Your medical plan options

When it comes to your health, choice matters. Dolby provides multiple medical plan options to ensure you can select the plan that is right for you and your family.

Comparing medical plan features

The table below shows in-network coverage only. For the OAP and HSA Compatible PPO out-of-network details, visit Dolby.BenefitSpot.com.

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Plan Feature

Cigna Open Access Plus (OAP)

Cigna HSA Compatible Preferred Provider Organization (PPO)

Cigna Health Maintenance Organization (HMO)

Kaiser Health Maintenance Organization
(HMO - CA Only)

Includes Health Savings Account (HSA)?

Yes. Dolby contributes $1,000 for employee-only and $2,000 for employee + dependent coverage

Includes Out-of-Network coverage?

Yes, but you'll save more by staying in-network

No, except in case of emergency

Coinsurance

10%

Copays may apply

Preventive Visits

No charge; not subject to copay or deductible

No charge; not subject to deductible or coinsurance

No charge; in-network only

Deductible

$400 individual / $1,200 family

$2,000 individual / $4,000 family

Prescription Drug (Retail)

30-day fill: $15 / $30 / $50

30-day fill:
30% / 40% / 50% after deductible

30-day fill:
$15 / $30 / $50

30-day fill: $15 / $30

Prescription Drug (Mail Order)

90-day fill:
$30 / $60 / $100

90-day fill:
30% / 40% / 50% after deductible

90-day fill:
$30 / $60 / $100

90-day fill:
$30 / $60

Office Visit

$25

You pay 10% after deductible

$20

Specialist Office Visit

$25

You pay 10% after deductible

$20

$40

Emergency Room Visit

You pay 10% after deductible

$150

Fertility Benefit*

You pay 10% after deductible

Cost varies based on place of service

Plan covers three fertility cycles per lifetime to treat diagnosed infertility

Annual Out-of-Pocket Max

$3,000 individual / $6,000 family

$4,000 individual / $8,000 family

$2,400 individual / $4,800 family

*For details on covered fertility services, check with your medical plan carrier and/or plan documents.