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Published byJerome Waters Modified over 8 years ago
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Duke University & Health System Oct. 24 – Nov. 4, 2016 Open Enrollment for 2017 Benefits
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2 Duke’s medical insurance plans Duke offers 4 plans: – Duke Basic (HMO administered by Aetna with Triangle network primarily of Duke physicians) – Duke Select (HMO administered by Aetna with Triangle network primarily of Duke physicians) – Blue Care (BCBS HMO with statewide network) – Duke Options (BCBS PPO plan with international network)
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3 Duke’s medical insurance plans Five tiers of coverage – Employee – Employee & Spouse – Employee & Child – Employee & Children – Family
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4 Medical insurance premiums Premium increases will again be less than the projected increases nationally $648$606$141$132Duke Options $656$613$147$137Blue Care $461$445$78$75Duke Select $292$282$31$30Duke Basic 2017201620172016 FamilyIndividual
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5 What if you had to be hospitalized
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6 Medical Plan Changes Coventry is now Aetna, and new member ID cards for January Inpatient hospitalization copay increase: – From $450 to $600 for Duke Select, Blue Care, and Duke Options at Duke hospitals – Options and Blue Care copay for non-Duke In-Network hospitals will move to $700, Out-of- Network hospitals under Options will move to $900. Outpatient Surgery copay increase from $200 to $250 for Duke Select and Blue Care Out-of-Network annual deductible for Duke Options: – from $500 to $650 for individuals, and from $1,500 to $1,950 for family Duke Options Out-of-Network coinsurance maximum: – from $3,000 to $4,000 for an individual and from $9,000 to $12,000 for family Specialty Drug dispensing limited to Accredo (Express Scripts) or Duke Pharmacies unless medication is required immediately Coverage added to Duke Options for ABA Therapy (Applied Behavioral Analysis) an intensive, early intervention program for children with Autism Spectrum Disorder when medically necessary and by a certified provider. – Details on www.hr.duke.edu Dollar maximum for transgender surgery will be eliminated from Duke Options
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7 Tobacco Surcharge In 2017, tobacco use surcharge will increase from $40 to $50 per month for health insurance The surcharge does not apply to dependents Surcharge will be removed if employee successfully completes a tobacco cessation program available at no charge through Live for Life
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8 PHARMACY PLAN Open Enrollment for 2017
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9 Pharmacy Usage Trends Each 1% increase in Generic Dispensing Rate = reduces plan costs $1m
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10 *Participants in the Duke Basic plan have a $100 deductible for all prescription drugs, including generic, mail order and on- site Duke Pharmacies. Retail pharmacy Express Scripts Mail order or on-site Duke Pharmacy Up to a 34-day supplyUp to a 90-day supply First 3 purchases of any medication After 3 rd purchase of long- term medication Anytime Generic (no deductible)* $15 (or cost of drug if less) 50%* Min. $15, Max. $30 (or cost of drug if less) $25 (or cost of drug if less) Brand ($100 per person annual deductible applies. No deductible for mail order or on-site Duke pharmacies.)* $50 50%* Min. $70, Max. $165 $130 Non-formulary ($100 per person annual deductible applies. No deductible for mail order or on-site Duke pharmacies.)* $70 50%* Min. $85, Max. $180 $180
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11 Pharmacy Plan Increase in co-pays (up to 34 day supply) for: Generic from $10 to $15 for up to 34-day supply Formulary drugs by from $45 to $50 Non-formulary drugs from $65 to $70 Increases in Mail Order 90-day supply* co-pays for: Generic from $20 to $25 Brand from $120 to $130 Non-Formulary from $155 to $180 *obtained via mail order or on-site Duke Pharmacies Specialty medications available through Duke Pharmacy or Accredo only, unless STAT medication
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12 VISION PLAN Open Enrollment for 2017
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13 Duke’s vision plan for 2017 Individual Employee & Child Employee & Children Employee & Spouse Family $9.66$18.49$19.46$18.50$29.97 No changes to premiums for 2017 Increase in frame allowance from $130 to $150 once every 24 months
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14 DENTAL PLAN Open Enrollment for 2017
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15 Dental Premiums for 2017 PPO Plan: Modest increase in premium Dental Plan A: Modest increase in premium Dental Plan B: No premium increase IndividualFamily 2016201720162017 PPO$38.44$39.21$116.46$118.79 Dental Plan A$42.11$44.13$127.55$133.67 Dental Plan B$12.18 $45.24
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16 Dental Late Entrant If you or a dependent are planning to enroll for 2017 but are not currently enrolled for dental coverage at Duke – Coverage will only include two preventive care exams (not including X-rays), two cleanings, and one fluoride application (for children under age 19) for the first 12 months
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17 REIMBURSEMENT ACCOUNTS Open Enrollment for 2017
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18 Save with reimbursement accounts Pre-tax savings is about 30 percent of every dollar you put in the accounts Health Care Reimbursement Account: $2,550 maximum Health Care Reimbursement Account allows for up to $500 to be carried over from one plan year to the next plan year Dependent Care Reimbursement Account: $5,000 combined household maximum (carry over not allowed)
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19 Managing Your Account WageWorks Health Care Card App for iPhones, Androids and Blackberries Website Paper forms (fax/mail)
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20 Summary for 2017 No increase in co-pay for Primary Care Physician (PCP) or Specialist office visit Moderate premium increase for health plan, significantly less than national average Modest increase in pharmacy co-pays Increase in inpatient admission and outpatient surgery copays No premium increases to vision No premium increases to Dental Plan B, moderate increase to Dental Plan A and Dental PPO
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21 Open enrollment: Oct. 24 - Nov. 4 1.Enroll online through the Duke@Work Self-Service website Or 2.By phone at 919-684-5600
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22 What’s next?
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Duke University & Health System Questions?
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