Medical Plans
- Effective January 1, 2027, Bariatric Surgery and Panniculectomy services under the Duke Select HMO and Duke Options PPO plan are available at all Duke facilities (Duke Regional, Duke Raleigh, Duke University Hospital, and Lake Norman Medical Center) for members residing in North Carolina. Members enrolled in the Duke Options PPO plan who permanently reside outside of North Carolina may access Cigna Open Access Plus In-Network Providers. Two years of continuous service, medical policy criteria, and prior authorization are required.
- Effective January 1, 2027, the annual speech therapy benefit under each Duke Health Plan option will be 40 visits per year for each member.
- Effective January 1, 2027, the Duke Select HMO and Duke Options PPO plan will provide fertility benefits up to the current cycle limits, not to exceed a $25,000 lifetime maximum per member. Rx charges do not accrue to the lifetime maximum. Other eligibility requirements, medical policy criteria, and prior review and certification remain in place.
- The Duke Basic HMO will cover Behavioral Health and Substance Abuse Outpatient (All Other Services category) at 100%, with no cost to the member. This modification is retroactive to January 1, 2026. Any claims previously processed under a different cost-sharing level will be automatically reprocessed to reflect this change.
- Effective January 1, 2027, Duke will no longer make an annual contribution to a Health Care Flexible Spending Account for members who are enrolled in the Duke Basic HMO medical plan.
- The Duke Basic HMO medical plan will continue to be offered in 2027 but will remain a frozen plan. Current participants can remain in this plan but will not be able to add new dependents.
- The Cigna Care HMO medical plan will end on December 31, 2026. Participants currently enrolled in Cigna Care HMO must select a new medical plan during Open Enrollment from one of four (4) available options. Participants who do not select a new medical plan during Open Enrollment will automatically be enrolled in the Duke Options PPO plan effective January 1, 2027, at the same coverage tier in effect as of December 31, 2026 (Individual, Employee/Child, Employee/Children, Employee/Spouse, or Family).
- Health plan premiums for 2027 will transition to a five-tier structure based on employee salary. Under this progressive premium structure, premium contributions will vary by salary tier and are designed to better align costs with pay levels. The new premium rates will take effect January 1, 2027.
Dental Plans
- The Duke Dental Plan will continue to be administered by Ameritas. Dental Plan rates will increase slightly effective January 1, 2027.
- As a reminder, if you or a dependent are not currently enrolled for dental coverage through Duke and enroll for 2027, the “late entrant” provision will apply.
Vision Plan
- The Duke Vision Plan will continue to be administered by UnitedHealthcare.
- No change in copays, deductibles or premiums for the vision plan.
Flexible Spending Accounts
- Flexible Spending accounts will continue to be administered by HealthEquity.
- Maximum annual contribution for the Health Care Flexible Spending Account is $3,400 (subject to IRS regulations). Up to $680 of your unused 2027 Health Care Flexible Spending Account balance can be carried over to the 2028 plan year.
- Maximum annual contribution for the Dependent Care Flexible Spending Account is $7,500 per family. There is no carryover for the Dependent Care Flexible Spending Account.
- Duke also offers a Limited Purpose Flexible Spending Account (LPFSA). The LPFSA is available to employees enrolled in the Duke Advantage medical plan. The LPFSA is a pre-tax spending account that works alongside a Health Savings Account (HSA) to pay for eligible dental and vision expenses. The LPFSA is subject to the same IRS maximum annual contribution and carryover allowance amount as the general purpose Healthcare Flexible Spending Account.
Duke Health Savings Account (Duke HSA)
- The Duke HSA is administered by Fidelity Investments.
- Only participants enrolled in the Duke Advantage plan are eligible for the Duke HSA.
- HSAs can be used to pay for qualified medical expenses such as deductibles, coinsurance, prescriptions, dental care, vision care and can be used to reimburse yourself for Medicare premiums once you have turned 65 and are enrolled in Medicare.
- You are ineligible for the Duke HSA if you have other medical coverage through Medicare, Tricare or a plan that is not a high deductible plan such as an HMO or PPO. You are also ineligible if you have received medical benefits from the VA in the previous three (3) months. You may not enroll in the HSA if you or your spouse has coverage with a general-purpose Health Care FSA or Health Care Reimbursement Account (HRA).
- The maximum combined annual contribution (employer and employee) for the Duke HSA is $4,500 for Individual coverage and $9,000 for Family coverage. Duke will make an annual contribution of $200 for Individual coverage and $500 for Family coverage during the first pay period of the calendar year. Any level of coverage above Employee Only is considered Family coverage.
Medicare Enrollment: You are ineligible to enroll in an HSA once you are covered by Medicare Part A or B. If Medicare Part A enrollment is delayed after age 65, a 6 month look-back rule will apply and Medicare will be retroactive for 6 months. Therefore, HSA contributions must end 6 months before enrollment in Medicare. If you are ineligible to contribute to an HSA and still would like coverage in the Duke Advantage HDHP please contact the Human Resources Information Center at 919-684-5600.
