my BENEFITS - forms.hr.duke.edu · Duke continues to offer four medical insurance options with modest premium increases (refer to your “My Info” fact sheet included in this booklet

2019 Open Enrollment

October 22 — November 2, 2018

BENEFITSmy

2019 Plan Highlights and Changes ....................................................................3

What You Need to Know .......................................................................................4

Your Medical Plan Options ...................................................................................5

Questions to Ask ....................................................................................................6

Medical Plans Comparison Chart .......................................................................7

Mental Health and Substance Abuse Benefits ................................................11

Pharmacy Benefits .............................................................................................. 12

Health Management Programs ......................................................................... 13

Your Dental Plan Options ................................................................................... 14

Questions to Ask………………………………………………………….. .............................. 15

Dental Plans Comparison Chart ....................................................................... 16

Your Vision Plan Option ......................................................................................17

Vision Plan Chart………………………………………………………….. ............................. 18

Health Care Reimbursement Account ............................................................ 19

Dependent Care Reimbursement Account .................................................... 21

Glossary .................................................................................................................23

Contacts ................................................................................................................ 24

How to Enroll Using the Duke@Work Website ............................................. 25

Table of Contents

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 2019, 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 2018 will continue for 2019.

Duke’s medical plans are considered “grandfathered” under the Patient Protection and Affordable Care Act (the Affordable Care Act).

This enrollment guide and the Open Enrollment website at hr.duke.edu/enrollment2019 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.

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.

2

Decisions to make during open enrollmentOpen Enrollment is the one time of year when benefit eligible employees can enroll in or change their medical, dental and/or 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 2019? 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 plans and a vision plan 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 respectively. 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 2018 for your medical, dental, and vision coverage will continue for 2019. To continue to use a reimbursement account, you must re-enroll for 2019.

Deductions for insurance benefits are paid in advance and will be deducted monthly from your paycheck beginning December 2018. Deductions for reimbursement accounts will start in January 2019.

Open Enrollment representatives are available at (919) 684-5600, option #1 during the following times:

8 a.m. – 6 p.m. weekdays, October 22 – November 2

10 a.m. – 3 p.m., Saturday, October 27

2019 Open Enrollment 3

2019 Plan Highlights and ChangesMedical PlansDuke continues to offer four medical insurance options with modest premium increases (refer to your “My Info” fact sheet included in this booklet for premiums).

Under all Duke’s medical plans,

Co-payment will be waived for most contraceptive drugs (refer to hr.duke.edu/pharmacy for details).

Co-payment will be waived for IUDs, contraceptive implants, tubal ligations, and vasectomies.

Cigna Behavioral Health now allows video visits for patients seeing a participating in-network provider. The co-pay is the same as an in-person visit.

In support of the Healthy Duke initiative, coverage for breast cancer and colorectal screenings are being enhanced.

Breast Cancer Screening

Co-payment and deductible will be waived for breast cancer screenings at in-network providers under the Duke Options plan. They are already 100% covered under Duke Select, Duke Basic, and Blue Care.

Colorectal Screening

Extend 100% coverage for both diagnostic and screening colonoscopies at in-network providers under Duke Options and Blue Care plans. They are already 100% covered under Duke Select and Duke Basic.

Waive the deductible and coinsurance for Cologuard® colorectal screening, where clinically appropriate, for Duke Options plan. This screening test is already 100% covered under Duke Select, Duke Basic, and Blue Care.

Dental Plans

No change in co-pays, premiums or deductibles for the dental plans.

As a reminder, if you or a dependent are not currently enrolled for dental coverage through Duke and enroll for 2019, a “late entrant” provision will apply (refer to page 14 for more information).

Vision Plans No change in co-pays, premiums or deductibles for the vision plan.

Reimbursement Accounts Maximum annual contribution for Health Care Reimbursement Account is $2,650 (subject to IRS regulations).

Maximum annual contribution for Dependent Care Reimbursement Account is $5,000.

4

When Can I Enroll?Since your premiums for medical, dental and vision insurance and reimbursement accounts are pre-tax, federal law limits when you can change your selections 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, or 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.

We may request dependent documentation at any time. This documentation includes birth certificates, marriage certificate, and proof of joint occupancy.

Update Your Personal InformationDuring the Open Enrollment period, staff and faculty should review and update their personal data and information in the Duke@Work selfservice website. Updated contact information helps ensure that you receive benefits communications throughout the year.

Log onto Duke@Work at Work.duke.edu and click on the “My Info” tab and then the “My Profile” section to review and update your work and home addresses, phone numbers (home, work and mobile), race/ethnicity, county of residence, veteran status, disability status, and dependent information.

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 insurance*

Employee/Spouse

Family (includes Spouse)

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 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, option #1.

What You Need To Know

* 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.

**Legal guardianship obtained outside of NC must meet the NC qualifications.


Need to Find a Provider?

At hr.duke.edu/provlders, you will find:

A directory of participating health care providers, and

Mobile apps for our medical plans.

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 uses a health care provider network unique to Duke. Since this network is unique, we encourage you to carefully review the provider listing at hr.duke.edu/provlders. 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 uses a health care provider network unique to Duke. Since this network is unique, we encourage you to carefully review the provider listing at hr.duke.edu/provlders. 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 of North Carolina - Blue Cross NC) HMO – 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 7-10 for details on other coverage options. All of our medical plans will cover pre-existing conditions for covered services.

For Employees Who Travel Internationally 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 the employee’s regular health insurance plan. The coverage also includes up to seven days of personal travel when taken in conjunction with a covered business trip.

For more information, including coverage limits and eligibility requirements, visithr.duke.edu/abroad.

Tobacco Use Surcharge (Fee) Duke charges employees covered under a Duke medical insurance plan who smoke or use other forms of tobacco a monthly surcharge (fee) 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.

6

Duke Select Duke Basic Blue Care Duke Options (HMO) (HMO) BlueCrossNC BlueCrossBlueShield(PPO) (HMO) In-Network Out-of-Network

Questions to Ask: 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 that matches the needs of you and your family. 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, members in this plan receive an annual contribution to a Health Care Reimbursement Account based on the level of coverage selected:

$200 for Employee $400 for Employee/Spouse* $300 for Employee/Child $500 for Family (includes Spouse*) $400 for Employee/Children

PLEASE NOTE: Duke will not make additional contributions to the Health Care Reimbursement Account for Duke Basic participants if dependents are added during the year due to a qualifying event such as a birth or marriage. Also, if your spouse is enrolled in a Health Savings Account (HSA), please contact the HR Information Center at (919) 684-5600 before enrolling in Duke Basic.

* 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 network?

Yes Yes Yes Yes No

Will my dependent children who live in a different location be covered?

Emergency/urgent care only. No follow-up care


Yes, if within NC and in-network – otherwise, emergency care only

Yes, worldwide listing of doctors

Yes

Since I travel a lot, can I see doctors in other locations around the world?




Yes, worldwide listing of doctors

Yes

Can I participate in the DukeWell care management program and get assistance with the cost of medica-tions?

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/ urgent 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 Yes No

Do all plans cover the same services?

Special Services include: Bariatric and Infertility

No special services covered

Special Services include: Bariatric, and dependent pregnancy

Special Services include: ABA Therapy, Bariatric, Infertility, International health services, Transgender surgery, and dependent pregnancy

Special Services include: ABA Therapy, International health services, Transgender surgery, and dependent pregnancy


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Cigna Behavioral Health

In-Network Care Out-of-Network Care

Duke Select Duke Basic Blue Care Duke Options (HMO) (HMO) BlueCrossNC BlueCrossBlue (HMO) BlueShield(PPO)

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 (no visit limit applies for Duke Options)

• 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 (no day limit applies for Duke Options)

• Must be precertified prior to admission

• For Duke Options, the out-of-network deductible and co-insurance maximum will be consolidated with medical claims

2019 Mental Health and Substance Abuse BenefitsDuke 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 visit hr.duke.edu/providers.

Cigna Behavioral Health now allows video visits for patients seeing a participating in-network provider. The patient will have to download the appropriate software or app used by the provider if this type of service is desired. The copay is the same as an in-person visit.

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.

12

2019 Pharmacy BenefitsExpress Scripts, a national pharmacy benefit manager, provides pharmacy benefits for all four medical plans. Co-pays and deductibles vary depending on the type of medicine prescribed (generic, brand or non-formulary), the length of the prescriptions, and whether you purchase at a retail pharmacy, through the Express Scripts mail order pharmacy, or through participating on-site Duke Pharmacies (Duke Outpatient Pharmacy, Duke Children’s Health Center Retail Pharmacy, Campus Center Pharmacy at the Student Wellness Center, Duke Specialty Pharmacy at the Cancer Center, and Duke Raleigh Hospital Plaza Pharmacy).

Specialty medications must be purchased through Accredo®, the specialty pharmacy for Express Scripts, or Duke Specialty Pharmacy to be eligible for coverage under the plan, unless they are medications which are intended for an immediate need. See hr.duke.edu/pharmacy 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 annual deductible for all prescription drugs (except for certain contraceptive drugs) including generic and mail-order prescriptions. Duke Basic participants are required to use mail order or Duke Pharmacies for long-term medications.

Certain contraceptive drugs are covered at no cost to the member. More information is available at hr.duke.edu/pharmacy.

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

BrandAnnual $100 per person retail deductible applies. No deductible for 90-day supply through mail order or Duke Pharmacies except for Duke Basic participant

Non-formularyAnnual $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 (orcostof (orcost drugifless) Costofdrugtomax.$30 ofdrugifless)

$50 50%† $130

Min.$70,Max.$165

$70 50%† $180

Min.$85,Max.$180

† Duke Basic participants are required to use the mail order or Duke Pharmacies for long-term medications.


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, Take the Stairs, and Your Weigh... Together.

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: bluecrossnc.com Phone: (800)260-0091

Maternity Programs All of Duke’s medical plans have voluntary maternity programs focusing on providing expectant moms the tools, resources and support to stay informed every step of the way.

Duke Select and Duke Basic members: (800) 272-3531 or log onto aetna.com and select Stay Healthy

Duke Options and Blue Care members: Download the Blue Cross NC My Pregnancy App

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.

14

Your Dental Plan Options Coverage provided and underwritten by Ameritas Life Insurance CorpDuke employees scheduled to work at least 20 hours per week, can choose from three dental options, depending on the extent of coverage you and your family may need. All options cover Type 1 (preventive), Type 2 (basic), Type 3 (major) and Type 4 (periodontics/endodontics), but differ in how they pay for covered services.

The PPO plan includes a higher maximum annual benefit that Plan A and Plan B, lower negotiated procedure rates and your out of pocket costs are usually lower. However, participants in the PPO should use an in-network provider. If you select the PPO and use an out-of-network provider, the amount the plan pays will be based on discounted network charges and you will be responsible for any charged amount over that allowance. A list of network dentists is available at ameritas.com/group/olbc/duke or by calling Ameritas at 1-800-755-8844. There is also a direct link to the Dental Plan on the Duke Benefits page that can be used to find a network provider.

If you select Plan A, you have the freedom to visit any licensed dentist of your choice. You may also choose to use a network provider. Using a network provider will limit your out of pocket cost. Also if you utilize a network provider, the deductible is waived for all covered procedures.

Plan B provides a very basic benefit and payments are based on a fixed schedule of fees. The schedule for Plan B is available on the Ameritas website at ameritas.com/group/olbc/duke. You should review the fixed schedule before selecting this option.

How to Increase Your Annual Maximum BenefitDental plan members having had at least one covered dental service in the prior calendar year and having less than $500 in claims payments will have their annual maximum benefit increased by $250 in the following year. 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 2019If you or a dependent are not currently enrolled for dental coverage through Duke and enroll for 2019, 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 dental or orthodontia procedure or services will be covered during the first 12 months, if a member is enrolled as a late entrant.

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 an eligible dependent within 30 days of a qualifying event such as marriage or adoption.


Questions to Ask: Making Your Dental Plan Decisions

When comparing Duke’s dental plans, it is important to compare out-of-pocket expenses as well as premiums. Here are some questions to ask yourself when choosing a dental plan that matches the needs of you and your family. For specific coverage information, please refer to the Dental Plans Comparison Chart on the following page.

PPO Plan Plan A Plan B

Can I visit any dentist? No, you must use a network dentist

Yes, you may choose any licensed dentist or use a network dentist

No

Am I required to use a network dentist?

Yes No No

If I don’t enroll within 30 days after my date of hire or eligibility, and enroll in the future, will I be a “late entrant”?

Yes, please see page 14 for more details



Will my dependent children who live in a different location be covered?

Yes, may choose a dentist within a nationwide network

Yes Yes

Is there a dental deductible before the insurance will pay for covered services?

Yes, an annual $50 deductible for “major” services

Yes, a $100 lifetime deductible for “basic” services and an annual$75 deductible for “major” services

Yes, a combined annual$50 deductible for “basic” and “major” services

Will I have out-of-pocket costs for preventive services?

No Yes, cost sharing may be required if dentist charges above U&C

Yes

I need an existing filling replaced. Will it be covered if I enroll in a Duke dental plan?

Yes, if the filling is at least 6 months old



Are teeth whitening services covered under dental coverage?

No No No

16

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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. You are eligible to participate in the vision plan if you are a regular employee scheduled to work at least 20 hours per week.

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/enrollment2019/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 MyEyeDr located near the Duke Eye Center is a network provider and accepts the vision plan insurance 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.

Source:UnitedHealthcare

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

Materials 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

18

Benefits In-Network Benefits Out-of-Network Reimbursement

Vision Exam (once every 12 months) $30 co-pay up to $40

Materials Co-pay1 $20 co-pay Not applicable

Frames2 (once every 24 months) Private Practice Provider Covered-in-full; $50 wholesale frame allowance up to $45 (approximate retail value of $120 - $150); receive wholesale price and $50 credit towards wholesale price 30% discount applied to frame allowance coverage5

Retail Chain Provider Covered-in-full; $150 retail frame allowance up to $45 30% discount applied to frame allowance coverage5

Eyeglass Lenses per pair (once every 12 months) Single Vision Covered-in-full up to $40 Bifocal Covered-in-full up to $60 Trifocal Covered-in-full up to $80 Lenticular Covered-in-full up to $80

Lens Options

Standard (including scratch-resistant coating, standard/ Covered-in-full Not covereddeluxe/premium/platinum progressive lenses, polycarbonate lenses, tints, UV coating, anti-reflective coating, photochromic, and Transitions®) Non-standard May be available at a discount Not covered

Contact Lenses3 – in lieu of eyeglasses (once every 12 months)

Elective Covered-in-full lenses (including but not limited to Covered-in-full (up to 6 boxes)3 including up to $150 Acuvue® by Johnson & Johnson, Optima® by evaluation, fitting, and up to two Bausch & Lomb) follow-up visits

All other elective lenses (including but not limited Up to $150 allowance towards the fitting/ up to $150 to toric, gas permeable and bifocal contact lenses) evaluation fees and lenses purchase (materials co-pay does not apply)

Medically Necessary4 Covered-in-full after applicable co-pay up to $210

2019 Vision Plan Chart

1 Materials co-pay is a single payment that applies to the purchase of eyeglass lenses and frames or contact lenses (in lieu of eyeglasses). All contact lenses must be purchased at one time.

2 Receive a $50 wholesale frame allowance at a private practice provider or a $150 retail frame allowance at a retail chain provider (a corporately-owned provider that uses their own lab and materials).

3 All 6 boxes of contact lenses must be purchased at one time in order to receive the full $150 in-network allowance. There is only one annual service authorization for this benefit.

4 Determined at the provider’s discretion for one or more of the following conditions: following post-cataract surgery without intraocular lens implant; to correct extreme vision problems that cannot be treated with spectacle lenses; with certain conditions of anisometropia; with certain conditions of keratoconus. If your provider considers your contacts necessary, you should ask your provider to contact UnitedHealthcare Vision confirming how much of a reimbursement you can expect to receive before you purchase such contacts.

5 Discount available at participating providers; verify discount on frame overage with your provider.

Note: The following services and materials are excluded from coverage under the vision care plan: post cataract lenses; non-prescription items; medical or surgical treatment for eye disease that requires the services of a physician; Workers’ Compensation services or materials; services or materials that the patient, without cost, obtains from any governmental organization or program; services or materials that are not specifically covered by the policy; replacement or repair of lenses and/or frames that have been lost or broken; and cosmetic extras, except as stated in the policy.


Health Care Reimbursement AccountDuke faculty and staff can protect up to $2,650 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 may save you an average of $30 on every $100 you spend on eligible expenses. The maximum allowable contribution for a Health Care Reimbursement Account is $2,650 (subject to IRS regulations).

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, 2019 will be forfeited unless Pay Me Back claims are submitted by April 15, 2020 for eligible expenses incurred January 1–December 31, 2019. The health care card cannot be used in 2019 for 2018 expenses. 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 or visit hr.duke.edu/benefits/reimbursement-accounts/health-care-account/orthodontia 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 $2,650 annual limit.

Estimated Expenses for 2019

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, 2019. 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

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)

Health Care Reimbursement AccountHow much can I contribute? The maximum contribution you can make to your Health Care Reimbursement Account in 2019 is $2,650 (subject to IRS regulations). 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 6, 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 31, 2019 will be forfeited unless claims are submitted by April 15, 2020 for eligible expenses incurred January 1–December 31, 2019. 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 review a full list, contact WageWorks at (877) 924-3967, or visit wageworks.com/employees/support-center/healthcare-fsa-eligible-expenses-table/, or refer to Internal Revenue Service (IRS) Publication 502, available by calling (800) TAX-FORM or by accessing the IRS website at irs.gov.

* 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 or online claim form, accompanied by the physician prescription and a copy of the receipt.

When calling WageWorks, you will be prompted to provide the last four digits of your social security number or employee ID. You must provide the last four digits of your Duke Unique ID number instead. Your Duke Unique ID is located on the back of your ID badge.


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 2019

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, 2019. Note: Any money left in your Dependent Care Reimbursement Account after December 31, 2019 will be forfeited unless claims are submitted by April 15, 2020 for eligible expenses incurred Jan 1 - Dec 31, 2019.

$

22

How 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 2019 plan year will be forfeited, unless claims are filed by April 15, 2020. Review your dependent care bills carefully from 2018 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, 2019), until April 15, 2020.You will forfeit any money left unclaimed in your Dependent Care Reimbursement Account after April 15, 2020.

The Dependent Care Reimbursement Account Plan is required to complete annual testing to ensure compliance with Internal Revenue Code regulations. One test examines the participation rates in the plan by income levels. If participation rates are not in accordance with the regulations, your contribution amount may be adjusted. The Duke Benefits Office will contact you to provide notice in advance of any adjustment.

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 Customer Service at (877) 924-3967 or wageworks.com/employees/support-center/dcfsa-eligible-expenses-table/,

IRS website at irs.gov, or

Refer to IRS Publication 503 available by calling (800) TAX-FORM (829-3676)

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)

Dependent Care Reimbursement Account


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-payment: 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.

Maximum Allowable Charges (MAC): the maximum dollar amount that the insurance company will reimburse a provider for a specific service.

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. See the HR website for a link to Express Scripts’ listing of Specialty Medications.

Spouse: Legally married spouse. In addition, it refers to an employee’s registered same-sex spousal equivalent providing the employee was hired prior to January 1, 2016 and registered their partner as their same-sex spousal equivalent in Duke HR prior to January 1, 2016. This employee’s registered partner is grandfathered under Duke’s Same-Sex Spousal Equivalent Policy (providing the employee’s continuous service date is prior to January 1, 2016) and is included in the meaning of “spouse” for the purposes of this benefit program as permissible under federal and state law. The grandfather status covers only this same-sex partner and continues for the course of this pre-January 1, 2016 registered relationship only.

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

hr.duke.edu/enrollment2019

or

hr.duke.edu/selfservice

Open Enrollment Representatives are available at (919) 684-5600, option #1

8 a.m.– 6 p.m., October 22 – November 2

10 a.m. – 3 p.m., Saturday, October 27

Ameritas (dental)

ameritas.com/group/olbc/duke

Toll-free (800) 487-5553

WageWorks (reimbursement accounts)

hr.duke.edu/reimbursement

Toll-free (877) 924-3967

Duke Select HMO and Duke Basic HMO

aetna.com

Toll-free (800) 385-3636

Duke Well

dukewell.org

(919) 660-WELL (9355)

Blue Care HMO and Duke Options PPO

bluecrossnc.com

Toll-free (877) 275-9787

Express Scripts (pharmacy manager)

express-scripts.com

Toll-free (800) 717-6575

Cigna Behavioral Health

hr.duke.edu/mentalhealth

Toll-free (888) 253-8552

UnitedHealthcare Vision

myuhcvision.com

Toll-free (800) 638-3120

Need to Find a Provider?Directories of participating medical, dental, and vision providers are available at hr.duke.edu/providers.

25

1 Log on to the

Duke@Work website at hr.duke.edu/selfservice.

Click on “Benefits Open Enrollment for 2019.”

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/enrollment2019.

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, option 1, during the following times to speak with a customer service representative:

• 8 a.m. – 6 p.m. from October 22 – November 2

• 10 a.m. – 3 p.m. Saturday, October 27

Open enrollment ends at 6 p.m. on Friday, November 2.

]

2 Accept terms

and conditions.

3 Complete the step-by-step enrollment process.

Documents

my BENEFITS - forms.hr.duke.edu · Duke continues to offer four medical insurance options with modest premium increases (refer to your “My Info” fact sheet included in this booklet