Prescription Insurance
ChoicePlus PPO & Core Network PPO (Low Deductible)
PROVIDER: Optum Rx
Contact Information:
www.optum.com
+ 1.877.559.2955
- Coordinated with the medical insurance (same ID card)
- Employees become eligible the first day of the month after 30 days of employment
- Full time employees working an average of 30 hours per week or more (or on Shared Work program)
- Dependent children through the last day of the month of their 26th birthday
- Spouses who are NOT offered benefits through their employer
- Limited quantity and/or pre-authorization required on certain controlled drugs
- Restricted Generics – if employee chooses not to use generic medication (when available) they pay the cost difference between generic and brand
- Step Therapy is required for new prescriptions where appropriate
- For maintenance medication, employees are automatically enrolled in the mail order pharmacy, if employees do not wish to participate; they must opt out of the mail order program. If opting out you must refill retail Rx monthly (no 90 day supply) at full copay
- Mail order service will reset! You will have the option to enroll in mail order service. Should you choose to use a retail pharmacy instead, you will need to opt out again
| GENERIC | BRAND | PREMIUM | SPECIALTY | |
|---|---|---|---|---|
| Retail (30 Day Supply) | $10.00 | $35.00 | $60.00 | 20% Coinsurance ($80 max) |
| Mail Order (90 Day Supply) | $20.00 | $70.00 | $120.00 | 20% Coinsurance ($160 max) |
- ONLINE: www.optum.co
- MEMBER SERVICES: 1.877.559.2955
- RX BIN: 610127
- RX PCN: 01960000
- RXGRP: 01961320
Cost is shared between Employee and Duke Manufacturing (included in Medical insurance costs)
ChoicePlus HDHP & Core HDHP (High Deductible)
PROVIDER: Optum Rx
Contact Information:
www.optum.com
+ 1.877.559.2955
- Coordinated with the medical insurance (same ID card)
- Employees become eligible the first day of the month after 30 days of employment
- Full time employees working an average of 30 hours per week or more (or on Shared Work program)
- Dependent children through the last day of the month of their 26th birthday
- Spouses who are NOT offered benefits through their employer
- Limited quantity and/or pre-authorization required on certain controlled drugs
- Restricted Generics – if employee chooses not to use generic medication (when available) they pay the cost difference between generic and brand
- Step Therapy is required for new prescriptions where appropriate
- For maintenance medication, employees are automatically enrolled in the mail order pharmacy, if employees do not wish to participate; they must opt out of the mail order program. If opting out you must refill retail Rx monthly (no 90 day supply) at full copay
- Mail order service will reset! You will have the option to enroll in mail order service. Should you choose to use a retail pharmacy instead, you will need to opt out again
| GENERIC | BRAND | PREMIUM | |
|---|---|---|---|
| Retail (30 Day Supply) | $10.00 | Deductible & Coinsurance | Deductible & Coinsurance |
| Mail Order (90 Day Supply) | $20.00 | Deductible & Coinsurance | Deductible & Coinsurance |
| *see preventive prescription listing for further information | |||
- ONLINE: www.umr.com
- MEMBER SERVICES: 1.877.559.2955
- RX BIN: 610127
- RX PCN: 01960000
- RXGRP: 01961320
Cost is shared between Employee and Duke Manufacturing (included in Medical insurance costs)
Helpful Videos
What is the automatic refill program?
Optum Online Tools
What is Home Delivery?
Compare ChoicePlus And Core Network To HDHP
| ChoicePlus PPO | Core Network PPO | ChoicePlus HDHP & Core HDHP |
|---|---|---|
| DEDUCTIBLE | ||
| $1,500 In-Network (individual) | $1,000 In-Network (individual) | $2,000 In-Network (individual) |
| $3,000 Out of Network (individual) | $2,000 Out of Network (individual) | $4,000 Out of Network (individual) |
| $3,000 In-Network (family) | $2,000 In-Network (family) | $4,000 In-Network (family) |
| $6,000 Out of Network (family) | $4,000 Out of Network (family) | $8,000 Out of Network (family) |
| PARTICIPATION/ COVERAGE | ||
| 80% coverage In-Network | After deductible is met, same as PPO | |
| 60% coverage Out of Network | ||
| CO-PAY | ||
| $30 for Routine Provider | $25 for Routine Provider | Pay full negotiated rate until |
| $50 for Specialist | $40 for Specialist | Deductible, then pay Coinsurance |
| OUT OF POCKET MAXIMUM | ||
| Medical & Rx combined in One Out Of Pocket Maximum | Same as PPO, except there are only copays for preventive Rx | |
| PPO CoPays included | ||
| OUT OF POCKET DOLLAR LIMITS | ||
| $4,250 In-Network (individual) | $3,750 In-Network (individual) | $6,000 In-Network (individual) |
| $8,500 Out of Network (individual) | $7,500 Out of Network (individual) | $12,000 Out of Network (individual) |
| $8,500 In-Network (family) | $7,500 In-Network (family) | $12,000 In-Network (family) |
| $17,000 Out of Network (family) | $15,000 Out of Network (family) | $24,000 Out of Network (family) |
| PRESCRIPTIONS | ||
| PREVENTIVE | ||
| Same rates as below | ACA Approved: $0 Retail: $10.00 Mail: $20.00 |
|
| GENERIC | All non-preventive are subject to Deductible & Coinsurance | |
| Retail: $10.00/ Mail: $20.00 | ||
| BRAND | ||
| Retail: $35.00/ Mail: $70.00 | ||
| PREMIUM | ||
| Retail: $60.00/ Mail: $120.00 | ||
| SPECIALTY | ||
| Retail: 20% coinsurance ($80 Max)/ Mail: 20% coinsurance ($160 Max) | ||
| MEDICAL SPENDING ACCOUNTS | ||
|
Flexible Spending (FSA) Only/Pre-tax Maximum based on IRS guidelines Use it or lose it rule |
Health Savings (HSA) Only/Pre-tax $4,150 individual/$8,300 family max. Unused funds roll over Duke Contributes You own account |
|
2024 Bi-Weekly Deductions
| CHOICEPLUS PPO NETWORK—MEDICAL + RX | ||
|---|---|---|
| NON-TOBACCO USER | DIFFERENCE FROM 2023 | |
| Employee Only | $84.86 | $5.66 |
| Employee + Spouse | $202.29 | $13.50 |
| Employee + Child(ren) | $166.96 | $11.14 |
| Family | $261.70 | $17.46 |
| TOBACCO USER* | DIFFERENCE FROM 2023 | |
| Employee Only | $200.25 | $5.66 |
| Employee + Spouse | $317.68 | $13.50 |
| Employee + Child(ren) | $282.35 | $11.14 |
| Family | $377.08 | $17.46 |
| CHOICEPLUS HDHP—MEDICAL + RX | ||
|---|---|---|
| NON-TOBACCO USER | DIFFERENCE FROM 2023 | |
| Employee Only | $44.56 | $0.00 |
| Employee + Spouse | $107.04 | $0.00 |
| Employee + Child(ren) | $89.04 | $0.00 |
| Family | $138.12 | $0.00 |
| TOBACCO USER* | DIFFERENCE FROM 2023 | |
| Employee Only | $136.86 | $0.00 |
| Employee + Spouse | $199.35 | $0.00 |
| Employee + Child(ren) | $181.34 | $0.00 |
| Family | $230.43 | $0.00 |
| CORE PPO NETWORK—MEDICAL + RX | ||
|---|---|---|
| NON-TOBACCO USER | DIFFERENCE FROM 2023 | |
| Employee Only | $64.45 | $3.45 |
| Employee + Spouse | $155.23 | $8.30 |
| Employee + Child(ren) | $130.01 | $6.95 |
| Family | $200.35 | $10.71 |
| TOBACCO USER* | DIFFERENCE FROM 2023 | |
| Employee Only | $179.83 | $3.45 |
| Employee + Spouse | $270.62 | $8.30 |
| Employee + Child(ren) | $245.40 | $6.95 |
| Family | $315.73 | $10.71 |
| CORE HDHP NETWORK—MEDICAL + RX | ||
|---|---|---|
| NON-TOBACCO USER | DIFFERENCE FROM 2023 | |
| Employee Only | $36.40 | $0.00 |
| Employee + Spouse | $83.17 | $0.00 |
| Employee + Child(ren) | $71.22 | $0.00 |
| Family | $105.81 | $0.00 |
| TOBACCO USER* | DIFFERENCE FROM 2023 | |
| Employee Only | $128.71 | $0.00 |
| Employee + Spouse | $175.48 | $0.00 |
| Employee + Child(ren) | $163.53 | $0.00 |
| Family | $198.12 | $0.00 |
*Pursuant to Duke’s policy, all tobacco users (defined as anyone that has smoked a cigarette, cigar or used smokeless tobacco or utilized the ‘e-cigarette’ in the last six months) will be required to pay an additional premium amount. This surcharge is being assessed to offset the cost of increased expenses due to tobacco use-related illnesses.
