Medical Insurance

To continue to receive the health insurance plan in retirement, all employees must meet the following criteria:

  • You must be actively employed at Duke and participating in the health insurance plan at the time of retirement. (Note - Health insurance may also be continued for your spouse or same-sex spousal equivalent and eligible dependent children who are covered at the time of your retirement.   Effective January 1, 2012, you will only be allowed to drop dependents or coverage due to a qualifying event in the future.)  
  • Meet the eligibility requirements for your operating entity described below.

Eligibility Requirements for Duke University and Medical Center

You must meet the Rule of 75, which became effective July 1, 1990. It requires that your age plus years of continuous service with Duke at retirement must be equal to or greater than 75.

Note about Transfers: Employees who have transferred to the University/Medical Center from the Health System will not immediately fall under the eligibility rules for the University/Medical Center. After working 5 continuous years for the University/Medical Center, the eligibility rules for the University/Medical Center in place at that time will apply.

Note: If a faculty or staff member meets the retiree health eligibility requirements and retires (early or normal), the retiree may suspend health coverage and contributions at any time while employed and receiving benefits elsewhere*. Re-enrollment in the health plan must occur within 60 days of the termination of other employer sponsored coverage. Proof of continuous coverage through another employer plan will be required. If the individual attempts to re-enroll after this 60 day period, the individual must pay the full premium (including the employer share) retroactive to the termination of the prior employer coverage and up to the time of re-enrollment. Thereafter, the individual shall pay the retiree share.

*Coverage under another plan available to the individual as a retiree of another employer, through a spouse's health plan, or from service with the military does not count as an employee under another employer sponsored plan.

Health Insurance Premium Contributions for Duke University and Medical Center

Once you have determined that you are eligible, then the bulleted list below will help you determine the amount that Duke contributes towards your insurance.

  • If you met the 'Rule of 75' prior to January 1, 2002, then the retiree pays 20 percent of the individual premium
  • If you met the 'Rule of 60' prior to January 1, 2002, then the retiree pays 30 percent of the individual premium
  • All other eligible retirees pay 40 percent of the individual premium

Note: Duke contributes 50 percent towards the premium for spouse/same-sex spousal equivalent and other dependents.

Eligibility/Premium Requirements for Duke University Health System (DUHS)

  • Employees hired on or after July 1, 2002 with no break in service are eligible for retiree health coverage if they meet the following criteria:
     
    • Have 15 years of continuous service after age 45 — Retiree pays 100 percent of the premium.  
    • DUHS employees approved for group long term disability benefits hired after July 1, 2002, may retain their health coverage until age 65, as currently permitted, but will not receive credit for years of continuous service while on disability.  
  • Employees employed by DUHS prior to July 1, 2002 with no break in service are eligible for retiree health coverage if they meet one of the following criteria:
     
    • Employee met the Rule of 75 (your age + years of continuous service = 75) as of July 1, 2002 — Retiree pays premiums outlined below:
       
      • If you met the 'Rule of 75' prior to January 1, 2002, then the retiree pays 20 percent of the individual premium  
      • If you met the 'Rule of 60' prior to January 1, 2002, then the retiree pays 30 percent of the individual premium

        Note: Duke contributes 50 percent towards the premium for spouse/same-sex spousal equivalent and other dependents.  
    • Employee had at least 15 years of continuous service (but did not meet the Rule of 75) as of July 1, 2002, then the employee is grand-fathered under the Rule of 75 eligibility provision with the premiums outlined in the table below:
       
      • If the employee met the 'Rule of 60' prior to January 1, 2002, then as a retiree you pay 30 percent of the individual premium  
      • All other eligible retirees pay 40 percent of the individual premium  
      • Note: Duke contributes 50 percent towards the premium for spouse/same-sex spousal equivalent and other dependents.  
    • Employee was at least 60 years of age with 10 or more years of continuous service (but did not meet the Rule of 75) as of July 1, 2002, then the employee is grand-fathered under the Rule of 75 eligibility provision with the premiums outlined below:
       
      • If the employee met the 'Rule of 60' prior to January 1, 2002, then as a retiree you pay 30 percent of the individual premium  
      • All other eligible retirees pay 40 percent of the individual premium  
      • Note: Duke contributes 50 percent towards the premium for spouse/same-sex spousal equivalent and other dependents.  
    • All other employees employed by DUHS prior to July 1, 2002 with no break in service are eligible for retiree health coverage at time of retirement if they meet one of the following eligibility criteria:
       
      • Have 15 years of continuous service after age 45 — DUHS will pay a portion of the premium as detailed below:
         
        • If the employee met the 'Rule of 60' prior to January 1, 2002, then as a retiree you pay 30 percent of the individual premium  
        • All other eligible retirees pay 40 percent of the individual premium

          Note: Duke contributes 50 percent towards the premium for dependents.

          OR  
      • Met Rule of 75 — Retiree pays 100 percent of the premium.

Note about Transfers: Employees who have transferred to the Health System from the University/Medical Center will remain under the University/Medical Center eligibility rules if at the time of the transfer the employee met the Rule of 75 or had 15 or more years of continuous service as of July 1, 2002. Otherwise, the Health System eligibility rule of 15 years of continuous service after age 45 will apply.

Note: If a staff member meets the retiree health eligibility requirements and retires (early or normal), the retiree may suspend health coverage and contributions at any time while employed and receiving benefits elsewhere*. Re-enrollment in the health plan must occur within 60 days of the termination of other employer sponsored coverage. Proof of continuous coverage through another employer plan will be required. If the individual attempts to re-enroll after this 60-day period, the individual must pay the full premium (including the employer share) retroactive to the termination of the prior employer coverage and up to the time of re-enrollment. Thereafter, the individual shall pay the retiree share.

*Coverage under another plan available to the individual as a retiree of another employer, through a spouse's health plan, or from service with the military does not count as an employee under another employer sponsored plan.

Health Care Plan Offerings

Duke provides a choice of group health care plans for retirees and their covered family members who are not Medicare-eligible. A comparison sheet of the health plans are available here. If you or any of your covered family members are Medicare-eligible, then all of you will be covered under the Duke Plus health plan. All of the provisions of the health care benefits are subject to change, including plans offered, services covered, payment arrangements, and Duke's contributions towards premiums.

Premium Payment

  • You are responsible for paying the retiree health insurance premium. Arrangements to have it drafted from your checking or savings account should be made during your appointment with a Benefits representative. If you are receiving a retirement check from the Employees' Retirement Plan (ERP), the premium is deducted from your retirement check.

COBRA Continuation

  • If you are not eligible for continuation of the health insurance plan in retirement as outlined above, you may be eligible to continue the coverage as provided under the federal COBRA law for up to 18 months, or until you become eligible for Medicare. You are responsible for the full premium payment, plus an additional 2 percent.  
  • You will receive a COBRA notification by mail. Follow the instructions in the letter or you may contact our COBRA Administrator, ADP, at 1-800-526-2720 to enroll in COBRA coverage.

Retiring at 65 or older

  • Once you are 65 and retired, Medicare is the primary payer and Duke the secondary payer through the Duke Plus health plan. Therefore, enrollment in Medicare Part A & B is required for retirees and spouses age 65 and over.  
  • If you retire at 65, but do not enroll in Part B at the earliest opportunity:
     
    • you will be required to pay medical expenses that Medicare would have paid, and
    • you will pay higher Medicare premiums for this coverage than you would have otherwise.  
  • Exception: If you are retiring after reaching 65, or are covering a spouse who is 65 or older at the time of your retirement, there is only a conditional penalty for late enrollment. This penalty may be avoided as long as you provide Social Security with verification that you were covered by Duke's group plan during the period between reaching 65 and retiring. You must obtain this letter of verification from the Benefits office during your appointment with a Benefits representative and enroll no later than 30 days after retirement in order to avoid this penalty.

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