Each employee’s needs are different — that’s why Duke offers four (4) different medical plans to meet the needs of you and your family. Eligibility for some plans is based on the employee’s permanent home zip code. All Duke Health Plans are administered by Cigna.
If you need assistance, the Cigna team is available to answer questions about your plan options and provider access.
| Eligibility | Plan Options |
|---|---|
| Employees who live in zip codes 272, 273, 275, 276, 277 | Duke Select |
| Open to All employees | Duke Advantage Duke Options Duke USA |
Duke Select (HMO) is a plan available only to participants living in zip codes beginning with 272, 273, 275, 276, and 277. This plan uses a health care provider network unique to Duke. Since this network is unique, we encourage you to carefully review the provider listing. Out-of-network care is only covered for emergency or urgent care, and limited to 20 visits and 20 days for behavioral health or substance use disorder when out-of-network.
Duke Advantage (HDHP) is a high deductible health plan available to all benefits eligible employees. 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 uses the Cigna Open Access Plus national network of health care providers and hospitals and 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 the annual deductible before the plan covers most services, including office visits and prescriptions. However, preventive care is covered at 100%, with no deductible required, and Duke Advantage members may access virtual primary, urgent, specialty, and behavioral health care through MDLive, covered at no cost to the member before the deductible is met.
Duke Options (PPO) uses the Cigna Open Access Plus national network of health care providers and hospitals, and provides access to full out-of-network benefits, including out-of-network behavioral health and substance use disorder benefits. If you live outside of the Triangle area and need access to certain benefits, such as bariatric surgery and infertility services, and you prefer low deductibles and out-of-pocket limits, Duke Options may be a plan for you to consider.
Duke USA (PPO) is available to all benefits eligible employees. This plan uses the Cigna Open Access Plus network of health care providers and hospitals, just as the Duke Options and Duke Advantage plans. Premiums are lower than Duke Options but out-of-pocket costs (such as deductibles, coinsurance, and out-of-pocket maximums) are higher. Additionally, certain benefits covered through the Duke Options plan, such as bariatric surgery and infertility coverage, are not covered under the Duke USA plan. If you are in need of these benefits, you should select a different plan.
Please refer to the Medical Plans Comparison Chart. Pharmacy benefits for all medical plans are covered through Evernorth (formerly Express Scripts). A complete description of coverage under each plan is available online at the Duke Human Resources website. All of Duke’s medical plans comply with the provisions of the Patient Protection and Affordable Care Act.
Cigna
- Phone: 1-800-440-DUKE (3853)
- Website: cigna.com
- Email: dukeinquiry@cignahealthcare.com
Duke Advantage HSA Contribution
To help offset the higher out-of-pocket expenses under the Duke Advantage health plan, Duke Advantage members will receive an annual contribution to a Health Savings Account (HSA) based on the level of coverage selected:
- Individual (Employee) $200
- Family (All other coverage tiers) $500
Please Note
- If you or your spouse is enrolled in a General Purpose Health Care Flexible Spending Account, you are not eligible for the HSA.
- 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.
*Flexible spending account and health savings account plans are governed by Internal Revenue Code guidelines that limit the reimbursement of either health care expenses or dependent care expenses to a spouse and legal dependents.
