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HR Home >> Benefits >> Health & Dental >> Medical Care >> Plan Comparison

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2010 Medical Plans Comparison Chart

More Issues to Consider | 2009 Comparison
 

The following chart gives an overview of the differences among the four medical plans. Bold text notes areas of coverage that have changed for 2010.

 

Duke Select (HMO)

Duke Basic (HMO)

Duke Options
(Blue Cross Blue Shield PPO)

Blue Care (Blue Cross Blue Shield HMO)

In-Network

Out-of- Network

Annual Deductible

Individual

None

$5001

$100

$500

None

Family

None

$1,5001

$300

$1,500

None

Co-insurance Maximum

Individual

None

$2,0002

$2,0002

$3,0002

None

Family

None

$6,0002

$6,0002

$9,0002

None

Physician Office Visit

PCP

$15 co-pay

$20 co-pay

$15 co-pay

You pay 30% after deductible3

$15 co-pay

Specialist

$45 co-pay

$60 co-pay

$45 co-pay

You pay 30% after deductible3

$45 co-pay

MRI, CT, PET Scan

$150 co-pay

$150 co-pay

You pay 10% after deductible

You pay 30% after deductible3

Covered in full

Lab & Other X-Ray

Covered in full

Covered in full

You pay 10% after deductible

You pay 30% after deductible3

Covered in full

Annual Physical

$15 co-pay primary care
$45 co-pay specialist

$20 co-pay primary care
$60 co-pay specialist

$15 co-pay primary care
$45 co-pay specialist

Well visits not covered; you pay 30% after deductible3 for annual Pap smear, mammogram, or PSA

$15 co-pay primary care
$45 co-pay specialist

OB/GYN Exams

$15 co-pay primary care
$45 co-pay specialist

$20 co-pay primary care
$60 co-pay specialist

$15 co-pay primary care

Well visits not covered; you pay 30% after deductible3 for annual Pap smear, mammogram, and sick visits

$15 co-pay

Well Baby Visits (under age 2)

Covered in full

Covered in full

$15 co-pay primary care
$45 co-pay specialist

Not covered

$15 co-pay primary care
$45 co-pay specialist

Maternity Care: includes pre-natal and post-delivery care

$15 co-pay primary care or $45 co-pay specialist first visit, then professional services covered in full

$60 co-pay first visit, then professional services covered in full

You pay 10% after deductible for professional services

You pay 30% after deductible3 for professional services

$15 co-pay first visit, then professional services covered in full

Hospital Care

Inpatient

$450 per admission
co-pay4, then covered in full

Subject to $500 annual deductible; you pay 10% co-insurance up to maximum of $2,0004

After $450, or $550 per admission co-pay5 and deductible,  you pay 10% up to maximum of $2,000

After $700 per admission co-pay, you pay 30% up to maximum of $3,000

$450 or $550 per admission
co-pay5, then covered in full

Outpatient

$200 co-pay

You pay 10% after deductible

You pay 10% after deductible3

You pay 30% after deductible3

$200 co-pay

Emergency Care

$250 co-pay, waived if admitted

$250 co-pay, waived if admitted

$250 co-pay, waived if admitted

$250 co-pay, waived if admitted

$250 co-pay, waived if admitted

Urgent Care

$35 co-pay

$50 co-pay

$35 co-pay

$35 co-pay

$35 co-pay

Ambulance

Covered in full when medically necessary

You pay 20% after deductible

You pay 10% after deductible when medically necessary

You pay 10% for emergency services3 - otherwise, the deductible and co-insurance when medically necessary

Covered in full when medically necessary

Other Services

Infertility

Provided at Duke Medical Center for employees with two years of service; limits apply

Not covered

Provided at Duke Medical Center for employees with two years of service; limits apply

Not covered

Does not include COH, IVF, or other types of artificial conception; limits apply

Infertility Testing and Treatment, Subject to Precertification

Fixed price; precertification required; limits apply

Not covered

Fixed price; plan pays up to $5,000 lifetime maximum for diagnostic services; precertification required; other limits apply

Not covered

$15 co-pay primary care; $45 co-pay specialist; covered in full for testing; $5,000 lifetime maximum

Skilled Nursing Facility

Covered in full when authorized by doctor; 60-day annual maximum

Covered in full when authorized by doctor; 60-day annual maximum

You pay 10% after deductible when authorized after $250 per admission co-pay; 60-day annual maximum

You pay 30% after deductible3 when authorized after $250 per admission co-pay; 60-day annual maximum

Covered in full when authorized by doctor; 60-day annual maximum

Home Health Care

Covered in full when authorized by doctor; up to 100 visits per calendar year

$20 co-pay per visit when authorized by doctor; up to 100 visits per calendar year

You pay 10% after deductible when authorized; 100 combined visits per calendar year

You pay 30% after deductible3 when medically necessary; 100 combined visits per calendar year

Covered in full when authorized by doctor; up to 100 visits per calendar year

Hospice Care

Covered in full when authorized by doctor

Covered in full when authorized by doctor

You pay 10% after deductible

You pay 30% after deductible3

Covered in full when authorized by doctor

Durable Medical Equipment

You pay 10%; plan pays up to $15,000 annual limit

You pay 20% after deductible; plan pays up to $5,000 annual limit

You pay 10% after deductible; plan pays up to $15,000 combined annual limit

You pay 30% after deductible3; plan pays up to $15,000 combined annual limit

Covered in full up to $15,000 annual limit

Prosthetics

You pay 10%; plan pays up to $15,000 annual limit

You pay 20% after deductible; plan pays up to $5,000 annual limit

You pay 10% after deductible; plan pays up to $15,000 annual limit

You pay 30% after deductible3; plan pays up to $15,000 annual limit

Covered in full up to $15,000 annual limit

Physical Therapy (PT)
Occupational Therapy (OT)

$15 co-pay; 20 visits per calendar year for combined PT and OT6

$60 co-pay per visit; 20 visits per calendar year for combined PT and OT7

$45 co-pay; 30 visits per calendar year for combined PT, OT, and chiropractic in- and out-of-network6

You pay 30% after deductible3; 30 visits per calendar year for combined PT, OT, and chiropractic in- and out-of-network6

$15 co-pay primary care $45 co-pay specialist for PT and OT; 20 visits per calendar year for combined PT and OT7

Chiropractic Care

$45 co-pay; plan pays up to $750 annual maximum

$60 co-pay; plan pays up to $750 annual maximum

$45 co-pay; 30 visits per calendar year for combined PT, OT, and chiropractic in- and out-of-network

You pay 30% after deductible3; 30 visits per calendar year for combined PT, OT, and chiropractic in- and out-of-network

$45 co-pay; 20 visits per calendar year
Nutrition $15 co-pay; 6 visits per calendar year $20 co-pay; 6 visits per calendar year Covered in full up to 6 visits per calendar year Not covered Covered in full up to 6 visits per calendar year

Speech Therapy

$15 co-pay; 20 visits per calendar year; precertification required6

$60 co-pay per visit; 20 visits per calendar year; precertification required7

$45 co-pay; 20 visits per calendar year for combined in- and out-of-network6

You pay 30% after deductible3; 20 visits per calendar year for combined in- and out-of-network6

$45 co-pay; 20 visits per calendar year7

Vision Exam

$45 co-pay; limit 1 per calendar year

$60 co-pay; limit 1 per calendar year

$45 co-pay; limit 1 per calendar year; 30% lens and frame discount; 15% disposable contacts discount

Not covered

$15 co-pay; limit 1 per calendar year; 30% lens and frame discount; 15% disposable contacts discount

Bariatric Surgery8

$4,000 co-pay

Not covered

$4,000 co-pay

Not covered

$4,000 co-pay

Lifetime Maximum Plan Payment

$2 million9

$2 million9

$2 million9

$2 million9

$2 million9
  1. Deductible does not apply to office visits for primary care and specialist.
     
  2. Excluding deductibles, co-pays, prescription drug co-pays, urgent care and emergency room co-pays, mental health and developmental disabilities co-pays and co-insurance.
     
  3. All payments are based on the allowable charge. You are liable for charges over the allowable charge when receiving out-of-network services.
     
  4. Wake Med Health is considered in-network only for obstetrics and most pediatric admissions.
     
  5. $450 per admission co-pay for Duke Hospital, Durham Regional Hospital, and Duke Raleigh Hospital facilities and $550 for all others in-network.
     
  6. For children under 18 with significant disabilities, the plan will pay 100 percent for in-network benefits after appropriate co-pay per visit to an annual maximum of $10,000 in charges for employees hired prior to January 1, 1997. After $10,000 in charges, plan pays 75 percent. Treatment must be received at Duke Medical Center.
     
  7. There are no benefits available under this plan for children with developmental disabilities.
     
  8. For qualified patients only. For details, click here.
     
  9. If the $2 million maximum is reached under one plan, you may transfer to another plan if that plan is offered in your area of residence.