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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.

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)?
No
Yes. Dolby contributes $1,000 for employee-only and $2,000 for employee + dependent coverage
No
No
Includes Out-of-Network coverage?
Yes, but you'll save more by staying in-network
Yes, but you'll save more by staying in-network
No
No
Coinsurance
10%
10%
Copays may apply
Copays may apply
Preventive Visits
No charge; not subject to copay
No charge; not subject to deductible or coinsurance
No charge; in-network only
No charge; in-network only
Deductible
$400 individual/$1,200 family
$2,000 individual/$4,000 family
$0
$0
Prescription Drug (Retail)
$15/$30/$50
You pay 30%/40%/50% after deductible
$15/$30/$50
$15/$30
Prescription Drug (Mail Order)
$30/$60/$100
You pay 30%/40%/50% after deductible
$30/$60/$100
$30/$60
Office Visit
$25
You pay 10% after deductible
$20
$20
Fertility Benefit*
10% after deductible up to a lifetime maximum of $20,000
10% after deductible up to a lifetime maximum of $20,000
Coverage varies based on place of service up to a lifetime maximum of $20,000
Plan covers one fertility cycle per lifetime. Additional eligible services subject to 50% coinsurance
Annual Out-of-Pocket Max
$2,500 individual/$5,000 family
$3,000 individual/$6,000 family
$2,000 individual/$4,000 family
$2,000 individual/$4,000 family

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

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