Matthew Rougeux covers his wife and five children on his Duke health insurance plan.
Anne Davis would have spent up to $350,000 on her son's care after he suffered a traumatic brain injury if it weren't for her plan.
For Myra Townes, Duke's medical benefits - from covering the birth of her threes sons to providing insurance while they were in college - have played an important role in spending 30 years at Duke.
Open Enrollment for health benefits begins Oct. 26 through Nov. 6 when Duke University and Duke University Health System staff and faculty will enroll or consider changes to their medical, dental and vision benefits. Rougeux, Davis and Townes, and their dependents, are among 63,786 individuals covered by Duke health plans. In the past fiscal year, Duke provided $198 million in total payments for health concerns for all plan participants, up $27 million from the previous year.
In 2016, premium rates will increase between $1 and $5 per month for individual coverage and $6 and $24 per month for family coverage, depending on the plan.
As part of Open Enrollment this year, hear from employees about how Duke's health plans have helped their families.
In 2012, Matthew and Julie Rougeux traveled to Uganda to welcome two adopted boys into their family. Despite potential health issues - including one suffering from sickle cell disease - the parents have kept medical bills small for their family, which now includes five children.
Matthew Rougeux, administrative director with Duke Hospital's Emergency Services, most commonly saves around $1,700 on an emergency room visit for 4-year-old Joshua, whose sickle cell disease impacts oxygen carried by red blood cells.
"Any time Joshua gets a fever of 101, he has to come in for an IV and antibiotics, and with a household of kids, someone can easily share a fever with him," Rougeux said.
After arriving in the U.S. from Uganda, Joshua's brother, John, 5, received medical treatment, including checkups from Duke doctors and dental work to fix cavities. Copays have stayed minimal for Rougeux, who also saved about $6,000 on emergency care and doctor visits when his 5-year old daughter, Ainsley, broke her arm.
Duke's health plan allows Rougeux to focus on making memories with his entire family.
"I love the smaller moments, when I come home and five kids come running at me, tackle me and we're rolling around," he said. "There's nothing like it in the world when you hear five sets of feet running to you. It's the highlight of my day."
A 2:30 a.m. phone call jolted Anne Davis awake, bringing bad news from a family member: Davis's 22-year-old son, Steven, had fallen from the back of a pickup truck and was on his way to Duke University Hospital.
Davis assumed he just needed stitches, but at the hospital, she discovered her son suffered a severe traumatic brain injury.
Steven, who hit the back of his head against the pavement, exhibited no brain activity. Doctors initially said he might not survive, but he slowly began to recover, first by showing brain activity. After 10 days in a coma, he began rehab.
During her son's treatment over the past three years, Davis paid for medical costs such as a $450 hospital admission fee and copays for physical therapy and specialty doctor visits. But without Duke health insurance, Davis, a single parent, said she would have spent up to $350,000 for her son's care.
An administrative services manager at the Nicholas School of the Environment, Davis is one of 8,590 people covered under Duke's employee and children health plan category. In addition to Steven, Davis includes two other children under her plan.
Steven, who turns 25 in October, visits a Duke neurologist regularly and is planning to start occupational rehabilitation.
"If I hadn't had excellent insurance, I probably would have had to sell my home," Davis said, "and even then, it would not have paid for all of the medical costs Steven incurred."
Relationships with coworkers are among the reasons Myra Townes has stayed at Duke for over 30 years.
Townes, a clinical laboratory technologist in Clinical Microbiology, is quick to point out that the medical benefits she's received for her family, from covering the birth of three sons to providing insurance while they were in college, have also played an important role in spending a full career at Duke.
Her son, Robert, who attended University of Miami, and Myca, who went to Wake Forest University, were covered until after their graduation. Timothy, now a senior at Oral Roberts University, has had his annual round of checkups over the years, including visits with his dentist and optometrist while home this summer.
"I liked that they could come home and have the ability to get exams every year," Townes said.
Myra Townes, Timothy, and her husband, Robert, are among 21,942 people covered under the "family" category - the largest tier of Duke's health plans. After Timothy graduates, he'll be eligible to remain covered until his 26th birthday.
When swine flu broke out in 2011 at Wake Forest, where her other son, Myca, was going to school, Townes found comfort in knowing he had health coverage. He did not catch the illness, but world-class medical care wouldn't be far if he had to travel back to Durham.
"We haven't had to deal with any big health things as they all started college," Townes said. "But it was always good to know that if something were to happen, they would be taken care of."
Duke nurse Renee Brammer travels up to 250 miles a day visiting patients in their homes as part of Duke HomeCare and Hospice. She changes dressings, draws blood and monitors vitals.
As she's caring for patients, she's also mindful of caring for herself.
Brammer has had type 1 insulin-dependent diabetes since she was 4 years old and closely monitors her blood sugar. She takes medicines for diabetes, asthma and high cholesterol.
As part of her Duke health insurance plan, Brammer participates in DukeWELL, a disease management initiative that provides a care team, waives some medication co-payments, and connects her to free resources.
"Chronic diseases can be very tiring on a person, so this just gives you extra support and somebody to talk to," said Brammer, 40.
Brammer, her husband and two children are among 63,786 individuals covered by Duke's health plans, which will see premium increases lower than the national average next year.
Duke premiums compare more favorably when considering national factors that are affecting costs such as the increased use of specialty medications that help treat chronic conditions such as rheumatoid arthritis, diabetes and hepatitis C. More specialty medications are being brought to market and filled by employees. For example, a new hepatitis C drug, Harvoni, costs about $95,000 for a 12-week treatment, but it can cure patients with hepatitis C.
"The cost escalation of these specialty drugs, which are a terrific benefit to our employees and their family members, is also being felt by other employers across the country," said Joyce Williams, assistant vice president for Duke Human Resources Benefits.
Healthcare decisions made by Duke employees, such as visiting a primary care doctor instead of going to urgent care and participating in a fitness or wellness initiative, can help reduce health plan costs.
Brammer, the HomeCare and Hospice nurse, continues to participate in DukeWELL, the disease management program. A representative talks with her once a month and helps her schedule doctor's appointments. Brammer is walking more and drinking more water.
"My diabetes is under control," she said. "My overall health has improved."
Filling prescriptions by using mail-order or Duke pharmacy, enrolling in an employee wellness program, or seeing a primary care physician can save you money, help you stay well, and reduce healthcare costs for Duke as a whole.
"All of us want to have a high-quality, affordable health plan," said Joyce Williams, assistant vice president for Duke Human Resources Benefits, "and there are things that we as consumers can do to help."
Here are five tips:
A year ago, Duke Physics researcher Thang Hoang took part in HealthCheck, a free, confidential assessment offered to employees by roving campus nurses with LIVE FOR LIFE, Duke's employee wellness program. During the assessment, he discovered his body mass index, cholesterol and blood pressure were higher than normal.
He turned warning signs into a call to action by losing 10 pounds and lowering his cholesterol and blood pressure. "Something was not right, and you have to do something about it," Hoang said.
Learn more at the LIVE FOR LIFE Events Calendar and arrange an appointment by calling (919) 684-3136 (option 1).
Are you seeing a primary care physician annually to connect the dots when it comes to your health?
"Having a primary care doctor is important because it's someone who knows you longitudinally over time, but it's also someone who understands the whole you," said Dr. Mohammad Shahsahebi with Duke Community and Family Medicine.
Also, visiting a primary care doctor costs less than urgent care. Find a physician at the network providers page.
Use Express Scripts mail order, Duke's online benefit for long-term prescriptions, or visit a participating Duke pharmacy for reduced copays or waived deductibles, depending on your health plan.
For example, an employee on the Duke Select health plan buying a generic medication for the first time will pay $10 for a 34-day supply. However, a 90-day generic prescription through a participating Duke pharmacy or by mail order costs $20. Visit the Pharmacy Benefits website for more information.
Last fall, Tracy Bethel enrolled in Duke's Health Care Reimbursement Account, which sets aside pre-tax dollars from her paycheck for approved expenses such as copays and deductibles.
"The tax benefits are really big, and if you're looking for ways to reduce your taxable income this is a great tool," said Bethel, a program manager in the National Center for Child Traumatic Stress.
A reimbursement account allows up to $2,550 in pre-tax contributions per year and the rollover of up to $500 of unused funds into the following year. Employees can only sign up during Open Enrollment or within 30 days of a qualifying life event. Visit the Health Care Reimbursement Account website to learn more.
Employees who monitor their health can avoid chronic healthcare issues down the road, said Bernard Fuemmeler, an associate professor in Duke Community and Family Medicine. Fuemmeler suggests participating in programs through LIVE FOR LIFE, which holds free monthly fitness events, connects Duke employees to nutritionists, and more.
"When we make health a priority, we can also ensure that our performance stays at its top level," he said.
Learn about LIVE FOR LIFE free programming at the LIVE FOR LIFE website.
While new health care exchanges became available through the Patient Protection and Affordable Care Act in 2013, Duke has continued to offer eligible staff and faculty the option of four medical insurance plans. Working@Duke talked with Kyle Cavanaugh, vice president for administration, to find out what impact the legislation is having on Duke's medical benefits.
There are essentially two options for employers like Duke: either 'pay or play.' You can pay a tax or premium per employee and let folks get coverage through either private or public health care exchanges, or you can continue to offer your own health insurance as long as it meets specific criteria. Right now, it makes the most sense for us to continue to offer our own insurance.
We have watched the exchange market closely since inception to determine if it would make sense for us to terminate our plans and have people get coverage through the exchanges. While the cost to Duke would likely go down, our employees would have to pay more and receive less in terms of services. It's also too early for the exchanges to establish any track record for stability. For example, we are seeing significant jumps in the cost of exchange options for 2016.
We also are fortunate that we have the size in terms of number of covered lives to give us some economies of scale to better manage our health care spending. For example, we work closely with our network of providers and have introduced innovative approaches to the management of chronic diseases and the appropriate use of medications. Those efforts have made a huge impact on restraining the increasing cost for our employees. If we got out of providing our own plans, we would lose control of all of those types of issues.
The act introduced a host of new regulations and requirements for employers like Duke who offer coverage. The federal government allows employers to offer health insurance as a pretax benefit, which helps reduce the cost to employers and employees. But the new legislation establishes a ceiling beginning in 2018 for how much an employer can contribute toward employee health insurance before the contribution becomes taxable. We need to stay below that threshold to avoid the excise tax implications, which could be a several million dollar hit for Duke.
We are trying to tweak the plans now with slight increases to deductibles, co-pays and premium structures to ensure we remain below that threshold. By taking those changes now, we can avoid more significant changes later if we were hit with several million in taxes.
- Interview by Paul Grantham
In 2016, Duke health plan premium rates will see increases between $1 and $5 per month for individual coverage and $6 and $24 per month for family coverage, depending on the plan. Copayments for generic medications and primary care provider visits will not increase. Copayments for a specialist visit will increase $10 to $15, depending on the plan.
Kyle Cavanaugh, vice president for administration, said Duke is able to keep premium rates lower than the national average because of a university-wide focus on preventive health care, incentives for employees who exhibit healthy behaviors, and accurate navigation of Affordable Care Act requirements.
"By using a comprehensive set of cost management strategies, Duke medical plan premiums will only increase slightly next year," Cavanaugh said. "Our rate increases are still well below the national average, and that's due to a successful health plan design and management."
The premium rate increase for Duke's most popular plan, Duke Select, is expected to be a third of the increase that large U.S. corporations project for their 2016 plan premiums, according to a June 2015 survey by the National Business Group on Health, a nonprofit association of employers.
For more information on Duke's medical benefits, please visit the Open Enrollment website.
Learn more about Open Enrollment and medical benefits.
Written by April Dudash and Bryan Roth and edited by Leanora Minai, Duke University Office of Communication Services. Tell us what you think about this special package of stories.
