![]() 90% of MAC 2during second year of coverage if a covered procedure is received during the first year.80% of MAC 2 during first year of coverage.Pays a predetermined fixed amount 4 based on procedure received Fluoride treatments (for children under age 19).2 routine prophylaxis (cleanings) per year.You are liable for charges over the allowable charge when receiving out-of-network services.Īnnual Maximum Benefit for Preventive, Basic, and Major Covered Services All payments are based on the allowable charge.After $900 per admission co-pay, plan pays 70% of allowable charge 1.Must be precertified prior to admission.Co-pay of $600 per admission at Duke Hospital, Duke Regional Hospital or Duke Raleigh Hospital $700 per admission at other network hospitals.After $650 annual deductible, plan pays 70% of allowable charge 1.Precertification required for psychological testing, electroshock therapy, and hypnosis.$20 co-pay per visit for individual/family therapy.On-Site Duke Pharmacies - $100 deductible and $180 co-payīehavioral Health and Substance Abuse Benefits.Mail order - No deductible and $180 co-pay.On-Site Duke Pharmacies - $100 deductible and $130 co-pay.Mail order - No deductible and $130 co-pay.(Annual $100 per person deductible applies at retail and participating on-site Duke pharmacies.) Through the Express Scripts Mail Order Pharmacy or Participating On-Site Duke PharmaciesĪfter third purchase of a long-term medication Listed below is the information about the Express Scripts Medicare Part D Prescription Plan (PDP) for Duke University. There are no benefits available under this plan for children with developmental disabilities.You are responsible for charges when receiving out-of-network services. You are liable for charges over UCR when receiving out-of-network services. All payments are based on the usual, customary, and reasonable (UCR) allowable charge.Excluding deductibles, co-pays, prescription drug co-pays, urgent care and emergency room co-pays, and mental health co-pays and co-insurance.The benefits for in-network and out-of-network are combined. ![]() Plan pays 70% after deductible 4 6 visits per calendar year $20 co-pay 20 visits per calendar year 1 Ģ0 visits per calendar year for combined in- and out-of-network 1 ,5 You pay 10% plan pays up to $15,000 annual limit 1Ĥ0 visits per calendar year for combined PT and OT 1,5 $250 per admission co-pay, then covered in full for 60 days 1 when authorized by doctorĬovered in full when authorized by doctor Ĭovered in full when authorized by doctor Routine Infertility Testing and Treatment $600 per admission at Duke Hospital, Duke Regional Hospital or Duke Raleigh Hospital $700 per admission at other network hospitals Then professional services covered in full Maternity Care: includes prenatal and post-delivery care Plan pays 70% after deductible 3 for annual Pap smear, mammogram, and sick visits Plan pays 70% after deductible 3 for annual Pap smear, mammogram, and PSAĬolonoscopy and Cologuard® Colorectal Screening Plan pays 70% per visit after deductible 3 Out-of-Network or Non-Medicare Accepting Provider In-Network or Medicare Accepting Provider If you or a covered dependent are not Medicare-eligible, please visit the United Health Choice Network website to locate an in-network provider. For further assistance please call the number on the back of your Duke Plus Member card. If you or a covered dependent are Medicare-eligible, you may see any provider who accepts Medicare. Behavioral Health and Substance Abuse Benefits.View the Duke Plus Summary Chart for an overview of what is covered by the plan including Pharmacy, Behavioral Health and Substance Abuse. you become disabled and are covered by Medicare.you are retired and have a dependent on Medicare, OR.you are eligible to continue health insurance as a retiree, and age 65 or over, OR.You may continue your health insurance coverage on the Duke Plus plan if: UMR - Duke Plus (Medical & Behavioral Health/Substance Abuse)Įxpress Scripts - Medicare Prescription Plan (PDP)ĭuke Plus is Duke's retiree health plan administered by UMR. Duke Plus Member Guide Contact Information
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