Duke Announces New Health Plan

Duke officials this week announced a new health plan designed to provide a lower cost option for employees at a time when health care costs nationally are entering their third consecutive year of double-digit increases.

The new plan, called Duke Basic (HMO), is one of four that will be offered to Duke employees for 2004. The other plans are Duke Select (HMO), Blue Care (HMO) and Duke Options (PPO). Employees will receive personalized open enrollment packets in mid-September that include detailed information on all four plans.

Duke employees will be able to enroll or make changes in their health and dental coverage or reimbursement accounts for the coming year during the annual open enrollment period from Sept. 29 - Oct. 11.

"We've seen a lot of information in the media recently about how the rising cost of health care has forced many employers to reduce coverage or dramatically increase rates," said Lois Ann Green, director of benefits. (The Associated Press reported Sept. 8 that health care costs rose an average of 13.9 percent this year.) "At Duke, we are fortunate to be able to offer employees comprehensive coverage at a lower cost than what is available in the market or at most local and regional employers."

Green said employees should review this information closely to choose the plan that is best for them and their families.

"We know that health care coverage is one of the most important benefits to employees, and when it comes to selecting coverage, each employee's needs are different," she said. "Duke's health plans provide a wide range of choices and coverage options to help meet those diverse needs."

The new Duke Basic plan expands Duke's current offerings by adding basic health care coverage at a lower monthly premium than the other Duke plans but with higher deductibles, co-insurance and co-pays.

"The monthly premium for Duke Basic is significantly lower than Duke's other plans, but depending on the type of health care services expected during the year, one of Duke's other plans may actually be less expensive," Green said. "For example, if an employee or a family member has an existing condition that requires regular doctor visits or treatment, the cost of health care may be more expensive under Duke Basic than under one of Duke's other plans because of the higher out-of-pocket costs."

Another main feature of Duke Basic is that it rewards participants with a $100 contribution to a health care reimbursement account for taking an active role in preventive care, which is one of the best ways to improve health and reduce costs. Duke will contribute $100 for each person covered by the plan after completion of a health questionnaire by the employee and his/her spouse or same-sex domestic partner. (See shaded box for more information about Duke Basic.)

Premiums for Duke's other health care plans will increase in 2004, but despite the rising cost of health care across the country, Duke's premiums continue to remain below the national and state averages, officials said.

For Duke Select, which covers the majority of Duke's health plan participants, the premiums will increase approximately $4 per month for an individual and about $24 per month for family coverage. The increase in monthly premiums is similar for Blue Care and Duke Options but differs slightly depending on the coverage selected.

Changes for 2004 also include modest increases for a few services covered by Duke Select, Blue Care and Duke Options. Changes to the health plans include:

¢ Increase of $5 for specialty care co-pay (co-pay for primary care remains unchanged)

¢ Increase of $25 for emergency room co-pay (co-pay for urgent care remains unchanged)

For Duke's pharmacy benefits, co-pays for generic drugs will remain the same as 2003. Co-pays for a 34-day supply of formulary prescription drugs will increase $5 and non-formulary prescription drugs will increase $15. Mail order co-pays will increase $25 for formulary and $30 for non-formulary medications. For participants in Duke Basic, each participant must satisfy a $100 per person prescription deductible before the plan begins to pay benefits toward the cost. (See shaded box about Duke Basic.)

Duke will continue to offer a choice of two dental plans for 2004 and will expand its orthodontia coverage to include adults. The higher-level dental plan will have a slight premium increase of $0.85 for individuals and $2.59 for family coverage while the cost for the basic dental plan will remain unchanged.

Another change for 2004 will be a new mental health management vendor for Duke Select, Duke Options and Duke Basic. The change to CIGNA Behavioral Health will enhance customer service and claims processing. For participants of Blue Care, the mental health plan provider will remain unchanged.

Details about these changes and how to enroll are included in the open enrollment packet that will be mailed to employees in mid-September.

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Duke Basic -- A new low-cost option for Duke employees