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.
Frequently Asked Questions
The Duke Advantage plan offers cost savings in the form of lower premiums. The plan also includes enrollment into a Health Savings Account (HSA). In addition to your pre-tax contributions, Duke will make an annual contribution of $200 for those enrolled in individual coverage and $500 for those enrolled in all other coverage levels. The combination of lower premiums and the HSA contributions make this a great plan for those who are not frequent users of healthcare or who are looking for additional tax savings.
Duke Advantage is a High-Deductible Health Plan (HDHP). This type of plan requires participants to meet their annual deductible before cost sharing applies, including for office visits and prescription drugs. Certain services, such as annual wellness / well-baby visits and virtual visits provided through MDLive, are covered at 100% before the deductible is met.
| In Network | Out of Network | |
|---|---|---|
| Deductible | $3,000 individual/$6,000 family | $6,000 individual/$12,000 family |
| Coinsurance | 25% | 45% |
| Out of Pocket Maximum | $7,500 individual/$15,000 family | $15,000 individual/$30,000 family |
Note: Please note that when you have family coverage (any tier other than Employee Only) the full family deductible must be met before the coinsurance would apply.
No. Copays do not apply to this plan. If the visit is your annual wellness visit (i.e., preventative care only) or you are accessing telehealth services through MDLive, then you will not incur a charge.
Duke Options utilizes the Cigna Open Access Plan (OAP) network, a nationwide network of providers and facilities.
Out-of-pocket costs are higher in the Duke Advantage HDHP, but you can use your Duke Health Savings Account (HSA) to pay for qualified medical expenses. Participants can also minimize their out-of-pocket cost by utilizing MDLive telehealth services for medical and behavioral health care, when appropriate.
Due to the lower premiums, you may want to consider Duke Advantage if you are not a frequent user of medical care, you are not anticipating major expenses in the upcoming year, and you are able to contribute additional funds to the Duke Health Savings Account (HSA).
You should consider how prepared you may be to cover your healthcare expenses from your own pocket. If you, or a covered family member, have a serious health condition or are expecting major health care expenses in the coming year, this may not be the best option for you. You should carefully evaluate each plan’s premiums, deductibles, coinsurance amounts and out-of-pocket maximums when making your decision.
No, you cannot enroll in a general Health Care FSA. However, you may enroll in a Limited Purpose FSA (LPFSA). The LPFSA can be used to pay for your dental and vision needs while allowing you to continue to build your HSA for future health care needs.
Yes, provided you meet the IRS eligibility requirements for the HSA. When you enroll in the Duke Advantage plan, you should automatically enroll in the HSA, even if you choose to delay making contributions. Please remember that you will not receive Duke’s contribution to your HSA until you are enrolled. Also remember that any contribution you choose to make to the HSA, regardless of how big or small, is an investment in your financial future and will assist in covering your qualified medical expenses.
Yes, MDLive is available only to members enrolled in the Duke Advantage plan. MDLive is a virtual platform and dedicated network of physicians that can offer primary, urgent, dermatology, and behavioral health visits.
No. Coverage will be provided for the treatment of an underlying medical condition up to the point an infertility condition is diagnosed. Comprehensive fertility coverage is only available on the Duke Select and Duke Options plans.
No. Bariatric surgery is covered on the Duke Select and Duke Options plans.
More Information
Please refer to the links below for more information:
Pharmacy Benefits
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 plan
