When comparing Duke’s medical plans, it is important to compare the cost of out-of-pocket expenses as well as premiums. For more information, please see Medical Premiums and Salary-Based Premiums.
Please refer to the comparison charts below to help you choose the best plan to fit your and/or your family’s needs. The Cigna Easy Choice Tool can also help you choose the medical plan that is right for you.
Need Help Choosing a Plan?
The Easy Choice Tool is a decision tool which can be used to compare Duke plan options and find the plan that works best for your situation.
| Duke Select (HMO) Zip code requirement | Duke Options (PPO) In-Network | Duke Options (PPO) Out-Network | Duke USA (PPO) In-Network | Duke USA (PPO) Out-Network | Duke Advantage (HDHP) In-Network | Duke Advantage (HDHP) Out-Network | |
|---|---|---|---|---|---|---|---|
| Annual Deductible | |||||||
| Individual | None | $130 | $650 | $2,000 | $6,000 | $3,000 | $6,000 |
| Family | None | $390 | $1,950 | $6,000 | $12,000 | $6,000* | $12,000* |
| Coinsurance | |||||||
| Member Cost Share | 0% | 10% | 30% | 20% | 40% | 25% | 45% |
| Out of Pocket Limit | |||||||
| Individual | $3,000 | $3,000 | $6,000 | $6,800 | $13,600 | $7,500 | $15,000 |
| Family | $6,000 | $6,000 | $12,000 | $13,600 | $27,200 | $15,000 | $30,000 |
| Physician Office Visit | |||||||
| PCP | $20 copay | $20 copay | 30% after deductible | $25 copay | 40% after deductible | 25% after deductible | 45% after deductible |
| Specialist | $55 copay | $55 copay | 30% after deductible | $55 copay | 40% after deductible | 25% after deductible | 45% after deductible |
| MDLive virtual care | Not available | Not available | Not available | Not available | Not available | Covered in full | Not available |
| MRI, CT, PET Scan | $150 copay | 10% after deductible | 30% after deductible | 20% after deductible | 40% after deductible | 25% after deductible | 45% after deductible |
| Lab & Other X-Ray | Covered in full | 10% after deductible | 30% after deductible | 20% after deductible | 40% after deductible | 25% after deductible | 45% after deductible |
| Annual Preventive Visit | Covered in full | Covered in full | 30% after deductible | Covered in full | Not covered | Covered in full | Not covered |
| Maternity Care | $20 copay primary care or $55 copay specialist first visit | $20 copay primary care or $55 copay specialist first visit | 30% after deductible | $25 copay primary care or $55 copay specialist first visit | 40% after deductible | 25% after deductible for each visit, physician’s charges, labor and delivery charges, and facility charges | 45% after deductible for each visit, physician’s charges, labor and delivery charges, and facility charges |
| Urgent Care | $35 copay | $35 copay | $35 copay | $50 copay | $50 copay | 25% after deductible | 25% after deductible |
| Hospital Care | |||||||
| Inpatient | $600 per admission copay (Duke) or $700 (non-Duke) per admission copay | 10% after $600 (Duke) or $700 (non-Duke) per admission copay and deductible | 30% after $900 per admission copay and deductible | 20% after $600 (Duke) or $700 (non-Duke) per admission copay and deductible | 40% after $900 per admission copay and deductible | 25% after deductible | 45% after deductible |
| Outpatient | $250 copay | 10% after deductible | 30% after deductible | 20% after deductible | 40% after deductible | 25% after deductible | 45% after deductible |
| Emergency Care | $250 copay | $250 copay | $250 copay | $250 copay | $250 copay | 25% after deductible | 25% after deductible |
| Behavioral Health and Substance Abuse | |||||||
| Outpatient – Physician’s Office | $20 copay | $20 copay | 30% coinsurance after deductible | $25 copay | 40% coinsurance after deductible | 25% coinsurance after deductible | 45% coinsurance after deductible |
| MDLive virtual care | Not available | Not available | Not available | Not available | Not available | Covered in full | Not available |
| Outpatient – All Other Services | No charge | 10% coinsurance (deductible waived) | 30% coinsurance after deductible | 20% coinsurance (deductible waived) | 40% coinsurance after deductible | 25% coinsurance after deductible | 45% coinsurance after deductible |
| Inpatient | $600 copay per admission | $600 (Duke) or $700 (non-Duke) per admission copay, then 10% after deductible | $900 per admission copay, then 30% after deductible | $600 (Duke) or $700 (non-Duke) per admission copay, then 20% after deductible | $900 per admission copay, then 40% after deductible | 25% after deductible | 45% after deductible |
| Other Services | |||||||
| Infertility ($25,000 lifetime maximum per member applies) | Provided only at the Duke Fertility Center for employees with two years of service; limits apply | Provided only at the Duke Fertility Center for employees residing in NC with two years of service; cycle limits apply. Out of state employees may access a Cigna in-network provider. | Not covered | Coverage will be provided for the treatment of an underlying medical condition up to the point an infertility condition is diagnosed. Services will be covered as any other illness in-network. | Coverage will be provided for the treatment of an underlying medical condition up to the point an infertility condition is diagnosed. Services will be covered as any other illness out-of-network. | Coverage will be provided for the treatment of an underlying medical condition up to the point an infertility condition is diagnosed. Services will be covered as any other illness in-network. | Coverage will be provided for the treatment of an underlying medical condition up to the point an infertility condition is diagnosed. Services will be covered as any other illness out-of-network. |
| Physical Therapy (PT) Occupational Therapy (OT) Speech Therapy | $20 copay; visit limits apply | $55 copay; limits apply | 30% after deductible; limits apply | $55 copay; limits apply | 40% after deductible; limits apply | 25% after deductible; limits apply | 45% after deductible; limits apply |
| Durable Medical Equipment (Note: CGMs and supplies are excluded on medical. They are covered under the Rx plan) | 10% after deductible | 10% after deductible | 30% after deductible | 20% after deductible | 40% after deductible | 25% after deductible | 45% after deductible |
| Vision Exam (Duke Eye Center only) | $55 copay | $55 copay | Not covered | $55 copay | Not covered | 25% after deductible | Not covered |
| Bariatric Surgery | $2,500 surgical copay | $2,500 surgical copay | Not covered | Not covered | Not covered | Not covered | Not covered |
| Gender Affirmation Surgery | Not covered | 10% after $600 (Duke) or $700 (non-Duke) per admission copay and deductible | 30% after $900 per admission copay and deductible | 20% after $600 (Duke) or $700 (non-Duke) per admission copay and deductible | 40% after $900 per admission copay and deductible | 25% after deductible | 45% after deductible |
*An individual cannot have claims covered under the plan coinsurance until the total family deductible has been satisfied.
Duke Basic HMO (frozen*)
| Duke Basic HMO (frozen*) | |
|---|---|
| Annual Deductible | |
| Individual | $600 |
| Family | $1,800 |
| Out of Pocket Limit | |
| Individual | $3,000 |
| Family | $6,000 |
| Physician Office Visit | |
| PCP | $25 copay |
| Specialist | $75 copay |
| MRI, CT, PET Scan | $150 copay |
| Lab & Other X-Ray | Covered in full |
| Annual Preventive Visit | Covered in full |
| Maternity Care | $25 copay primary care or $75 copay specialist first visit |
| Hospital Care | |
| Inpatient | 10% after deductible |
| Outpatient | 10% after deductible |
| Emergency Care | $250 copay, waived if admitted |
| Other Services | |
| Infertility | Coverage will be provided for the treatment of an underlying medical condition up to the point an infertility condition is diagnosed. Services will be covered as any other illness. |
| Physical Therapy (PT) Occupational Therapy (OT) | $75 copay; limits apply |
| Vision Exam (Duke Eye Center only) | $55 copay |
| Bariatric Surgery | Not covered |
| Gender Affirmation Surgery | Not covered |
| Behavioral Health and Substance Abuse | |
| Outpatient – Physician’s Office | $25 copay |
| Outpatient – All Other Services | Covered in full |
| Inpatient | 10% after deductible |
*The Duke Basic plan will end after 2029 and is only available to current participants.
