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.
Frequently Asked Questions
Duke Options is a PPO medical plan that provides flexibility and broad provider access. Members can access a national network of physicians and hospitals, Cigna’s Open Access Plus network. Choosing to see network providers for your care will result in lower out-of-pocket cost. Routine preventive services, including annual wellness exams, OB/GYN exams, immunizations, and well-baby visits, are covered in full when received from in-network providers. This plan may be a good option for employees or family members who travel frequently or use doctors and facilities outside of Duke.
Duke Options is a Preferred Provider Organization (PPO) medical plan. The plan provides both in- and out-of-network options allowing participants to seek care at the provider or facility of their choice.
| In Network | Out of Network | |
|---|---|---|
| Deductible | $130 individual/$390 family | $650 individual/$1,950family |
| Coinsurance | 10% | 30% |
| Out of Pocket Maximum | $3,000 individual/$6,000 family | $6,000 individual/$12,000 family |
Some services are subject to copays, while other services and procedures have a deductible and coinsurance that applies. Once the applicable out-of-pocket maximum is reached, covered services are paid at 100% for the remainder of the plan year.
Yes.
- Primary care: $20 copay
- Specialist visits: $55 copay
- Urgent care visits: $35 copay
Duke Options utilizes the Cigna Open Access Plan (OAP) network, a nationwide network of providers and facilities.
The premiums for Duke Options are higher than the Duke USA PPO, but the out-of-pocket expenses are lower. You should carefully evaluate each plan’s premiums, deductibles, coinsurance amounts and out-of-pocket maximums when making your plan selection.
Duke Options may be a good fit if you want flexibility in choosing your healthcare providers. The plan offers access to a national provider network and offers both in- and out-of-network coverage. It may be especially beneficial if you travel frequently, have family members who live outside the Triangle area, or want the option to receive both in-network and out-of-network care. While the plan includes deductibles and coinsurance, using in-network providers helps keep your out-of-pocket costs lower. Special services, including bariatric coverage and infertility services, are included on the Duke Options PPO plan but excluded from some of the other plans.
If you aren’t a frequent user of the plan, and value lower monthly premiums over lower out-of-pocket expenses, you may want to explore other plan options. You should carefully evaluate each plan’s premiums, deductibles, coinsurance amounts and out-of-pocket maximums when making your decision.
Yes. The HCFSA will compliment your medical plan by allowing you to pay for your copays, coinsurance amounts and deductibles with pre-tax dollars.
No. The HSA is paired with the Duke Advantage HDHP, and only those enrolled in that plan can participate in the HSA.
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
