Medical Insurance
ChoicePlus PPO & Core Network PPO (Low Deductible)
PROVIDER: UMR (A United Healthcare Choice PPO Network)
Contact Information:
www.umr.com
MEMBER SERVICES: + 1.866.799.2728
PRIOR AUTHORIZATION: + 1.866.494.4502
Most offerings are the same between the ChoicePlus PPO and the Core Network PPO. The differences are the network of doctors, deductible amounts, out of pocket max and office visit co-pays. To see if your doctor is in network visit UMR.COM
- One of the nation’s largest provider networks
- Integrated Nurse line and Maternity Management program
- Coordinated with the Rx plan through OptumRx
- TELADOC Featured Service
- MANAGEMENT program: Featured Service
- DISEASE MANAGEMENT program: Featured Service
- WEIGHT LOSS program Real Appeal Featured Service
- Emergency Room Visits $150 plus 20% Co-Pay
- 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
- Premiums are a pre-tax deduction
- In-Network eligible expenses are covered at 80%; Out-of-Network eligible expenses are covered at 60%
- Copays: $20 Teladoc
- Copays: $150 ER (True Emergency)/$350 ER (Non-Emergency)
- High Tech Radiology procedures require pre-authorization
- ONLINE: www.umr.com
- MEMBER SERVICES: 1.800.826.9781
- PRIOR AUTHORIZATION: 1.866.494.4502
- GROUP NUMBER: 76-411376
- Mobile App available
Cost is shared between Employee and Duke Manufacturing
ChoicePlus HDHP & Core HDHP (High Deductible)
Provider: UMR (A United Healthcare Choice PPO Network)
Contact Information:
www.umr.com
MEMBER SERVICES: + 1.866.799.2728
PRIOR AUTHORIZATION: + 1.866.494.4502
- One of the nation’s largest provider networks
- Integrated, Nurse line and Maternity Management program
- TELADOC Featured Service
- WEIGHT LOSS program: Real Appeal Featured Service
- 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
- Deductibles and out-of-pocket costs are higher, but premiums are lower, out-of-pocket maximum is higher
- High Tech Radiology procedures require pre-authorization
- After deductible is satisfied, In-Network eligible expenses are covered at 80%; Out-of-Network eligible expenses are covered at 60% until out-of-pocket max is met;
- Copays: none*—negotiated rates are applied and then employee pays cost (*Preventive care is still covered at 100%)
- Coordinates with a Health Savings Account
- ONLINE: www.umr.com
- MEMBER SERVICES: 1.800.826.9781
- PRIOR AUTHORIZATION: 1.866.494.4502
- GROUP NUMBER: 76-411376
- Mobile App available
- If interested in the HDHP, please get additional information from HR
Cost is shared between Employee and Duke Manufacturing (included in Medical insurance costs)
Special note: Participants in the HDHP may want to consider the Voya supplemental insurance (see supplemental benefits page)
Helpful Videos
How to order or fax a medical card
Where to get care (Urgent Care,
Emergency, Family Doctor)
Wellness/Weight Loss Program
With no cost to Team members with Duke medical insurance. Click here to visit Real Appeal!
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.
