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.
Note: 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.
Basic & Enhanced PPO
The Basic PPO and Enhanced 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
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
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.
To access more detailed benefits documentation, including plan summaries and required legal notices, head over to the Document Library.
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.
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
BCBSTX Resources
Blue Cross & Blue Shield of Texas (BCBSTX)
Medical Insurance (PPO & HSA)
Contact Information
Phone: 1-877-269-1180
Quick Links
Provider Finder
Mercer Health Advantage (MHA) 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.
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
Kaiser Resources
Kaiser Permanente
Enrollment Information & Featured Services
Travel Coverage
Open Enrollment Self-Guide