Medical Coverage - Michaels Benefits

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Medical Insurance Plan Options

Michaels offers several medical plan options, all with prescription drug coverage. Here you’ll find information about how each plan works, what costs to expect, and the resources available to you after you’ve enrolled.

Basic & Enhanced PPO	Choice HSA	Kaiser HRA
Administered by BCBSTX¹		Administered by Kaiser
The Basic and Enhanced PPO plans have copays, deductibles, and coinsurance. You can choose any provider, but you’ll save money when you use a provider in the Blue Choice PPO Network.	The Choice HSA plan uses the same network as the PPO plans and covers the same services. You can choose any provider, but you’ll save money when you use in-network providers.	California residents can choose to enroll in the Kaiser HRA plan, but must use a Kaiser provider for the plan to pay benefits.
¹All plans offered by Blue Cross and Blue Shield of Texas (BCBSTX) have separate and higher deductibles and out-of-pocket maximums for out-of-network care. Review the Enrollment Guide for more details on out-of-network benefits.

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What You'll Pay for Medical Care

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	Choice HSA	Basic PPO	Enhanced PPO	Kaiser HRA (CA only)
Money from Michaels (Amount deposited into HSA or HRA; you can use this money to pay for qualified expenses)
Individual	$500	N/A	N/A	$425
Family	$1,000	N/A	N/A	$950
Deductible (Amount you pay before you and Michaels share the cost of care)
Individual	$2,000	$2,500	$1,000	$1,500
Team Member + Spouse/Child	$4,500⁶	$5,000	$2,000	$3,000
Family	$4,500	$5,000	$2,500	$3,000
Out-of-pocket maximum (The most you will pay – including your deductible and copays – before Michaels pays 100% of remaining eligible expenses for the rest of the plan year)
Individual	$6,000	$4,500	$4,500	$3,000
Team Member + Spouse/Child	$12,000	$10,600	$9,000	$6,000
Family	$14,500	$10,600	$10,000	$6,000
What you pay after you meet the deductible (Except as noted)
Office Visits
* Preventive Care²	$0, no deductible	$0, no deductible	$0, no deductible	$0, no deductible
* Primary Care	20%	$25 copay, no deductible	$30 copay, no deductible	$20 copay
* Specialist	20%	$50 copay, no deductible	$50 copay, no deductible	$20 copay
Urgent Care³	20%	$75 copay, no deductible	20%	$20 copay
Retail Clinic⁴	20%	$25 copay, no deductible	20%	$20 copay
Emergency Room⁴	20%	25%	$250 copay + 20%	20%
Hospital Care and Mental Health⁵	20%	25%	20%	20%
Routine Prenatal Care	$0, no deductible	$0, no deductible	$0, no deductible	$0, no deductible
Delivery	20%	25%	20%	20%
¹Out-of-network expenses are paid based on the allowed charge. You are responsible for any amount above the allowed charge, even after you reach your out-of-pocket maximum, if applicable. ²Preventive care includes, but is not limited to, annual exams, annual gynecological exams, routine mammograms, colonoscopies and immunizations (based on age and gender). ³Must be an urgent care issue or you will pay 100% of the cost. Routine, preventive and diagnostic procedures are not covered at urgent care facilities. See your Summary Plan Description (SPD) for more details. ⁴Must be a true emergency or you will pay 100% of the cost. ⁵Pre-certification is required for inpatient care except for delivery. ⁶You must meet the family deductible before the plan shares expenses for any covered family member.

What Each Plan Costs

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	Choice HSA	Basic PPO	Enhanced PPO	Kaiser HRA (CA only)
You
Biweekly	$57.06	$41.26	$109.29	$88.34
Annually	$1,483.56	$1,072.76	$2,841.54	$2,166.84
You + Spouse/Domestic Partner¹
Biweekly	$153.10	$111.29	$274.74	$199.26
Annually	$3,980.60	$2,893.54	$7,143.24	$5,180.76
You + Child(ren)
Biweekly	$112.74	$75.03	$209.47	$157.56
Annually	$2,931.24	$1,950.78	$5,446.22	$4,096.56
You + Family
Biweekly	$189.28	$130.04	$333.94	$234.75
Annually	$4,921.28	$3,381.04	$8,862.44	$6,103.50
¹By law, if a domestic partner does not qualify as a tax dependent, the cost for his/her benefits cannot be paid pretax, and the “value” of Team Member and employer-provided domestic partner contributions is taxable.

Pharmacy Benefits

For more pharmacy information and resources included in each medical plan, visit the Pharmacy Benefits page.

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	BCBSTX Choice HSA	BCBSTX Basic PPO	BCBSTX Enhanced PPO	Kaiser HRA
In-Network Benefits Only
Preventive Drug List¹	$0 copay	$0 copay	$0 copay	$0 (based on ACA required coverage)
Generic	Before you meet deductible, you pay full cost of drug. After you meet deductible, you pay 20%	Retail²: $14 copay Mail-order³: $35 copay	Retail²: $10 copay Mail-order³: $20 copay	Retail²: $10 copay Mail-order³: $20 copay
Preferred Brand	Before you meet deductible, you pay full cost of drug. After you meet deductible, you pay 20%	Retail²: 25% ($50 min; $130 max) Mail-order³: $125 copay	Retail²: $35 copay Mail-order³: $70 copay	Retail²: $30 copay Mail-order³: $60 copay
Non-Preferred Brand⁴	Before you meet deductible, you pay full cost of drug. After you meet deductible, you pay 50% ($100 min; $250 max)	50% after deductible ($100 min; $250 max)	50% after deductible ($100 min; $250 max)	Retail²: $30 copay Mail-order3: $60 copay
Specialty Pharmacy⁵	Before you meet deductible, you pay full cost of drug. After you meet deductible, you pay: Generic: 20% ($200 max) Preferred brand: 20% ($250 max) Non-Preferred brand: 50% ($350 max)	Generic: $14 copay	Generic: $10 copay	$30 copay in most cases
		Preferred brand: 25% ($50 min; $130 max)	Preferred brand: $35 copay
		Non-Preferred brand: 50% after deductible ($350 max)	Non-Preferred brand: Non-Preferred brand: 50% after deductible ($350 max)
Out-of-Pocket Maximum (If you reach this limit, Michaels pays 100% of all remaining eligible prescription drug costs for the rest of the plan year).
Individual	Included in medical out-of-pocket max	$2,050	Included in medical out-of-pocket max	Included in medical out-of-pocket max
Family	Included in medical out-of-pocket max	$4,100	Included in medical out-of-pocket max	Included in medical out-of-pocket max
¹Review the preventive drug list. ²Up to 30-day supply. ³With BCBSTX plans, up to 90-day supply; also available at your local CVS pharmacy, the same as through mail order. The Kaiser HRA allows up to a 100-day supply. ⁴Non-preferred brand drug costs don’t apply to the out-of-pocket-maximum. Up to a 30-day supply. Specialty drug costs apply to out-of-pocket-maximum.

Medicare Eligibility

Are you turning 65 and eligible for Medicare? Contact Medicare Transition Services for information and assistance.

Choosing & Using an HSA or HRA Plan

To help you pay for eligible in-network health care expenses, Michaels contributes to either a Health Savings Account (HSA) if you enroll in the Select HSA plan, or a Health Reimbursement Account (HRA) if you enroll in the Kaiser HRA plan.

The two types of accounts work differently: follow the links for a closer look at each account in order to help you choose.

Deductibles & Coinsurance

Coinsurance and deductibles function differently depending on the plan you choose.

PPO & Kaiser HRA Plans: If you have Family coverage, one person can meet the individual deductible, and then the plan will share costs for that individual (coinsurance).

Choice HSA Plan: If you enroll yourself and at least one (1) dependent, there is no individual deductible. The entire family deductible must be met before the plan pays coinsurance for any covered family member.

To access more detailed benefits documentation, including plan summaries and required legal notices, head over to the Document Library.

Visit the Document Library

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Resources for BCBSTX Plan Members

Your BCBSTX medical plan includes access to a wide variety of medical resources and programs available to you at no additional cost – use the links below to learn more.

Provider Finder

Well onTarget & Health Assessment Program

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Group Numbers for BCBSTX Medical Plans

Enhanced Plan: 363243
Basic Plan: 363244
Choice Plan: 363245

Community Resource Directory

BCBSTX members have access to an online directory with information regarding community resources (i.e. financial assistance, food pantries, medical care, and other free or reduced-cost help) in all states, not just Texas.

Find Services Near You

Helpful Links for BCBSTX Members

Member Welcome: English | Spanish

Blue Access for Members: We’re With You Wherever You Go | Your Health at Your Fingertips

Services: Preventative Services | Virtual Visits | Breast Cancer Screenings

Flu Season Resources: English | Spanish

Travel Coverage with Global Core

Like your passport, always carry your Blue Cross and Blue Shield of Texas (BCBSTX) ID card with you when you travel or live abroad.

Through the Blue Cross and Blue Shield Global Core program, you have access to doctors, hospitals and other health services in nearly 200 countries and territories around the world.