Mercer Health Advantage (MHA) Program
This program is for Team Members enrolled in a BCBSTX medical plan.
Health Care Help for You
Sometimes managing your health requires more than doctor visits, lab tests, and prescriptions. Blue Cross and Blue Shield of Texas (BCBSTX) makes it easier than ever for you to get the most from your health plan benefits. Your health plan includes the Mercer Health Advantage program, which offers specialized training and support from Personal Health Clinicians and Benefits Value Advisors (BVAs).
To reach a Personal Health Clinician or BVA, simply call the number on the back of your member ID card.
Program Overview
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Personal Health Clinicians
Personal Health Clinicians* are trained to help with your health and benefit questions, concerns, and more. Each clinician is backed by a team of health specialists, including behavioral health clinicians, social workers, and a pharmacist.
A Personal Health Clinician* can help you:
- Keep up with doctor’s appointments and other care-related activities.
- Review your doctor’s instructions.
- Coordinate your care needs after an illness, procedure or surgery.
- Know what to expect if you spend time in the hospital.
*Talking with a Personal Health Clinician is not a substitute for medical advice. Care and treatment decisions are between you and your health care provider. If you are having a medical emergency, call 911.
Benefits Value Advisors (BVAs)
Available 24 hours a day, seven days a week, Benefits Value Advisors (BVAs) partner with dedicated Personal Health Clinicians to help you get the most from your benefits. BVAs can help you get costs for providers and procedures, assist with referrals and prior authorizations, schedule appointments and more.
Know Your Benefits
24/7 Nurseline
- Answers general health questions
- Helps you decide where to get care
Behavioral Health
- Covers treatment for anxiety, stress and depression
- Helps with substance use and eating disorders, autism and other conditions
Fitness Program
- A choice of gym networks to fit your budget and preference
- Different membership options2 to best meet needs and preferences
- Provides discounts at 40,000 well-being providers nationwide
Women’s and Family Health
- Ovia®, Ovia® Pregnancy, or Ovia™ Parenting Apps
- Helps with high-risk pregnancies
- Support from maternity specialists
Stay in Touch with BCBSTX
You can decide how you want Blue Cross and Blue Shield of Texas (BCBSTX) to contact you about your health plan benefits. Below are three quick steps to take now to make using your health plan easier. This way, when you need to use your benefits, you’ll be ready to go.
Step 1: Put the BCBSTX phone number in your contact list.
- You can reach a BCBSTX Personal Health Clinician or Benefits Value Advisor (BVA) by calling the number on the back of your member ID card.
- Personal Health Clinicians can answer questions about your health insurance and help you navigate the health care system. A BVA can help you get costs for providers and procedures, assist with referrals, schedule appointments, set up pre-authorizations and more.
- Put this number in your phone contact list now!
Step 2: Tell BCBSTX how you want to stay in touch.
- Add or update your contact preferences by visiting upp.bcbstx.com.
- This way, BCBSTX will know how to reach you with important benefits and health information.
Step 3: Download and use the BCBSTX app to find a doctor, access your digital ID card, and more. To download, just text BCBSTXAPP to 33633.
Nobody wants to imagine their pet getting sick or injured, but when it comes to your pet’s health, it’s best to expect the unexpected. When you enroll in Pet Health Insurance, administered by Wishbone, you will receive a 70% reimbursement on your pet’s veterinary care after meeting the $250 deductible. Protecting your pet’s health and your finances has never been easier!
Wishbone Pet Insurance is accepted at any vet in the U.S., including emergency hospitals. Once you file a claim, you can expect a fast reimbursement via a mailed check.
This benefit will not be set up as a payroll deduction but instead by credit card payment through Wishbone.
Helpful Resources
Provider
Blue Cross & Blue Shield of Texas (BCBSTX)
Medical Insurance (PPO & HSA)
Contact Information
Phone: 1-877-269-1180
Quick Links
Pet Health Insurance
Prepare for the Unexpected with Your Pet's HealthWishbone Pet Health Insurance
Plan Information
Nobody wants to imagine their pet getting sick or injured- but when it comes to your pet’s health, it’s best to expect the unexpected.
Enroll in pet health insurance from Wishbone and receive 70% reimbursement on your pet’s veterinary care. With a low deductible of $250, protecting your pet’s health and your finances
has never been easier!
Wishbone Pet Insurance is accepted at any vet in the U.S., including emergency hospitals. Once you file a claim, expect fast reimbursement via mailed check. It’s that easy!
Nobody wants to imagine their pet getting sick or injured, but when it comes to your pet’s health, it’s best to expect the unexpected. When you enroll in Pet Health Insurance, administered by Wishbone, you will receive a 70% reimbursement on your pet’s veterinary care after meeting the $250 deductible. Protecting your pet’s health and your finances has never been easier!
Wishbone Pet Insurance is accepted at any vet in the U.S., including emergency hospitals. Once you file a claim, you can expect a fast reimbursement via a mailed check.
This benefit will not be set up as a payroll deduction but instead by credit card payment through Wishbone.
Provider
Pet Benefit Solutions
Voluntary Hospital Indemnity Insurance
Voluntary Hospital Indemnity Insurance
Plan Information
Hospital Indemnity Insurance, administered by Reliance Matrix, provides a range of fixed, lump-sum daily benefits to help cover costs associated with a hospital admission, including room and board costs. These benefits are paid directly to the insured following a hospitalization that meets the criteria for benefit payment.
Voluntary Hospital Indemnity Insurance Plan Highlights: English | Spanish
Voluntary Hospital Indemnity Insurance, administered by Reliance Matrix, provides a range of fixed, lump-sum daily benefits to help cover costs associated with a hospital admission, including room and board costs. These benefits are paid directly to you following a hospitalization that meets the criteria for benefit payment.
If you are newly eligible to enroll in benefits, you can elect Hospital Indemnity Insurance coverage up to the Guarantee Issue without answering any health questions. Otherwise, you will be required to provide Evidence of Insurability (EOI) and be approved by Reliance Standard before coverage begins.
Voluntary Hospital Indemnity Insurance Plan Highlights: English | Spanish
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Eligibility
All benefits-eligible full-time Team Members and covered dependents are eligible for Hospital Indemnity Insurance.
Dependents can include:
- Your legal spouse or domestic partner.
- Your dependent children from birth to 26 years.
A person may not have coverage as both a Team Member and a dependent.
Biweekly Premiums
| Coverage | Premium – High |
Schedule of Benefits
| Benefits | Amount |
| Hospital Room & Board | $100 per day (30 daily benefits per plan year*) |
| Hospital Critical Care Unit | $200 per day (15 daily benefits per plan year) |
| Hospital Admission & Observation | $1,000 (2 daily benefits per plan year) |
| Hospital Critical Care Admission | $2,000 (1 daily benefit per plan year) |
| Wellness Care** | $50 (1 daily benefit per plan year) |
| On-Call Travel Assistance Services | Included |
*In no event will the Daily Benefits exceed 30 daily benefits per Coverage Year.
**Wellness Care means medical examinations and procedures that are preventive in nature and not for the treatment of Injury or Sickness.
Features
- Guaranteed issue; no medical questions
- No pre-existing conditions exclusions
- Mental & Nervous and Substance Abuse treated same as any
other hospital admission - No deductibles
- Eligible for continuation of coverage
- HIPAA privacy compliant
- Overlying Major Medical Plan NOT Required*
- Coverage Offered on a Voluntary Basis
Video Overview of Leave, Disability & Voluntary Benefits
Get Support
For assistance, contact Team Member Services at 855-432-MIKE (6453) and select option 2, available Monday through Friday from 8 a.m. to 5 p.m. CT. You can also open a Knowledge Zone support ticket.
File Your Claim(s) Online with Reliance Matrix
Guidance for Filing Claims with Reliance Matrix
How-To Guides
- Easy Access Claims Filing - Process flow overview for filing claims with Reliance Matrix.
- Filing Claims with Reliance Matrix - Applies to Leave of Absence (LOA), Disability, and Voluntary benefits.
- How to File Claims for Short-Term Disability (STD) & Family Medical Leave of Absence (FMLA)
- How to File Claims for Voluntary Accident, Hospital Indemnity & Critical Illness
- Download the Matrix eServices App
Important Note About Claims for Kaiser Members
Team Members who are enrolled in a Kaiser medical plan must complete an authorization release form in order to file a claim with Reliance Matrix.
- Reliance Matrix will provide you with the authorization release form to sign and return.
- This form is required in order for Reliance Matrix to obtain the required medical certification from your physician.
- Failure to provide the signed authorization release form to Reliance Matrix will result in your claim being denied.
Reliance Matrix
Disability, Life & AD&D, Accident, Critical Illness, Hospital Indemnity Insurance
Contact
Phone: 1-800-351-7500
Wellness Programs & Surcharges
Be Proactive with Your Wellness & Avoid SurchargesWellness at Michaels
Good health improves virtually every aspect of our personal and professional lives, and that’s good for you and for Michaels. Our wellness programs focus on more than just your physical health: they challenge you to be mentally, emotionally, and financially healthy, too. Whether your goal is to lose weight, be more proactive with your health, eat healthier, or save more, we’ve got you covered.
Benefits Plan Year: The plan year for Michaels benefits coverage begins on July 1 and ends on June 30, regardless of when you are hired.
Important Note
If you think you might not be able to meet a wellness or tobacco-use standard, resulting in a surcharge being added to your annual medical premium, you may qualify through other means. For further assistance, please call 1-855-432-MIKE (6453) and we will work with you – and if you wish, with your doctor – to find a reasonable alternative.
Wellness Exam Surcharge
Team Members and their spouse/domestic partner enrolled in a Michaels full-time medical plan are subject to an annual preventative wellness requirement, with the potential to waive wellness surcharges and lower annual premium costs.
Completing an annual physical exam during the current plan year will satisfy the wellness requirement and waive the surcharge for the next plan year.
Surcharge Rate
If you and your spouse/domestic partner do not satisfy the wellness requirement, you will pay a surcharge of $30 per person, per paycheck, totaling $780 per person for the 2024-2025 plan year.
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How to Have Your Wellness Surcharge Waived
To satisfy the wellness requirement, you (and if applicable, your spouse or domestic partner) must:*
First, complete a physical exam between July 1 and June 30 in one of two ways:
- Schedule an appointment with your primary care physician (PCP).
- Blue Cross & Blue Shield of Texas (BCBSTX) members can use the Catapult Health VirtualCheckup® Home Kit – the cost is 100% covered by Michaels! For more details, refer to the section below.
Then, submit your proof of exam documentation to insurance to waive your surcharge for the following plan year.
*If you were hired July 1 or later in the current plan year, please refer to the next section for information about one-time exceptions for new hires.
Example: You complete your annual physical exam on Aug. 2, 2024 and submit proof of your exam to insurance on Jan. 12, 2025, satisfying the wellness requirement. As a result, your surcharge is waived for the next plan year that goes from July 1, 2025 through June 30, 2026, lowering your annual premium cost for that plan year.
| 2024-2025 Plan Year | 2025-2026 Plan Year | |
|---|---|---|
| July 1, 2024 – June 30, 2025 | July 1, 2025 – June 30, 2026 | |
| Aug. 2, 2024 | Jan. 12, 2025 | Surcharge Waived (No wellness surcharge on next year's premium) |
| Annual Physical Exam | Submit Proof of Exam to Insurance | |
Exceptions for New Hires
There are exceptions to the wellness requirement for Team Members who begin their employment with Michaels after the current benefits plan year has already begun.
For new hires, benefits are effective the first day of the month following the Team Member’s date of hire.
For a Benefit Effective Date of March 2, 2024 or Later
- You are exempt from the wellness requirement for the current plan year (through June 30) and for the upcoming plan year (from July 1 through June 30), and this surcharge will automatically be waived.
- The above also applies to your spouse or domestic partner, if enrolled as your dependent.
Example: If your hire date was Feb. 15, 2024, your benefits will be effective on April 1, 2024, and you (and if applicable, your spouse or domestic partner) will not be required to satisfy the wellness requirement.
No-Cost VirtualCheckup® for BCBSTX Members
If you are enrolled in a BCBSTX medical plan, Michaels provides a convenient annual checkup at no cost to you using the Catapult Health VirtualCheckup® Home Kit. Getting a FREE preventive health checkup has never been easier, and a Catapult virtual exam counts toward your wellness requirement!
All covered employees and their spouse or domestic partner can register for a Home Kit. The cost of your VirtualCheckup® is covered 100% by Michaels.
Once you complete your Home Kit, you will review your results with a board-certified Nurse Practitioner via a virtual consultation and develop a personal action plan.
Additional Information
Next Steps for BCBSTX Members
Your wellness exam claim will automatically be processed by BCBSTX after your appointment. Once processed, your exam completion status will be reflected in the Well onTarget section of the BlueAccess for Members portal. In the portal, you can also access other historical data about your participation in the available wellness programs.
If you have any questions regarding wellness completion within the BCBSTX portal, please contact BCBSTX customer service at 1-877-269-1180.
Refer to the job aid below for instructions on how to log in to the BlueAccess for Members portal to confirm the status of your wellness requirement.
Job Aid: How to Confirm the Status of Your Wellness Requirement – Desktop | Mobile App
Next Steps for Kaiser Members
Once you have scheduled your wellness exam with your primary care physician (PCP), log in to the US Wellness portal to download/print the Physician Form and take it to your appointment.
After your appointment, upload the completed Physician Form to the US Wellness portal by June 30. You can upload the form using your desktop, tablet, or mobile device. Receipt of your form will be confirmed within two (2) business days to the email address provided at the time of upload.
Refer to the job aid below for instructions on how to download/print your Physician Form and upload your completed document in the US Wellness portal to complete your wellness requirement.
Job Aid: How to Download/Print the Physician Form & Complete Your Wellness Requirement
For assistance with this process, email US Wellness at support@uswellness.com or call 888-926-6099 ext. 900.
Tobacco Surcharge
Team Members and their spouse/domestic partner enrolled in a Michaels full-time medical plan are encouraged to be tobacco-free to waive tobacco surcharges and lower annual premium costs.
If you are considered tobacco-free, your tobacco surcharge will be waived for the current plan year.
Surcharge Rate
If you and your spouse/domestic partner are not considered tobacco-free, you will pay a surcharge of $30 per person, per paycheck, totaling $780 per person for the 2024-2025 plan year.
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How to Have Your Tobacco Surcharge Waived
You will select your tobacco-free or tobacco-use status when you enroll in your benefits each year, and you can only update your status during the enrollment period.
To be considered tobacco-free, you can’t use tobacco products for at least six (6) months. Tobacco use includes the use of e-cigarettes and non-nicotine vaporizers.
Tobacco Cessation Program
A Tobacco Cessation Program is available for Team Members who are enrolled in a BCBSTX medical plan. Choose an option below to access additional information about the program.
- Log in to your BCBSTX account.
- Visit the Well onTarget website and either register for an account or log in using your BCBSTX credentials.
Tobacco Cessation Resources
What is Supportiv?
Program Information & Resources
Through the Michaels Employee Assistance Program (EAP), you have unlimited access to Supportiv, an online peer support service that can help you cope with stress, work, family issues, loneliness, anxiety, parenting, motivation, and more.
Supportiv is an online tool that lets you talk through any mental health, emotional, or social struggles in small group chats with people who can relate. Discussions are anonymous and are guided and safeguarded in real time by professional facilitators. Supportiv is anonymous and available 24/7.
Supportiv is available to all Michaels Team Members and their household members.
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Get Started with Supportiv
Supportiv is free to use at your convenience, there’s no need to enter any personal information, and you’ll be live chatting in about 30 seconds.
- Visit Supportiv and select the “Chat Now” button.
- Submit your question or challenge.
- Get matched with peers to chat with, and receive guidance and hyper-targeted recommendations from a professional facilitator.
In the event of an emergency, please call 911. Additional crisis and emergency resources can be found by visiting the following link: Emergency Resources.
Video Introduction
The video below offers a one-minute demonstration of how Supportiv works.
401(k) Plan
Your Guide to the Michaels 401(k) Retirement Plan with Voya FinancialConfirm Your Mailing Address in Workday
Make sure your mailing address is up-to-date in Workday so that you don’t miss any upcoming mailings about the Voya 401(k) plan transition. You will receive a PIN in the mail that you’ll be required to have in order to register and access your Voya account.
Saving for Your Retirement
Today, becoming financially prepared for your retirement is more important than ever. We partner with Voya Financial® to bring you an enhanced experience for the Michaels Stores, Inc. Employees 401(k) Plan, previously administered by Vanguard.
Account Access & Support
Visit the Plan website to enroll in the plan, make changes to your account, and obtain forms or information.
- You will always need your PIN to speak with a Voya customer service associate about your account, to make a transaction, and/or to make automated transactions.
- You can make automated transactions 24 hours a day.
Plan Overview
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Eligibility Requirements
- Full-time team members who are 21 years of age and over are eligible to participate on their first day of employment.
- Part-time team members who are 21 years of age and over are eligible to participate after they have completed 500 hours of service.
Contribution Limits
You may contribute up to 80% of your eligible compensation* on a pre-tax, Roth, or after-tax basis. Please note: your after-tax contribution may not exceed 10% of your eligible compensation and your total contribution may not exceed 80%. If you are age 50 or older in the calendar year and you have reached the IRS contribution limit, your contributions will “spillover” for additional catch-up contributions up to the annual IRS annual limit*.
Voluntary Rate Escalator
Increasing your contributions on a regular basis may help you reach your savings goals faster. The Contribution Rate Escalator can automatically increase your contributions on a schedule you select. You can choose the increase percentage and how often it takes effect. You can change the settings or turn off rate escalation at any time.
Employer Match
Michaels Stores will match 100% up to the first 3% plus 50% on the next 2% of your eligible compensation. This contribution is an employer matching contribution.
- Please note that Michaels provides a true-up match in case you meet your IRS contribution early in the year.
- Full-time team members are eligible for the match after completing three months of service.
Note: After-tax contributions are NOT eligible to receive the company match.
Vesting & Rollovers
Vesting
To be vested is to own the money in your account. You’re 100% vested in your own contributions, employer matching contributions, rollover contributions, and any investment earnings on those contributions.
Rollovers
Balances from eligible retirement savings plans, such as a previous employer’s plan, may be rolled into your Plan account. Consolidating multiple retirement accounts may make it easier to manage your savings because your money is all in one place. Go the Plan website to download a Rollover-in form.
Investment Options & Advice
Investment Options
The Plan offers a range of Target Date Funds and Individual Core Funds. You can elect to invest in any fund or combination of funds, your choices should be made in increments of 1% and the total equals 100%. You may change your investment options at any time.
Investment Advice
Investment advice is offered through Voya Retirement Advisors** (VRA), powered by Edelman Financial Engines®. With VRA, you can receive investment advice by speaking to a VRA Investment Advisor Representative, using Online Advice, or enrolling in Professional Management.
Automatic Account Rebalancing
The value of your funds may go up and down over time which can cause your asset allocation to change, that is, your percentage in stocks, bonds, and cash. This could affect your investment objectives and risk level. Automatic rebalancing can help to maintain your preferred asset allocation percentages.
You can set your account to automatically rebalance quarterly, semi-annually, annually or on a one-time basis. If you manually change your investment elections or move money from one fund to another, automatic rebalancing will stop, and you will need to reset it to continue to have your account rebalanced. You can start, stop, or change the frequency of automatic rebalancing at any time.
Conversions
This plan offers in-plan Roth conversion. However, you must call Voya to make this election.
For assistance with electing in-plan Roth conversion, call Voya at 833-39M-401K (833-396-4015). Voya customer service associates are available weekdays from 7 a.m. to 7 p.m. CT, except on stock market holidays. Spanish-speaking associates are also available.
Transition from Vanguard
For Team Members who had a 401(k) plan administered by Vanguard, your account details – including your investments, contribution elections, beneficiaries and loans – were automatically transitioned to Voya. You will have access to your historical plan information at vanguard.com for two (2) years following the transition: for assistance with this information, call Vanguard at 800‑523‑1188.
Voya 401(k) Trainings
- Dive into asset classes, sub asset classes and risk
- In Retirement
- Understanding loans and withdrawals
- Nearing Retirement Series: Getting Started
All Team Members can access the Voya trainings regardless of their 401(k) participation status.
More Resources
Voya Retire App
Download the Voya Retire app to access a simplified version of the website.
Need Help?
If you need assistance, call Voya at 833-39M-401K (833-396-4015). Voya customer service associates are available weekdays from 7 a.m. to 7 p.m. CT, except on stock market holidays. Spanish-speaking associates are also available.
*Contributions are subject to annual IRS limits. Visit voyadelivers.com/IRSlimits for current limits.
**Advisory Services provided by Voya Retirement Advisors, LLC (VRA). VRA is a member of the Voya Financial (Voya) family of companies. For more information, please read the Voya Retirement Advisors Disclosure Statement, Advisory Services Agreement, and your plan’s Fact Sheet. These documents may be viewed online by accessing the advisory services link(s) through your plan’s website. You may also request these from a VRA Investment Advisor Representative by calling your plan’s information line. Financial Engines Advisors L.L.C. (FEA) acts as a sub advisor for Voya Retirement Advisors, LLC. Financial Engines Advisors L.L.C. (FEA) is a federally registered investment advisor. Neither VRA nor FEA provides tax or legal advice. If you need tax advice, consult your accountant or if you need legal advice consult your lawyer. Future results are not guaranteed by VRA, FEA or any other party and past performance is no guarantee of future results. Edelman Financial Engines® is a registered trademark of Edelman Financial Engines, LLC. All other marks are the exclusive property of their respective owners. FEA and Edelman Financial Engines, L.L.C. are not members of the Voya family of companies. ©2024 Edelman Financial Engines, LLC. Used with permission.
Nothing in this communication should be construed as constituting financial or tax advice. You are encouraged to consult with your personal financial planner and/or tax advisor.
Plan administrative services are provided by Voya Institutional Plan Services, LLC (VIPS). VIPS is a member of the Voya® family of companies.
This is a brief, non-technical description of certain provisions of the Plan. It is not intended to be a complete statement. If a description in this summary differs from the Plan documents, the Plan documents prevail. For additional information regarding the Plan, please refer to the Summary Plan Description (SPD).
Service Awards
Recognizing Team Members’ Years of ServiceService Award Program
The Service Award Program celebrates our incredible and creative Team Members across the business, recognizing anniversary milestones for Team Members’ years of service and awarding those who have spent a significant portion of their careers with Michaels. We value our Team Members’ continued commitment and contributions to Michaels – nothing we do would be possible without you.
Based on feedback from Team Members and in collaboration with leaders across the organization, this enhanced program replaces the prior service award program that was suspended in early 2020 during the COVID-19 pandemic.
Award Milestones
One-Year Anniversary
Team Members will receive a one-year anniversary certificate to celebrate this important milestone.
Five-Year Pins
Beginning at five years of service and every five years that follow, Team Members will receive a certificate of congratulations and an anniversary pin.
Anniversary Milestone Cash Awards
Upon achieving 20 years of service, Team Members will receive a cash award for their 20-year anniversary milestone and every five years that follow, according to the chart below. Please note that Team Members must be in an active status within Workday to receive the cash incentive.
| Anniversary Milestone | Cash Award |
| 20 years | $250 |
| 25 years | $500 |
| 30 years, 35 years | $1,000 |
| 40 years, 45 years | $1,500 |
| 50 years | $2,000 |
More than 750 cash awards were issued retroactively for active Team Members who achieved a milestone of 20 or more years of service on or after Jan. 1, 2020, and through Nov. 7, 2023.
Questions?
If you have a question regarding the Service Award Program, please either open a request with Human Resources in the Knowledge Zone or call 855-432-MIKE (6453) and select Option 2.
Benefits Orientation Video
Full-Time Team Members
Benefits Orientation Video
Part-Time Team Members
Document Library
For benefits effective July 1 to June 30Plan Year 2024-2025 Documents
This page houses information you may need as you use your benefits throughout the year. New and updated documents are posted regularly.
Required Legal Notices
Summaries of Benefits & Coverage (SBC)
Summary Plan Descriptions (SPD)
Short-Term Disability
- Short-Term Disability SPD – Class 1: 2024 | 2025
- Short-Term Disability SPD – Class 2: 2024 | 2025
- Short-Term Disability – Hourly Class 1 (US Full-Time Hourly Store Team Members)
- Short-Term Disability – Hourly Class 2 (US Full-Time Hourly Distribution Center & Artistree Team Members)
- Short-Term Disability – Hourly Class 3 (US Full-Time Hourly Support Center Team Members)
Long-Term Disability
- Long-Term Disability – Class 1 (US Full-Time Vice Presidents and above)
- Long-Term Disability – Class 2 (US Full-Time Directors, District Managers, Support Center Senior Buyers, Support Center Managers, Distribution Center & Artistree Management Level 2)
- Long-Term Disability – Class 3 (US Full-time Hourly Store Managers, Hourly Assistant Managers & Salaried Team Members)
- Long-Term Disability – Class 4 (US Full-time Hourly Team Members)
- Basic Life & AD&D (US Full-time Team Members)
- Optional Life (US Full-time Team Members)
- Optional AD&D (US Full-time Team Members)
- Executive Life Class 1 (US and Canadian Senior Vice Presidents and above)
- Executive Life Class 2 (US and Canadian Vice Presidents)
- Executive Life Class 3 (US and Canadian Directors)
Blue Cross & Blue Shield of Texas (BCBSTX)
Kaiser
Accident:
Critical Illness:
Hospital Indemnity:
Pharmacy Benefits
Save Time & Money on Your PrescriptionsPrescription Drug Coverage
Plan Highlights
Our BCBSTX medical plans use the Prime Therapeutics Balanced Drug List Formulary, which is a list of preferred drugs that cost you less. If your doctor writes you a prescription, make sure it’s on the formulary, and if it’s not, ask your doctor whether another drug on the formulary will work for you.
- You can fill one prescription for a maintenance medication at a retail pharmacy before the home delivery requirement applies.
- You have the option to get 90-day supplies at CVS Pharmacy locations.
- If you’re enrolled in the Choice HSA, you can use your HSA to pay for prescription drugs.
Note: If you’re enrolled in the Kaiser HRA plan, you must fill your prescriptions at a Kaiser-associated pharmacy in order for them to be covered. You can use your HRA to pay for prescription drugs.
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Retail Pharmacies
Retail pharmacies are best for filling medications that you’ll use for 30 days or less. You can get your medication and begin using it almost immediately. You can also receive a 90-day supply at your local CVS pharmacy, and you won’t have to wait to receive it.
CVS Pharmacy is In-Network
- CVS Pharmacy is in-network for BCBSTX and will fill your prescriptions.
- If your CVS Pharmacy is one that doesn’t immediately recognize your plan, you can request that they process your ID card again to confirm.
- Michaels and BCBSTX are working with CVS Pharmacy to ensure communication of the BCBSTX in-network status to all CVS Pharmacy locations so that Team Members will not experience issues getting prescriptions filled due to pharmacists incorrectly notifying Team Members that CVS does not accept BCBSTX coverage.
90-Day Home Delivery Prescriptions
Home delivery prescriptions are best for filling medications that you’ll take for 90 days or more.
- Make sure you ask your doctor to write the prescription for 90 days instead of 30.
- Your doctor may be able to upload your prescription directly to the prescription drug provider. Otherwise, you must complete a Home Delivery Service Form in the BCBSTX member portal and send in your written prescription.
- It can take up to two weeks for you to receive your medication using this method. If you need medication immediately, ask your doctor for a 30-day prescription that you can fill at your local pharmacy.
For maintenance medications, 90-day home delivery is required. Refer to the next section for more details.
Maintenance Medications
Maintenance medications are prescriptions that you need on a regular basis for an ongoing condition, such as high blood pressure.
Maintenance medications on the preventive drug list are available for $0 copay with no deductible.
90-Day Home Delivery Requirement
If you are enrolled in a BCBSTX plan and you take a maintenance medication, it is mandatory that you use 90-day home delivery. You will be allowed one 30-day fill at a pharmacy location. After that, you’re required to get a 90-day supply either through mail order or at a local CVS Pharmacy.
In-Network Benefits
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Tap or click the content below and scroll to access all the information.
| 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) |
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| 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. |
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Helpful Resources
Split-Fill Program
For no additional cost, eligible Team Members can take advantage of the Specialty Drug Split-Fill program to try a partial quantity of a newly prescribed specialty drug before the full month’s supply is filled.
Drug Lists
- Balanced Drug List Formulary (includes Dispensing Limits, Prior Authorization Programs, and Step Therapy Programs)
- Contraceptive List (ACA)
- Drug List (ACA)
- Specialty Drug List