Duke USA PPO

Duke USA is a Preferred Provider Option (PPO) 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.

The Duke USA plan is similar to Duke Options, but has higher cost sharing when coverage is utilized.  While the premiums for Duke USA are lower than those for Duke Options, the copays, deductibles, coinsurance amounts, and out-of-pocket maximums for Duke USA are higher.

Duke USA is a Preferred Provider Option (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.

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: $25 copay and
• Specialist visits: $55 copay
• Urgent care visits: $50 copay

Duke Options utilizes the Cigna Open Access Plan (OAP) network, a nationwide network of providers and facilities.

Duke USA offers a lower premium than the Duke Options plan, but copays, deductible, coinsurance and out-of-pocket maximums are higher. You should carefully evaluate each plan’s premiums, deductibles, coinsurance amounts and out-of-pocket maximums when making your decision.

If you would like to pay a lower monthly premium for your coverage but still want to be on a plan that offers copays for office visits, this may be a good plan for you. 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 local 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.

If you, or a covered family member, are expecting major health care expenses in the coming year, this may not be the best option for you due to the higher deductibles and coinsurance amounts. You should carefully evaluate each plan’s premiums, deductibles, coinsurance amounts and out-of-pocket maximums when making your decision. Additionally, some services, such as Bariatric Surgery and Infertility coverage, are excluded from this plan.

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.