Duke University & Health System

Oct. 24 – Nov. 4, 2016

Open Enrollment for 2017 Benefits

2

Duke’s medical insurance plansDuke 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)

3

Duke’s medical insurance plansFive tiers of coverage

– Employee

– Employee & Spouse

– Employee & Child

– Employee & Children

– Family

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 Basic2017201620172016 

FamilyIndividual

5

What if you had to be hospitalized

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

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

8

PHARMACY PLAN Open Enrollment for 2017

9

Pharmacy Usage Trends

Each 1% increase in Generic Dispensing Rate = reduces plan costs $1m

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 pharmacyExpress Scripts Mail order or on-site 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)* $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

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

12

VISION PLANOpen Enrollment for 2017

13

Duke’s vision plan for 2017

Individual Employee & Child

Employee & Children

Employee &

SpouseFamily

$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

14

DENTAL PLANOpen Enrollment for 2017

15

Dental Premiums for 2017• PPO Plan: Modest increase in premium• Dental Plan A: Modest increase in premium• Dental Plan B: No premium increase

  Individual Family2016 2017 2016 2017

PPO $38.44 $39.21 $116.46 $118.79Dental Plan A $42.11 $44.13 $127.55 $133.67Dental Plan B $12.18 $12.18 $45.24 $45.24

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

17

REIMBURSEMENT ACCOUNTSOpen Enrollment for 2017

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)

19

Managing Your Account• WageWorks Health

Care Card• App for iPhones,

Androids and Blackberries

• Website• Paper forms

(fax/mail)

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

21

Open enrollment: Oct. 24 - Nov. 41. Enroll online

through the Duke@Work Self-Service website

Or2. By phone at

919-684-5600

22

What’s next?When WhatSep 13 HR ForumOct. 3 Manager Memo/Presentation: Open enrollment

changes for 2017 benefitsOct. 6 Guide: Print guide mailed home. Oct. 10 Article: Open enrollment for 2017 benefitsOct. 24 Open Enrollment Period BeginsOct. 24 Email: Open enrollment period beginsOct. 31 Article: Reminder about deadlineNov. 3 Email: Reminder about deadlineNov. 4 Open Enrollment Period Ends

Duke University & Health System

Questions?