Duke Select, Duke Basic, and Blue Care. Member pays 30% of the allowable charge after $650 annual deductible has been met.
  12. Out-of-network benefits limited to 20 days per calendar year for Duke Select, Duke Basic, and Blue Care. Member pays 30% of the allowable charge after $900 per admission co-pay and annual deductible have been met.

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.

  Duke Select (HMO) Duke Basic (HMO) Blue Care
Blue Cross NC (HMO)		 Duke Options
(Blue Cross Blue Shield PPO)
In-Network Out-of- Network
Can I select any doctor I wish? No No No No Yes
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 No
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
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
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
Must I meet an annual deductible? No Yes, for some services No Yes, for some services Yes
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, travel benefits, and dependent pregnancy Special Services include: International health services, Transgender surgery, 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 $6,000 person/ $12,000 family

Benefits