Duke Introduces Salary-Based Health Premiums for 2027

Duke will begin basing health insurance premiums on a staff and faculty member’s salary in 2027, a significant change aimed at limiting the financial impact of the continued rise in healthcare costs nationally for employees in lower salary bands.

Healthcare premiums will increase for all employees next year, with increases larger than in recent years. How much employees pay will depend in part on their salary, with those in lower salary bands facing smaller increases.

The change comes as Duke, like other employers, faces sharply rising healthcare costs.

“Healthcare benefits are an essential part of what it means to work at Duke, and our goal is to continue providing high-quality coverage that is meaningful and accessible for our employees and their families,” Antwan Lofton, Vice President of Duke Human Resources and Chief Human Resources Officer for Duke University, and Rhonda Brandon, Senior Vice President and Chief Human Resources Officer for Duke University Health System, said in an email announcement to Duke University and Duke University Health System staff and faculty.

Under Duke’s current premium structure, employees earning less pay a higher share of their income for the same coverage as colleagues who earn more. The new structure will spread increases differently based on salary; how much a staff or faculty member pays will be tied to what they earn.

“The new model rebalances the cost share and shields those in lower bands from disproportionate cost increases, so health insurance remains accessible for all of our team members,” Lofton and Brandon noted.

Other changes coming to specific plans:

• Cigna Care: Duke will discontinue Cigna Care, as previously announced, and move participants to Duke Options, a PPO plan with a broader network and similar coverage. Participants will receive separate information about the transition.
• Duke Basic: Duke had planned to discontinue the plan after 2026 but will instead extend it for current participants with more substantial changes. Participants will receive details separately.
• Dental coverage: Dental plan premiums will increase slightly in 2027.

Several important costs will not change. Co-pays will remain the same across Duke’s health plans in 2027, and vision plan premiums will not increase. Employees and their families also will continue to have access to Duke’s robust and trusted provider network close to home.

Duke will hold information sessions in the coming weeks to explain the changes and answer questions before Open Enrollment for 2027 benefits begins Oct. 12 through Oct. 30, 2026. Employees are encouraged to review their current coverage and visit hr.duke.edu/enrollment2027 for a full breakdown of plan options and what to expect.

Because of the scope of changes for 2027, Duke is offering new and updated tools on the Open Enrollment website to help staff and faculty navigate information. Among the tools is a new OE Assistant chatbot that will only focus on questions related to 2027 health plans to avoid confusion with current plans.

Cigna’s “Easy Choice Tool” will also be available as a decision tool to quickly compare plan options and find one that works best for employees and families.

Duke leaders said the challenge is preserving health benefits that help attract and retain employees while confronting the increasing cost of providing that coverage.

“We recognize these changes will affect some more significantly than others,” Lofton and Brandon said in the announcement. “We are committed to being transparent about those changes and providing information and resources to help you understand what they mean for you and your family.”