2017 Open Enrollment - Duke University · 2020-04-23 · account, you must re-enroll for 2017....
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2017 Open Enrollment October 24 - November 4, 2016
Transcript of 2017 Open Enrollment - Duke University · 2020-04-23 · account, you must re-enroll for 2017....
2017 Open EnrollmentOctober 24 - November 4, 2016
October 2016
Dear Colleague,
At Duke, we now provide health benefits to the largest population in our history – more than 65,000 faculty, staff, and family members.
During our annual open enrollment period, I encourage you to carefully review Duke’s health, dental, vision and reimbursement account benefits to ensure your selections continue to meet the needs of you and your family. The enrollment period this year will be from Oct. 24 to Nov. 4. This annual period is the only time faculty and staff can enroll or make changes to these benefits outside of a qualifying life event such as marriage or the birth of a child.
For 2017, Duke continues to offer four health plans to meet the diverse needs of our faculty, staff and family members. The popularity of Duke’s plans is driven in part by lower costs compared to options available in the market. Duke has managed to keep its premium increases for its most popular plans well below the national average with Duke still paying 80 percent of the cost for individual coverage.
Please review the information in this guide closely and consider any necessary adjustments for next year. Plans and coverage differ, so be sure to select a plan that provides the appropriate network of coverage for you and your family.
If you have questions, please contact the Duke Open Enrollment Service Center at 1-919-684-5600. Representatives will be available from 8 a.m. – 6 p.m. weekdays, Oct. 24 – Nov. 4, and from 10 a.m. – 3 p.m. Saturday, Oct. 29.
Thank you for your commitment and service to Duke.
Sincerely,
Kyle CavanaughVice President, Administration
Para información detallada sobre sus beneficios, comuníquese por favor al Centro deRecursos Humanos de Duke al (919) 684-5600.
705 Broad Street Telephone: (919) 684-5600Box 90502 FAX (919) 684-8620Durham, North Carolina 27708 FAX (919) 681-8774
Table of Contents2017 Plan Highlights and Changes ...............................................................5
What You Need to Know .................................................................................6
Your Medical Plan Options ............................................................................7
Issues to Consider .......................................................................................... 8
Medical Plans Comparison Chart ................................................................ 9
Pharmacy Benefits ....................................................................................... 13
Mental Health and Substance Abuse Benefits ......................................... 14
Health Management Programs ................................................................... 15
Your Dental Plan Options ............................................................................. 16
Your Vision Plan Option ................................................................................ 18
Health Care Reimbursement Account ...................................................... 19
Dependent Care Reimbursement Account .............................................. 21
Glossary .......................................................................................................... 23
Contacts ......................................................................................................... 24
How to Enroll Using the Duke@Work Website ......................................... 25
This enrollment guide and the Open Enrollment website at hr.duke.edu/enrollment2017 highlight the medical, dental, and vision plan choices available to eligible employees and their dependents, as well as benefits available under the Health Care and Dependent Care Reimbursement Accounts. This enrollment guide serves as a summary of material modification to the benefits described in the official summary plan descriptions for these plans. The benefits that you receive are based upon the plan’s official plan documents, not this guide or any other written or oral statement. If there is a conflict between this guide and the official plan documents, the official plan documents will govern in all cases. Duke reserves the right at any time to change or terminate these plans.
Open enrollment is your opportunity to review your medical, dental, vision, and reimbursement account benefit selections and make any changes necessary to ensure your choices continue to meet your needs.
If you wish to participate in the Health Care or Dependent Care Reimbursement Accounts for 2017, you must enroll (or re-enroll). Participation in the reimbursement accounts does not automatically continue from year to year.
If you do not make changes to your medical, dental or vision coverage, your current medical, dental and vision coverage selections for 2016 will continue for 2017 for you and for the dependents for whom you have completed the dependent eligibility verification process.
Duke’s medical plans are considered “grandfathered” under the Patient Protection and Affordable Care Act (otherwise known as National Health Care Reform).
Let Us Know What You Think!We want to hear your thoughts about Duke’s benefits and the open enrollment process. Please visit hr.duke.edu/enrollmentsurvey to complete a short and anonymous survey.
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Decisions to make during open enrollment Open Enrollment is the one time of year when employees can enroll in or change their medical, dental and vision insurance plans, and enroll in reimbursement accounts. Here’s what you need to decide this year:
1. Where will you get health insurance for 2017? The U.S. government has mandated that almost everyone should have health insurance. Most eligible faculty and staff will meet that requirement with coverage through one of Duke’s four plans. Another option is coverage through the federal government in the Health Insurance Marketplace. Learn more at HealthCare.gov.
2. Will you cover yourself and/or dependents for dental and vision insurance? Duke offers three different dental insurance programs and a vision insurance program that covers eye exams, lenses and frames.
3. How much would you like to save on taxes? During Open Enrollment you can sign up to participate in a Health Care Reimbursement Account and/or a Dependent Care Reimbursement Account. Both these accounts allow you to put money aside before taxes to pay for health care costs and child or elder care costs. Because the money is taken out of your paycheck before taxes are calculated, you save about 30 percent of every dollar you put in the accounts.
Remember: If you take no action during Open Enrollment, the selections you made for 2016 for your medical, dental, and vision coverage will continue for 2017 for you and for the dependents for whom you’ve completed the dependent eligibility verification process. To continue to use a reimbursement account, you must re-enroll for 2017.
Deductions for insurance benefits are paid in advance and will be deducted monthly from your paycheck beginning December 2016. Deductions for reimbursement accounts will start in January 2017.
Open Enrollment representatives are available at (919) 684-5600 during the following times:
• 8 a.m. – 6 p.m. weekdays, October 24 – November 4
• 10 a.m. – 3 p.m. Saturday, October 29
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2017 Plan Highlights and ChangesMedical Plans (See your “My Info” fact sheet for premium levels.)
No change in the co-pay for a primary care physician or specialist office visit.
Co-pay for inpatient hospitalization on Duke Select, Duke Options and Blue Care changes from $450 to $600 for Duke hospitals, from $550 to $700 for non-Duke hospitals, and $900 for out-of-network hospitals.
Co-pay for outpatient surgery on Duke Select, and Blue Care changes from $200 to $250.
Annual deductible for Duke Options out-of-network moves from $500 individual to $650, and from $1,500 family to $1,950.
Out-of-network co-insurance maximum for Duke Options changes from $3,000 individual to $4,000, and from $9,000 family to $12,000.
The tobacco surcharge increases from $40 to $50 per month.
The third-party administrator for Duke Basic and Duke Select members is now Aetna, following its acquisition of Coventry. New ID cards will be issued from Aetna and Express Scripts.
Under Duke Options, coverage is changing to include Applied Behavior Analysis (ABA) therapy for children with autism where medically necessary and authorization is obtained. See www.hr.duke.edu for more information.
Dollar maximum for transgender surgery will be removed from Duke Options.
Pharmacy For a 34-day supply, co-pays for generic medications change to $15, brand to $50, and non-formulary
to $70.
For mail order or Duke pharmacy of up to 90 days supply, co-pays for generics are $25, brand $130, and non-formulary $180.
Specialty medications can only be purchased through Duke pharmacy or Accredo. Immediate need or “STAT” medications though may still be purchased at a retail pharmacy.
Dental Insurance Dental Plan A monthly premiums will increase between $2.02 for individual coverage and $6.12
for family coverage.
Monthly premiums for Dental PPO will increase between $ 0.77 for individual coverage and $2.33 for family coverage.
No change in co-pays and deductibles.
No change in premiums for Dental Plan B.
Vision Insurance No change in co-pays or premiums for the vision plan.
Increase in frame allowance from $130 to $150 once every 24 months.
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What You Need To Know
When Can I Enroll?Because your premiums for medical, dental and vision insurance and reimbursement accounts are pre-tax, federal law limits when you can change your elections for these benefits.
Changes made outside of the annual Open Enrollment period are allowed only within 30 days of a “qualifying event” such as marriage or divorce, birth or death of a dependent, or a change in insurance eligibility due to relocation of residence or work. For more information on qualifying life events, visit hr.duke.edu/lifeevents.
Who Can I Enroll?You can enroll the following dependents for medical, dental and vision insurance:
Your legal spouse.
Same-sex spousal equivalent registered with Duke HR prior to January 1, 2016.
Your children (includes natural children, stepchildren, adopted children, children of your registered same sex spousal equivalent, foster children) or children for whom you are a legal guardian, up to their 26th birthday. Dependent children do not include grandchildren, siblings or other family members, or children of whom you have legal custody but not guardianship.
How Much Coverage Can I Purchase?When making your medical, dental, and vision benefit selections, you may choose from among the following levels of coverage:
Employee
Employee/Child
Employee/Children – only available for medical and vision care*
Employee/Spouse
Family
Your premium for coverage — including your contribution and Duke’s contribution – will vary, depending on which level of coverage you select. Your Personal Information Fact Sheet (“My Info”) provides you with the premium amounts for each level.
Social Security Numbers for DependentsAs part of compliance with the Patient Protection and Affordable Care Act, Duke must request all employees to confirm or provide Social Security numbers for dependents enrolled for medical coverage.
You can review or add the Social Security numbers for covered dependents through the enrollment process on the Duke@Work self-service website or by calling the Open Enrollment Service Center at (919) 684-5600.
* Dental care coverage does not include an Employee/Children option. You may cover any number of children in the dental plan by choosing the Family option.
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Your Medical Plan OptionsEach employee’s needs are different — that’s why Duke offers four different medical plans to meet the needs of you and your family:
Duke Select – available only to employees living in ZIP codes beginning with 272, 273, 275, 276 and 277. This plan requires participants to use the Duke network of providers. Out-of-network care is only covered for emergency or urgent care. There is no annual deductible.
Duke Basic – available only to employees living in ZIP codes beginning with 272, 273, 275, 276 and 277. This plan requires participants to use the Duke network of providers. Out-of-network care is only covered for emergency or urgent care. Premiums are lower than Duke Select, but out-of-pocket costs are higher.
Blue Care (Blue Cross Blue Shield) – available only to employees living in North Carolina. Participants must use a statewide network of providers. Out-of-network care is only covered for emergency or urgent care.
Duke Options (Blue Cross Blue Shield) PPO – includes a worldwide network of health care providers and hospitals.
Each medical plan covers both pharmacy and mental health benefits. Please refer to the Medical Plans Comparison Chart on pages 9-12 for details on other coverage options. All of our medical plans will cover pre-existing conditions for covered services.
For Employees Who Travel on Duke BusinessDuke provides supplemental health insurance at no additional cost for full-time, benefits-eligible employees traveling internationally less than six months on Duke business. You must have health insurance from Duke or another provider in order to be eligible for this coverage.
This coverage, called Cigna’s Medical Benefits Abroad (MBA), offers eligible employees and their spouses or registered same-sex partners and dependents up to age 26 who are traveling with them, this supplemental medical insurance coverage for unexpected injuries and illnesses while abroad on Duke business. This coverage supplements Duke’s regular health insurance plans. The coverage also includes up to seven days of personal travel when taken in conjunction with a business trip.
For more information, including coverage limits and eligibility requirements, visit hr.duke.edu/abroad.
Tobacco Use SurchargeDuke charges employees covered under a Duke medical insurance plan who smoke or use other forms of tobacco a surcharge of $50. This includes use of nicotine in any form, including electronic cigarettes. The use of a nicotine patch and nicotine gum are not subject to the surcharge. The surcharge does not apply to dependents who use tobacco.
Duke will remove the monthly surcharge when the employee successfully completes a LIVE FOR LIFE tobacco cessation program. Visit hr.duke.edu/tobaccofree for more information about tobacco cessation options.
Did you know?Because of national health care reform, Duke offers dependent coverage for children under age 26 for medical, dental and vision benefits regardless of their student status or their marital status.
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Duke Select Duke Basic Blue Care Duke Options (HMO) (HMO) (BlueCross (BlueCrossBlueShieldPPO) BlueShieldHMO) In-Network Out-of-Network
Issues to Consider in Making Your Medical Plan Decisions
When comparing Duke’s medical plans, it is important to compare the cost of out-of-pocket expenses as well as premiums. Here are some questions to ask yourself in choosing a medical plan and your needs. For specific coverage information, please refer to the Medical Plans Comparison Chart on the following pages.
Duke Basic Reimbursement Account Contribution To help offset the higher out-of-pocket expenses of Duke Basic, Duke Basic members receive an annual contribution to a Health Care Reimbursement Account based on the level of coverage selected:
$200 for Employee
$300 for Employee/Child
$400 for Employee/Children
$400 for Employee/Spouse*
$500 for Family (includes Spouse)
* Reimbursement 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.
Can I select any doctor I wish?
No No No No Yes
Must I choose from doctors in a net-work?
Yes Yes Yes Yes No
Will my dependent children who live in a different location be covered?
Emergency care only. No follow-up care
Emergency care only. No follow-up care
Yes, if within NC and in-network – otherwise, emer-gency care only
Yes, worldwide listing of doctors
Yes
Since I travel a lot, can I see doctors in other locations around the world?
Emergency care only. No follow-up care
Emergency care only. No follow-up care
Emergency care only. No follow-up care
Yes, worldwide listing of doctors
Yes
Can I enroll in the DukeWell care man-agement program and get assistance with the cost of medications?
Yes, if you have certain medical conditions
Yes, if you have certain medical conditions
No No No
Am I permitted to use out-of-network providers?
No, emergency care only
No, emergency care only
No, emergency care only
Yes, under out-of-network benefits
Yes
Must I meet an annual medical deductible?
No Yes, for some services
No Yes, for some services
Yes
Will my child’s pregnancy be covered?
No No Yes No No
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ffice
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-pays
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-pays
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ake
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uke
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s in
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.
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ay p
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-pay
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uke
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uke
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0 i
n c
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ed p
rior
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97
. Aft
er $
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n c
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, pla
n p
ays
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per
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t. Tr
eatm
ent
mu
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e re
ceiv
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t D
uke
Hosp
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l a
nd i
ts
ou
tpa
tien
t cl
inic
s.
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her
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re n
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enefi
ts a
vail
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th
is p
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chil
dre
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ith
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r qu
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mm
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an
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over
age
for
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12
20
17 M
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al P
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pari
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uke
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uke
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-Net
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hir
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are
$55
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ay$7
5 co
-pay
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ay; 2
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sits
per
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-pay
; 30
visi
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ay 3
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-pay
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eech
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-pay
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ired
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-pay
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imit
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ram
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rger
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,500
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-pay
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-pay
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00 c
o-p
ayN
ot
cove
red
1 Se
e Su
mm
ary
of
Ben
efits
an
d C
over
age
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ail
s.
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ll p
aym
ents
are
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sed o
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allow
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ch
arg
e. Y
ou
are
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pon
sible
for
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rges
ove
r th
e a
llow
able
ch
arg
e w
hen
rec
eivi
ng
ou
t-of-n
etw
ork
ser
vice
s.
3 Fo
r ch
ildre
n u
nder
18
wit
h s
ign
ifica
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dis
abil
ity,
th
e pla
n w
ill pay
10
0 p
erce
nt
for
in-n
etw
ork
ben
efits
aft
er a
ppro
pri
ate
co-p
ay
per
vis
it t
o a
n a
nn
ua
l m
axi
mu
m o
f $
10
,00
0 i
n c
ha
rges
for
emplo
yees
hir
ed p
rior
to J
an
ua
ry 1
, 19
97
. Aft
er $
10
,00
0 i
n c
ha
rges
, pla
n p
ays
75
per
cen
t. Tr
eatm
ent
mu
st b
e re
ceiv
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t D
uke
Hosp
ita
l a
nd
its
ou
tpa
tien
t cl
inic
s.
4 T
her
e a
re n
o b
enefi
ts a
vail
able
un
der
th
is p
lan
for
chil
dre
n w
ith
dev
elopm
enta
l dis
abil
itie
s.
5 Fo
r qu
ali
fied
pa
tien
ts o
nly
. See
Su
mm
ary
of
Ben
efits
an
d C
over
age
for
det
ail
s.
13
Pharmacy BenefitsExpress Scripts, a national pharmacy benefit manager, provides pharmacy benefits for all four medical plans. Co-pays and deductibles vary depending on where you purchase your medications and the type of medicine prescribed (generic, brand or non-formulary).
Beginning January 1, 2017, “Specialty” medications must be purchased through Accredo or Duke pharmacy to be eligible for coverage under the plan, unless it is for immediate need called “STAT” medications. See www.hr.duke.edu for a listing of “Specialty” medications.
Below is a chart that outlines how filling your recurring, long-term medications through the mail order program or participating on-site Duke pharmacies can save money.
Participants in the Duke Basic medical plan have a $100 deductible for all prescription drugs including generic and mail-order prescriptions. Duke Basic participants are required to use mail order or Duke Pharmacies for long-term medications.
Injectable fertility drugs are not reimbursed according to our standard pharmacy benefit. Only plans covering infertility services include coverage of these drugs, which must be prescribed by a Duke Fertility physician.
More information is available at hr.duke.edu/infertility.
Through the Express Scripts Mail Order
Pharmacy or Participating on-site
Duke Pharmacies
Anytime
Co-pay Structure
At a participating retail pharmacy
Up to a 34-day supply 90-day supply
After the third purchase of a long-term
medication
First three purchases of any medication
GenericNo deductible except for participants covered by Duke Basic
Brand$100 per person retail deductible applies. No deductible for 90-day supply through mail order or Duke Pharmacies except for Duke Basic participant
Non-formulary$100 per person retail deductible applies. No deductible for 90-day supply through mail order or Duke Pharmacies except for Duke Basic participant
$15 50%† $25 (or cost of (or cost drug if less) Cost of drug to max. $30 of drug if less)
$50 50%† $130
Min. $70, Max. $165
$70 50%† $180
Min. $85, Max. $180
† Duke Basic participants are required to use mail order or Duke pharmacies for long-term medications.
14
Mental Health and Substance Abuse Benefits
Duke offers both outpatient and inpatient mental health and substance abuse benefits under each of our medical plans. To find a network provider, call Cigna Behavioral Health toll-free at (888) 253-8552 or log on to their website at cignabehavioral.com. You must use “Duke” as your Employer ID, and “employee” as the PIN.
Duke also offers up to eight free short-term counseling visits to Duke employees and their immediate family members through the Personal Assistance Service (PAS). The staff of licensed professionals offer assessment, short-term counseling and referrals to help resolve a range of personal, work and family problems. For information, call (919) 416-1727.
Details about mental health and substance abuse benefits are outlined below.
Cigna Behavioral Health
In-Network Care Out-of-Network Care
Duke Select Duke Basic Blue Care Duke Options (HMO) (HMO) (BlueCross (BlueCrossBlue BlueShieldHMO) BlueShieldPPO)
Outpatient
Inpatient
1. All payments are based on the allowable charge. You are responsible for charges over the allowable charge when receiving out-of-network services.
• Covered in full after $20 co-pay for individual/ family therapy ($25 co-pay for Duke Basic)
• Precertification required for psychological testing, electroshock therapy, and hypnosis
• Co-pay of $600 per admission
• Must be precertified prior to admission
• After $650 annual deductible, per visit you pay 30%1
• Limit of 20 visits per calendar year for Duke Select, Duke Basic, and Blue Care participants
• Precertification required for psychological testing, electroshock therapy, and hypnosis
• After $900 per admission co-pay and deductible, you pay 30%
• Limit of 20 days per calendar year for Duke Select, Duke Basic, and Blue Care participants
• Must be precertified prior to admission
• For Duke Options, the out-of-network deductible and co-insurance maximum will be consolidated with medical claims
15
Health Management ProgramsThe medical plans expenses are directly related to the medical and pharmacy claims of those covered by the plans. Higher claims mean increased cost for both Duke and you. Duke covers the majority of the cost for medical care, but an increase in claims also means an increase in monthly premiums for faculty and staff. One of the best ways to reduce claims cost and the rising cost of health care is by reducing health risks and making healthy choices.
Duke offers a variety of health management programs that emphasize a proactive approach to improving health and preventing disease. These include:
DukeWell This program for employees in Duke Select or Duke Basic medical plans is designed to identify risks for diseases and chronic conditions like hypertension and diabetes. It helps employees create a plan for optimal health and provides support and resources to achieve goals. DukeWell works closely with LIVE FOR LIFE programs. Eligible employees who fully participate in a care plan can earn generic medicines for diabetes and heart disease at no cost, as well as other incentives.
Website: dukewell.org Phone: (919) 660-WELL (9355)
LIVE FOR LIFE Available to all employees, LIVE FOR LIFE offers health assessments, fitness activities, tobacco cessation resources, gym discounts, consultations with fitness specialists and registered dietitians and run/walk clubs. LIVE FOR LIFE also organizes the farmers and mobile markets and promotes health education through programs such as Pathways to Change and Steps to Health.
Website: hr.duke.edu/liveforlife Phone: (919) 684-3136
Blue Cross Healthy Outcomes This program is for employees enrolled in Blue Care and Duke Options medical plans. Blue Cross Blue Shield offers a range of health management services and programs.
Website: bcbsnc.com Phone: (877) 224-3305
24-Hour Health Care Advice Line Round-the-clock heath advice lines are available under all of Duke’s medical plans. You receive confidential, up-to-date health information from professional staff, including help on how to navigate the health care system.
Duke Select and Duke Basic members: (888) 662-2296 Duke Options and Blue Care members: (877) 477-2424
Did you know?Personal Assistance Service (PAS), the faculty/employee assistance program at Duke, offers up to eight at no cost visits for counseling. For information, call (919) 416-1727.
16
Your Dental Plan Options Duke employees can choose from three dental options that offer different levels of coverage and different ways of choosing a dentist.
All three plans cover some or all of the cost of:
preventive procedures such as exams and cleaning,
basic services such as fillings, sealants, denture repair and removal of teeth, and
major services such as crowns, dentures and root canals.
With Plan A and Plan B, you may visit any licensed dentist. Both plans include deductibles that must be met before coverage begins for non-preventive procedures.
The PPO plan includes a higher maximum annual benefit than Plan A and Plan B, and lower negotiated procedure rates. However, participants in the PPO plan must use an in-network provider. A list of in-network dentists is available at ameritas-dental.prismisp.com.
If you do not plan to use an in-network provider, you should not enroll in the PPO plan.
Fee schedules for all three plans are available on the Ameritas website at ameritasgroup.com/duke.
How to Increase Your Annual Maximum BenefitDental plan members who had at least one dental claim filed in calendar year 2016, with less than $500 in claims payments, will have their annual maximum benefit increased by $250 in 2017. This accumulation can continue each year until the annual maximum has increased on the PPO plan from $1,250 to $2,250; on Plan A from $1,000 to $2,000; and on Plan B from $750 to $1,750. If you reach this annual maximum benefit, the insurance company will not reimburse any additional services for the remainder of the calendar year.
Late Entrant Restrictions on Benefits for 2017If you or a dependent are not currently enrolled for dental coverage through Duke and enroll for 2017, you or the dependent will be considered a “late entrant.”
As a “late entrant” your benefits during the first twelve months of coverage will be limited to preventive services: two preventive routine care exams (not including X-rays), two prophylaxis (routine) cleanings, and for children under age 19, one fluoride application. No other procedures would be covered during the first 12 months.
Periodontal procedures including maintenance would not be covered during this 12 month period.
Once you have been enrolled in a Duke dental insurance plan for at least 12 months, the insurance will also cover basic and major procedures such as fillings, extractions, crowns, root canals and periodontal treatment (including periodontal maintenance which apply toward cleaning frequency).
This 12-month waiting period does not apply:
if you are switching from one Duke dental plan to another Duke plan
if you enroll a child within 30 days of his/her second birthday
if you enroll an eligible dependent within 30 days of a qualifying event such as marriage or adoption.
17
Den
tal P
lan
s C
om
pari
son
Ch
art
1 A
ll p
aym
ents
are
ba
sed o
n t
he
Ma
xim
um
Allow
able
Ch
arg
es (
MA
C).
PP
O d
enti
sts
ha
ve a
gree
d t
o a
ccep
t th
e co
ntr
act
ed f
ee (
MA
C)
as
the
ma
xim
um
ch
arg
e.
2 A
ll p
aym
ents
are
ba
sed o
n t
he
usu
al a
nd c
ust
om
ary
(U
&C
) a
llow
able
ch
arg
e. Y
ou
are
res
pon
sible
for
cha
rges
ove
r U
&C
.
PPO
Pla
n In
-net
wor
kPl
an A
Plan
B
An
nu
al m
axim
um
ben
efit
for
pre
ven
tive
,
bas
ic a
nd
maj
or
cove
red
ser
vice
s $1
,250
per
per
son
$1,0
00 p
er p
erso
n
$750
per
per
son
Late
En
tran
t P
rovi
sio
n
(See
defi
nit
ion
on
pag
e 16
)A
pp
lies
Ap
plie
sA
pp
lies
Pre
ven
tive
: All
thre
e p
lan
s co
ver:
2
ro
uti
ne
exam
s p
er y
ear
2
ro
uti
ne
pro
ph
ylax
is (
clea
nin
gs)
per
yea
r
Sp
ace
mai
nta
iner
s
X-r
ays
No
ded
uct
ible
F
luo
rid
e tr
eatm
ents
fo
r ch
ildre
n u
nd
er a
ge 1
9
Co
vere
d in
fu
ll u
p t
o t
he
Max
imu
m
Allo
wab
le C
har
ge1
No
ded
uct
ible
Co
vere
d in
fu
ll u
p t
o U
&C
2 ,
No
ded
uct
ible
Pays
a p
red
eter
min
ed fi
xed
am
ou
nt
bas
ed o
n p
roce
du
re a
mo
un
t b
ased
on
pro
ced
ure
rec
eive
d
No
ded
uct
ible
Bas
ic: A
ll th
ree
pla
ns
cove
r:
F
illin
gs
S
eala
nts
F
ull
or
par
tial
den
ture
rep
air
A
nes
thes
ia f
or
ora
l su
rger
y
Rem
ova
l of
teet
h
No
ded
uct
ible
Rei
mb
urs
emen
t at
:
80%
of
MA
C1
du
rin
g fi
rst
year
of
cove
rage
90%
of
MA
C1
du
rin
g se
con
d y
ear
of
cove
rage
if a
co
vere
d p
roce
du
re is
re
ceiv
ed d
uri
ng
the
firs
t ye
ars.
1
00%
of
MA
C1
ther
eaft
er if
a
cove
red
pro
ced
ure
is r
ecei
ved
in t
he
seco
nd
an
d f
ollo
win
g ye
ars.
Aft
er a
$10
0 lif
etim
e d
edu
ctib
le p
er p
erso
n:
Rei
mb
urs
emen
t at
:
80%
of
U&
C2
du
rin
g fi
rst
year
of
cove
rage
90%
of
U&
C2
du
rin
g se
con
d y
ear
of
cove
rage
if a
co
vere
d p
roce
du
re is
re
ceiv
ed d
uri
ng
the
firs
t ye
ar.
1
00%
of
U&
C2
ther
eaft
er if
a c
ove
red
p
roce
du
re is
rec
eive
d in
th
e se
con
d a
nd
fo
llow
ing
year
s.
Aft
er a
co
mb
ined
bas
ic a
nd
maj
or
ann
ual
d
edu
ctib
le o
f $5
0 p
er p
erso
n, t
he
pla
n p
ays
a p
red
eter
min
ed fi
xed
am
ou
nt
bas
ed o
n
pro
ced
ure
rec
eive
d.
Maj
or:
All
thre
e p
lan
s co
ver:
C
row
ns
B
rid
gew
ork
P
arti
al o
r fu
ll d
entu
res
D
entu
res,
pro
sth
od
on
tics
, an
d in
lays
P
erio
do
nta
l mai
nte
nac
e (p
erio
do
nta
l cl
ean
ing)
an
d g
um
tre
atm
ent
E
nd
od
on
tic
pro
ced
ure
s (r
oo
t ca
nal
s, e
tc.)
Aft
er a
$50
cal
end
ar y
ear
ded
uct
ible
per
p
erso
n, r
eim
bu
sem
ent
is
5
0% o
f M
AC
1
6
5% o
f M
AC
1 fo
r p
erio
do
nti
c o
r gu
m
trea
tmen
t
65%
of
MA
C1
for
end
od
on
tic
pro
ced
ure
s
Aft
er a
$75
cal
end
ar y
ear
ded
uct
ible
per
p
erso
n, r
eim
bu
sem
ent
is
5
0% o
f U
&C
2
6
0% o
f U
&C
2 fo
r p
erio
do
nti
c o
r gu
m
tret
men
t
65%
of
U&
C2
for
end
od
on
tic
pro
ced
ure
s
Aft
er a
co
mb
ined
bas
ic a
nd
maj
or
ann
ual
d
edu
ctib
le o
f $5
0 p
er p
erso
n, t
he
pla
n p
ays
a p
red
eter
min
ed fi
xed
am
ou
nt
bas
ed o
n
pro
ced
ure
rec
eive
d.
Ort
ho
do
nti
a:
All
thre
e p
lan
s co
ver
ort
ho
do
nti
a o
nly
if
tre
atm
ent
beg
ins
afte
r th
e p
arti
cip
ant
bec
om
es c
ove
red
by
a D
uke
Den
tal P
lan
.
No
ded
uct
ible
50%
of
MA
C1
$1,0
00 li
feti
me
ort
ho
do
nti
a m
axim
um
b
enefi
t p
er p
erso
n (
adu
lts
and
ch
ildre
n)
No
ded
uct
ible
50%
of
U&
C2
$1,0
00 li
feti
me
ort
ho
do
nti
a m
axim
um
b
enefi
t p
er p
erso
n (
adu
lts
and
ch
ildre
n)
No
ded
uct
ible
50%
of
U&
C2
$750
life
tim
e o
rth
od
on
tia
max
imu
m
ben
efit
per
per
son
(ad
ult
s an
d c
hild
ren
)
18
Your Vision Care OptionWhile Duke’s medical plans provide coverage for annual eye exams, Duke also offers a nationwide vision care plan to manage the cost of eyeglasses and contact lenses, as well as eye examinations. You do not need to be enrolled in any of Duke’s medical plans to participate in the vision plan.
Vision Plan Coverage though UnitedHealthcare VisionThe vision care plan provides coverage for prescription lenses and frames, contact lenses (in lieu of eyeglasses), and a complete annual eye exam for a low monthly premium.
Under the plan, you can visit an optometrist or ophthalmologist within the UnitedHealthcare Vision network or you may choose to visit an out-of-network provider, which may result in higher out-of-pocket costs. If you visit an out-of-network provider, you must submit a claim to be reimbursed.
The vision plan covers:
One vision exam every 12 months ($30 co-pay in network)
Eyeglass lenses or contacts once every 12 months ($20 materials co-pay)
Frames once every 24 months (covered in full up to $150 allowance)
Further details about the vision plan are available online at hr.duke.edu/enrollment2017/vision.
If you have questions about the vision care plan or would like to find a network provider, you may call (800) 638-3120 or visit hr.duke.edu/providers.
Note: The Duke Eye Center is not a participating member of the UnitedHealthcare Vision network for eye exams. However, your Duke medical plan provides coverage for an annual eye exam at the Duke Eye Center and you are able to use the vision plan with out-of-network providers. Additionally, the Eye Care Associates store at the Duke Eye Center accepts the vision plan insurance coverage for the purchase of frames and lenses.
Below is an at-a-glance comparison of how your out-of-pocket expenses may vary depending on whether you have vision care coverage.
ServicesFor a person purchasing
with Duke’s Vision Insurance at a network provider
For a person purchasing at a retail chain with no insurance
Comprehensive eye exam with refraction $30 $136
Material co-pay $20 $0
Designer frames $0 $150
Progressive bifocal lens with anti-reflective coating $0 $545
Transition tinting to darken lenses in sunlight $0 $30
Annual Premium ($115) for individual $115 $0
TOTAL ANNUAL OUT-OF-POCKET EXPENSE $165 $861
Eyeing the Costs
Source: UnitedHealthcare
19
Health Care Reimbursement AccountDuke faculty and staff can protect up to $2,550 of their salary from taxes by signing up for a Health Care Reimbursement Account during open enrollment. This account allows you to set aside money to pay for eligible health expenses such as co-pays, deductibles, and medical supplies. You will be provided with a WageWorks health care card you can use to draw money from the account at the point of sale.
Money set aside in a Health Care Reimbursement Account is not subject to federal or state taxes. That means a reimbursement account can save you about $30-40 on every $100 you spend on eligible expenses. The maximum allowable contribution for a Health Care Reimbursement Account is $2,550.
Up to $500 of your unused Health Care Reimbursement Account balance can be carried over to the next plan year. Any amount above $500 remaining in your account after December 31 will be forfeited unless claims are submitted by April 15, 2018 for eligible expenses incurred January 1–December 31, 2017. The carryover only applies to the Health Care Reimbursement Account.
Can a Health Care Reimbursement Account Save Me Money?If your answer to any of the following questions is “yes,” then you should consider participating in a Health Care Reimbursement Account.
Do you expect to have medical, dental, or vision expenses that are not covered by your insurance plans, such as deductibles, co-pays, co-insurance, or amounts in excess of usual and customary (U&C) limits?
Do you expect to have prescription drug expenses not covered by insurance, such as deductibles or co-pays?
Do you plan to buy new eyeglasses or contacts, have your hearing tested, or expect orthodontia expenses that are not covered by insurance? (If you have questions about reimbursement account orthodontia expense guidelines, please call WageWorks at (877) 924-3967 for more information.)
Use the worksheet below or the WageWorks calculator at wageworks.com/myfsa to help you decide how much to contribute up to the $2,550 annual limit.
Estimated Expenses for 2017
Health and dental care deductibles $
Co-pays or co-insurance amounts for doctor visits $
Prescription drug co-pays and deductibles (OTC medications are not eligible for reimbursement unless prescribed by a physician.)
$
Dental costs in excess of the plan’s reimbursement amount/schedule $
Orthodontia costs not reimbursed by a dental plan $
Vision care expenses such as eye exams, eyeglasses, contact lenses and supplies (e.g., lens solution), and laser eye surgery not covered by insurance
$
Items not paid or only partially paid by your health, dental, and vision care plans: $
Hearing exams, hearing aids $
Expenses above your health care plan or dental plan limits (health care and dental expenses above usual, customary, and reasonable –UCR– limits)
$
Other health care costs allowed by the IRS that aren’t reimbursed by your health care, dental, or vision plans
$
Total Estimated Expenses for January 1 – December 31, 2017. Note: You can carry over up to $500 of unused funds into the next plan year for the Health Care Reimbursement Account only.
$
Please note: Insurance premiums are not eligible expenses under a reimbursement account plan.
20
Health Care Reimbursement AccountHow much can I contribute? The maximum contribution you can make to your Health Care Reimbursement Account in 2017 is $2,550. The minimum contribution is $130. Your contributions will be deducted pre-tax from your pay. However, if you enroll in the Duke Basic medical plan, the contribution made by Duke, which is described on page 8, is not included in this limit.
Up to $500 of your unused Health Care Reimbursement Account balance can be carried over to the next plan year. Any amount above $500 remaining in your account after December 30 will be forfeited unless claims are submitted by April 15, 2018 for eligible expenses incurred January 1–December 31, 2017. The carryover only applies to the Health Care Reimbursement Account.
Whose health care expenses can I pay for?Any dependent you claim on your federal income tax return is a dependent under the Health Care Reimbursement Account. Expenses for unmarried partners are not eligible for reimbursement, according to federal tax law unless he/she meets federal dependent eligibility criteria.
What can I pay for with a Health Care Reimbursement Account?In the box below are some examples of out-of-pocket expenses eligible or not eligible for reimbursement from the Health Care Reimbursement Account. To view a full list, contact WageWorks at (877) 924-3967, or refer to Internal Revenue Service (IRS) Publication 502, available by calling (800) TAX-FORM or by accessing the IRS website at irs.gov.
Acupuncture
Alcoholism treatment
Ambulance fees
Car controls for the disabled
Chiropractor fees
Contact lenses and cleaning solutions
Co-pays, deductibles, and co-insurance not covered by
insurance
Eyeglasses
Guide dogs
Hearing aids
Lab fees
Lamaze classes for expectant mothers
Orthodontia expenses
Oxygen
Prescription medications*
Smoking cessation program fees and prescription drugs
Varicose vein treatment
Wheelchairs
X-rays
Babysitting & child care
Calcium supplements
Cancelled appointment fees
COBRA premiums
Cosmetic surgery procedures
Electrolysis
Exercise equipment (unless physician certified as part of treatment program)
Fitness programs
Hair transplant
Herbs & herbal medicines
Insurance premiums
Over the counter medications* (unless prescribed by physician)
Personal trainer
Student health premiums
Tattoo removal
Teeth whitening/bleaching
Toiletries
Vitamins (unless prescribed by physician)
Weight loss programs and/or drugs (unless prescribed by physician)
Expenses eligible for reimbursement Expenses NOT eligible for reimbursement (per IRS)
* Reimbursement for over-the-counter medications is not allowed unless the medications are prescribed by a physician. Reimbursement requests for prescribed over-the-counter medications must be processed using a paper claim form or via your personal WageWorks online account, accompanied by the physician prescription and a copy of the receipt.
21
Dependent Care Reimbursement AccountCan a Dependent Care Reimbursement Account Save Me Money? If your answer to any of these questions is “yes,” then you should consider participating in a Dependent Care Reimbursement Account:
Do you spend money on day care for your children up to age 13?
Do you have children up to age 13 enrolled in a before- or after-school program, summer day camp, or intersession day camp while you work?
Do you spend money on adult day care for an elderly parent who lives with you and whom you claim as a dependent for income tax purposes?
Who is considered a dependent? Children up to their 13th birthday.
Any other individuals you claim as dependents on your federal income tax return, regardless of age, who live with you and are incapable of caring for themselves.
Use the Dependent Care Reimbursement Account Worksheet below or the WageWorks calculator at wageworks.com/mydcfsa to help you decide how much to contribute.
Estimated Expenses for 2017
Dependent child care for children up to their 13th birthday, such as aqualified day care center, nursery school tuition, or a baby-sitter inside or outside your home
$
Dependent adult care during working hours for adult dependents who live with you and who rely primarily upon you for support
$
Before-school and after-school day care programs for your child up to his or her 13th birthday
$
Intersession camp for your child up to his or her 13th birthday $
Summer day camp for your child up to his or her 13th birthday $
FICA and other taxes you pay for day care providers $
Total Estimated Expenses for January 1 – December 31, 2017. Note: Any money left in your Dependent Care Reimbursement Account after December 31, 2017 will be forfeited unless claims are submitted by April 15, 2018.
$
22
Dependent Care Reimbursement AccountHow much can I contribute? The maximum contribution to your Dependent Care Reimbursement Account is $5,000. The
minimum contribution is $130.
If both you and your spouse have Dependent Care Reimbursement Accounts, your total combined contribution limit is $5,000.
Your total contribution cannot be greater than your earned income or your spouse’s earned income, whichever is lower.
If your spouse has no earned income, you are not eligible for a Dependent Care Reimbursement Account. However, there are special rules if your spouse is a full-time student or is disabled. Contact WageWorks at (877) 924-3967 for more information.
If you are single with an eligible dependent, you can contribute up to the full $5,000.
If you receive a subsidy from a Duke-contracted child care facility such as the Duke Children’s Campus or The Little School at Duke, the amount that you can contribute to the Dependent Care Reimbursement Account is reduced dollar-for-dollar. Call (919) 684-5600 for more information.
According to federal law, any money left in your Dependent Care Reimbursement Account at the close of the 2017 plan year will be forfeited, unless claims are filed by April 15, 2018. Review your dependent care bills carefully from 2016 before deciding how much to contribute to a reimbursement account. Then estimate your expenses for the remainder of the calendar year. You may submit your claims for expense reimbursement for dependent care services received during the plan year (January 1–December 31, 2017), until April 15, 2018. You will forfeit any money left unclaimed in your Dependent Care Reimbursement Account after April 15, 2018.
What can I pay for with the Dependent Care Reimbursement Account?In the box below are some examples of out-of-pocket expenses eligible or not eligible for reimbursement from the Dependent Care Reimbursement Account. This is not a complete list. To check if an expense not listed is eligible, contact WageWorks at (877) 924-3967 or refer to IRS Publication 503, available by calling (800) TAX-FORM (829-3676) or by accessing the IRS website at irs.gov.
Day care or preschool for your child up to his or her
13th birthday
Day camp for your child up to his or her 13th birthday
Intersession camp for your child up to his or her 13th
birthday
Before-school and after-school day care programs
for your child up to his or her 13th birthday
Babysitting services (during your working hours)
for your child up to his or her 13th birthday
Household services for the care of an eligible elderly
or disabled dependent who lives with you
Expenses at an adult day care facility for an eligible
elderly or disabled dependent who lives with you
Babysitting by someone who is your tax dependent
Custodial elder care (not work-related)
Day nursing care
Educational, learning or study skills services
Household services
Sleep-away camp
School tuition (kindergarten and up)
Expenses eligible for reimbursement from a Dependent Care Reimbursement Account
Expenses NOT eligible for reimbursement from a Dependent Care Reimbursement Account (per IRS)
23
GlossaryBelow are definitions of some terms that are used in this guide:
Co-insurance: when you pay a percentage of medical charges instead of a fixed amount.
Co-pay: when you pay a fixed dollar amount for a medical service.
Deductible: the amount you pay each year toward certain covered expenses before your plan starts paying benefits.
Formulary: a preferred list of commonly prescribed medications that are selected based on their clinical effectiveness and opportunity to help contain costs within a prescription drug program. Non-formulary drugs are any drugs not found on this list.
Health Maintenance Organization (HMO): a type of health plan that consists of a network of doctors, hospitals, and other health care providers. This type of plan will not pay for an out-of-network provider except in emergency situations. Unlike traditional HMOs, with Duke Select, Duke Basic, and Blue Care, you do not need a referral from your Primary Care Physician (PCP) to see a network specialist.
Maintenance Medications: medications that a provider has prescribed for regular (e.g., daily) use. These include (but are not limited to) heart/ulcer/blood pressure medication, hormone therapy, and birth control pills.
Network: a group of doctors, hospitals, and other providers that have contracted with an HMO or PPO and have agreed to accept a lower percentage of usual, customary, and reasonable (UCR) rates.
Out-of-Pocket Expense: the amount you pay toward a medical, dental or vision service that isn’t reimbursed by your insurance plan.
Preferred Provider Organization (PPO): a type of health plan that consists of a network of doctors, hospitals, and other health care providers. You may visit doctors outside of this network for most services. If you use an in-network provider, you will be responsible for a lower portion of the bill than you would if you used an out-of-network provider.
Primary Care Physician (PCP): a health care provider (such as a nurse practitioner, physician, or physician assistant) who belongs to a network and who provides primary medical care in internal medicine, pediatrics, family practice, and/or general practice.
Specialty Medications: medications used to help manage complex and chronic health conditions such as anemia, cancer, rheumatoid arthritis, multiple sclerosis, and cystic fibrosis as well as other conditions. These medications usually have specialized ingredients and often need to be stored and/or handled in distinct ways. Beginning January 1, 2017, these are not covered if purchased through a retail pharmacy unless it is a “STAT” medication. See the HR website for a link to ESI listing of Specialty Medications.
Usual and Customary: This refers to the standard or most common charge for a specific medical, dental or vision service when rendered in a particular geographic area.
24
Selected Contacts
Duke Open Enrollment Service Center Customer Service Representatives available weekdays from 8 a.m.– 6 p.m. October 24 – November 410 a.m.– 3 p.m., Saturday, October 29hr.duke.edu/selfservice(919) 684-5600
Ameritas (dental)ameritasgroup.com/duketoll-free (800) 487-5553
WageWorks (reimbursement accounts)hr.duke.edu/reimbursementtoll-free (877) 924-3967
Duke Select HMO and Duke Basic HMOaetna.comtoll-free (800) 385-3636
Duke Well dukewell.org(919) 660-WELL (9355)
Blue Care HMO and Duke Options PPObcbsnc.comtoll-free (877) 224-3305
Express Scripts (pharmacy manager)express-scripts.comtoll-free (800) 717-6575
Cigna Behavioral Health cignabehavioral.comtoll-free (888) 253-8552
UnitedHealthcare Vision myuhcvision.comtoll-free (800) 638-3120
25
1 Log on to the
Duke@Work website at hr.duke.edu/selfservice.
Click on “Benefits Open Enrollment for 2017.”
When prompted, enter you Duke NetID (located on your “My Info” fact sheet) and your NetID password.
How to Enroll Using the Duke@Work Web SiteTake a quick tour of the website at hr.duke.edu/enrollment2017.
Note: If you are unable to log on to the Duke@Work website for any reason, contact the Duke Open Enrollment Service Center at (919) 684-5600 during the following times to speak with a customer service representative:
• 8 a.m. – 6 p.m. from October 24 – November 4
• 10 a.m. – 3 p.m., Saturday, October 29
Open enrollment ends at 6 p.m. on Friday, November 4.
]
2 Accept terms
and conditions.
3 Complete the step-by-step enrollment process.
