1. Duke University & Health System
Oct. 28 – Nov. 8, 2013
Open Enrollment for
2014 Benefits
2. 2
Current Status
• Covered Lives: 62,300
• Cost:
– Total: $246 million
– Net: Duke paid $172 million (minus employee
premiums)
• Experience: Costs lower than national average
– Favorable contract with Duke providers
– DukeWell: disease management
– Rx utilization: generic and mail order
4. 4
Duke’s medical insurance plans
•Duke offers 4 plans:
–Duke Basic (HMO with Triangle network primarily of
Duke physicians)
–Duke Select (HMO with Triangle network primarily of
Duke physicians)
–Blue Care (BCBS HMO with statewide network)
–Duke Options (PPO plan with international network)
New: Cigna Medical Benefits Abroad provides employer paid
coverage for international business travel of less than
6 months for full-time benefits eligible employees
5. 5
Duke’s medical insurance plans
• Five tiers of coverage
–Employee
–Employee Spouse/Same-Sex Partner
–Employee Child
–Employee Children
–Family
6. 6
Medical insurance premiums
• Premium increases will again be less than the
projected increases nationally
$563$537$123$117Duke Options
$569$543$128$122Blue Care
$425$414$72$70Duke Select
$269$262$29$28Duke Basic
2014201320142013
FamilyIndividual
8. 8
Tobacco Surcharge
• In 2014, tobacco use surcharge
will increase from $10 to $20
per month for health insurance.
• The surcharge does not apply to
dependents.
• Surcharge will be removed if
employee successfully
completes a tobacco cessation
program.
9. 9
Bariatric Surgery
• Reduction in co-pay for bariatric surgery
• Eligible patients pay $2,500 instead of $4,000
Injury to Mouth
• Coverage increased to $5,000 for traumatic injury
to teeth within 24 months of injury (previously
limited to $750) under Duke Select and Duke
Basic
Transgender Surgery
• Adding coverage for transgender surgery under
Duke Options - $50,000 lifetime limit
10. 10
Summary of Benefits and Coverage
• “Summary of Benefits and Coverage” is a
federally mandated document that will be
included again with Open Enrollment
materials.
• This document uses a federally required
template to explain health plan benefits so
consumers can compare plans from different
insurers or employers.
12. 12
Pharmacy Plan
• No increases in co-payments or
deductibles for generic, formulary or non-
formulary drugs (third consecutive year)
13. 13
13
*Participants in the Duke Basic plan have a $100 deductible for all prescription drugs, including
generic and mail order.
**The 50% co-pay will also be subject to a min. & max co-pay. Minimum $10 for generics, $55
for brand and $65 for non-formulary. $Max: $25 for generic, $125 for brand, and $135 for non-
formulary.
Retail pharmacy
Express Scripts Mailorder
or Duke pharmacy
Up to a 34-day supply Up to a 90-day supply
First 3 purchases of
any medication
After 3rd purchase of
long-term medication
Anytime
Generic (no deductible)*
$10 (or cost of drug
if less)
50%**
$20
(or cost of drug if less)
Brand ($100 per person
deductible applies. No
deductible for mail order or
participating Duke
pharmacies.)*
$40 50%** $100
Non-formulary ($100
per person deductible
applies. No deductible for
mail order or participating
Duke pharmacies.)*
$55 50%** $138
15. 15
Duke’s vision plan for 2014
Individual
Employee
& Child
Employee &
Children
Employee
&
Spouse/
Partner
Family
$9.47 $18.13 $19.08 $18.14 $29.38
• No increases in premiums or co-payments
(second consecutive year)
17. 17
Dental Premiums for 2014
• PPO Plan: No premium increases
• Dental Plan A: No premium increases
• Dental Plan B: No premium increases
$45.24$12.18$12.18Dental Plan B
$119.89$39.58$39.58Dental Plan A
2014201320142013
FamilyIndividual
$119.89
$45.24
$111.66$36.86$36.86PPO $111.66
18. 18
Dental Plan A vs. PPO Plan
Sample Cost Savings
Procedure % covered
under plan
Plan A
Your Cost
PPO Plan
Your Cost
Savings
Exam 100% $0 $0 N/A
Cleaning 100% $0 $0 N/A
Filling 80%
90%
100%
$26.40
$13.20
$0
$22.40
$11.20
$0
$4
$2
N/A
Simple
extraction
80%
90%
100%
$38.45
$25.55
12.65
$21.80
$10.90
$0
$16.65
$14.65
12.65
Root canal 65% $452.76 $309.40 $143.36
Crown 50% $736.90 $416 $320.90
19. 19
Late Entrant
• Late entrant: if you or a dependent are
planning to enroll for 2014 but are not
currently enrolled for dental coverage at Duke
– Only covers two preventive care exams (not
including X-rays), two cleanings, and one fluoride
application (for children under age 19) for the first
12 months
19
21. 21
Save with reimbursement accounts
• Pre-tax savings is about $30-$40 for every $100
of eligible expenses
• Health Care Reimbursement Account
• Dependent Care Reimbursement Account
• The maximum contribution for a health care
reimbursement account is $2,500.
• The maximum for dependent care is $5,000
22. 22
Many ways to save
• WageWorks Health
Care Card
• App for
iPhones, Androids
and Blackberries
• Website
• Paper forms
(fax/mail)
26. 26
Summary for 2014
• Modest premium increase less than national average
• No increases in deductibles or co-payments
• $10 increase in surcharge for tobacco users
• Increase to $5,000 from $750 on treatment within 24 months
of traumatic injury to teeth (Duke Select/Basic)
• Reduced co-pay for bariatric surgery
• Coverage of up to $50,000/lifetime under Duke Options for
transgender surgery
• Individual mandate for health insurance: Jan. 2014
• Required notice to all employees re: Marketplace
• Continue assessing potential changes for 2015
27. 27
Supplemental Life Enrollment
• Special Open Enrollment for Supplemental Life
Insurance from Oct. 28 to Nov. 8
– 20% premium reductions
– Simplified underwriting
– Enroll or change current coverage online or via
paper
– New rates and changes effective Jan. 1, 2014
28. 28
Open enrollment: Oct. 28 - Nov. 8
1. Enroll online
through the
Duke@Work
Self-Service
website
Or
2. By phone at
919-684-5600
hr.duke.edu/selfservice
29. 29
What’s next?
When What
Sept. 10 HR Forum
Sept. 26 Primetime Employee Forum
Sept. 30 Manager Memo/Presentation: Open enrollment
changes for 2014 benefits
Oct. 1 Article: Open enrollment for 2014 benefits
Oct. 7 Guide: Print guide mailed home.
Oct. 28 Open Enrollment Period Begins
Oct. 28 Email: Open enrollment period begins
Nov. 5 Article: Reminder about deadline
Nov. 7 Email: Reminder about deadline
Nov. 8 Open Enrollment Period Ends
But when looking at costs, you have to also consider the coverage and what you would pay if you had to use the benefit. For example, if you had to be hospitalized, your out-of-pocket costs would be significantly lower through Duke than at most of our peers.
More information about specific changes for benefits will be communicated next month as part of the annual open enrollment process.Articles and events are planned throughout the next few months to help provide context and set expectations about changes for 2011. Here are a few of the highlights of what you can expect to see.
