Change in Pharmacy Benefit Manager (pdf)
Copayments, deductibles and maximum out of pocket
- • Copayment increases – specialist and tier 2 medications have increased to $35.
- • Copayments remained the same for primary care and mental health providers
- • Annual deductible for out of network provider decreased to 250
- • Maximum out of pocket for in network and out of network increased.
Medications (Specific Generic vs. Brand Name info)
- • BCBS NC requires for ordering physician to specifically note on the prescription that the brand name is required when a generic version is available. There might be a monetary penalty if your physician does not specify for the brand name only.
- • Certain medications require prior authorization. To find out if your medication has a generic version or if prior authorization is needed, go to bcbsnc.com (under find a drug)
- • Student premiums and dependents increased.
- • If you have child, BCBS will let you pro-rate the premium for addition of child to policy
Out of network reimbursement
- • You may be responsible for paying any charges over the allowed amount in addition to any applicable deductible, coinsurance, or non-covered expenses. If you are in an area that has participating providers and you choose a provider outside the network (lower out of network benefits).
- • If you obtain insurance elsewhere, you must terminate the insurance during the month of December. If not, you can purchase extension coverage for up to 6 months.
- • If you are moving away, you must notify duke medicine of this (919-620-4555). Have them update both Duke Hospital and their physicians billing system. Ask them to review any unpaid moneys due to them.
Maternity and Vision Benefits
- • Same benefits as before with united health care. Student blue website www.bcbsnc.com/duke. Can browse website to review benefits information, view claims, download claims and other forms, etc.
Students must enroll or waive the new Blue Cross Blue Shield insurance at www.bcbsnc.com/duke by Sept 16th 2011 or be automatically enrolled for the entire 2011-2012 year. Full plan details, rates, a schedule of benefits, dependent enrollment information, and more information is available. You can search for a doctor using their online tool and choose Blue Options (Group PPO Plan).
The 2010-2011 plan ended on 7/31/2011. In order to get your medicines refilled and activate other coverages, please confirm your enrollment ASAP at www.bcbsnc.com/duke. The 2011-2012 plan started on 8/01/2011.
Mental Health Providers:
PDC/Duke are in the BCBS PPO Network and are thus provided. For those providers that are not Duke, CAPS is meeting with them to facilitate coverage.
Brand Name Medicines:
For Brand name medicines, students are responsible for a higher out-of-pocket expense, beyond their copay, for a brand name drug when a generic equivalent is available, unless the member’s physician specifically states that the brand name drug is necessary. If the physician does not specify the brand name drug, most members will be required to pay the higher tier copayment, plus the difference between the costs of the generic drug and the brand name drug.
- Anna Kenyon (Salinas), Duke Student Health Insurance Manager: firstname.lastname@example.org
You may direct any questions regarding Duke student health insurance to her(claim,coverage, etc).
- Duke Student Health Center (insurance page)
- BCBS: http://www.bcbsnc.com/duke
- Jean Hanson, Director of Student Health Center: email@example.com
- GPSC Health Insurance Committee: firstname.lastname@example.org
GPSC works with the Duke administration to develop health insurance plans through the Student Health (Insurance) Advisory Committee (SH(I)AC). SH(I)AC is active during the renewal of Duke’s student health insurance plan and meets as needed in the spring semester, typically 3 to 4 times. It examines benefits, premiums, and bids. GPSC selects 6 to 7 representatives to serve in this committee. If you are interested in applying, please contact the GPSC University Affairs Coordinator for more information or visit this page.