Medical Coverage
Effective July 1 to June 30Medical Plan Options
Michaels offers several medical plan options, all with prescription drug coverage. This page outlines how each plan works and what costs to expect. All 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.
PPO Plans
PPO plans have copay, deductibles, and coinsurance. You can choose any provider, but you’ll save money when you use a provider in the Blue Choice PPO Network.
Choice HSA Plan
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.
Kaiser HRA Plan
California residents can choose to enroll in the Kaiser HRA plan, but must use a Kaiser provider for the plan to pay benefits.
Costs & Coverage
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What You Pay When You Receive Care In-Network
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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) |
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| 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) |
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| 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) |
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| 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) |
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| 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. |
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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. | ||||
Medicare Eligibility
Are you turning 65 and eligible for Medicare? Contact Medicare Transition Services for information and assistance.
How to Choose Your Plan
Follow the link below for more guidance on how to choose the medical plan that best meets your needs.
Choosing & Using Your HSA or HRA
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.
BCBSTX Group Numbers
- Enhanced Plan: 363243
- Basic Plan: 363244
- Choice Plan: 363245
Kaiser Resources
Costs & Coverage
What You Pay When You Receive Care In-Network
| Choice HSA | Basic PPO | Enhanced PPO | Kaiser HRA |
| Money from Michaels (Amount deposited into HSA or HRA. You can use this money to pay for health care expenses.) | |||
| Individual | |||
| $500 | N/A | N/A | $425 |
| Family | |||
| $1,000 | N/A | N/A | $950 |
| Deductible (The amount you must pay before the plan will pay benefits for non-preventive care). | |||
| Individual | |||
| $1,750 | $2,500 | $750 | $1,500 |
| Family | |||
| $3,500 | $5,000 | $1,500 | $3,000 |
| Preventive Care2 | |||
| $0, no deductible | $0, no deductible | $0, no deductible | $0, no deductible |
| Office visits | |||
| 20% | Primary Care $25 copay, no deductible Specialist $50 copay, no deductible |
Primary Care $25 copay, no deductible Specialist $40 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 Room5 | |||
| 20% | 25% | $250 copay + 20% | 20% |
| Hospital Care and Mental Health6 | |||
| 20% | 25% | 20% | 20% |
| Routine Prenatal Care | |||
| $0, no deductible | $0, no deductible | $0, no deductible | $0, no deductible |
| Delivery | |||
| 20% | 25% | 20% | 20% |
| Out-of-pocket maximum (The maximum amount you will have to pay out of pocket. If you reach this amount, Michaels will pay 100% of your eligible expenses for the rest of the plan year). | |||
| Individual | |||
| $5,000 | $4,500 | $4,000 | $3,000 |
| Family | |||
| $12,500 | $10,600 | $8,000 | $6,000 |
1. Out-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.
2. Preventive care includes, but is not limited to, annual physical exams, annual gynecological exams, routine mammograms, colonoscopies and immunizations. Coverage for preventive care is based on federal guidelines for frequency and age.
3. Must be an urgent care issue or you will pay 100% of the cost. See your Summary Plan Description (SPD) for more details.
4. BCBSTX participants may only use clinics inside a pharmacy or retail store such as CVS MinuteClinic. Kaiser participants may use approved Kaiser clinics at specified locations or inside certain Target Stores.
5. Must be a true emergency or you will pay 100% of the cost. See your Summary Plan Description (SPD) for more details.
6. Pre-certification is required for inpatient care except for delivery.
What Each Plan Costs
| Choice HSA | Basic PPO | Enhanced PPO | Kaiser HRA | |
| Biweekly | $51.88 | $38.93 | $99.36 | $74.19 |
| Annually | $1,348.88 | $1,012.18 | $2,583.36 | $1,928.94 |
| Biweekly | $139.18 | $104.99 | $249.76 | $177.28 |
| Annually | $3,618.68 | $2,729.74 | $6,493.76 | $4,609.28 |
| Biweekly | $102.48 | $70.78 | $190.43 | $140.23 |
| Annually | $2,664.48 | $1,840.28 | $4,951.18 | $3,645.98 |
| Biweekly | $172.08 | $122.68 | $303.58 | $208.73 |
| Annually | $4,474.08 | $3,189,68 | $7,893.08 | $5,426.98 |
Medicare Eligibility
Are you turning 65 and eligible for Medicare? Contact Medicare Transition Services for information and assistance.
Choosing & Using Your HSA or HRA
BCBSTX Group Numbers
- Enhanced Plan: 363243
- Basic Plan: 363244
- Choice Plan: 363245
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.
Providers
- Phone: 1-877-269-1180
- Log In
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