Medical Insurance Plan Options
Already enrolled in a medical plan? Go to Member Resources & Programs.
Choice HSA
You pay the plan rate for doctor visits, services, and prescriptions until your annual deductible is met.
You can choose any provider, but you’ll save money when you use providers in the BCBSTX network.
Basic PPO
You pay a flat fee for doctor visits, services, and prescriptions. These expenses count toward your annual deductible.
You can choose any provider, but you’ll save money when you use providers identified in Tier 1 of the CareWay network.
Enhanced PPO
You pay a flat fee for doctor visits, services, and prescriptions. These expenses count toward your annual deductible.
You can choose any provider, but you’ll save money when you use providers identified in Tier 1 of the CareWay network.
360 Protect Plan
You pay a flat fee for doctor visits, services, and prescriptions, often at lower prices than a typical PPO. These expenses will count toward your annual deductible.
You can choose any provider, but you’ll save money when you use select or national select or national Imagine360 providers.
Kaiser HRA
California Only
Team Members in California may choose to enroll in the Kaiser HRA plan, which functions similarly to a PPO plan.
You must use a provider in the Kaiser network in order for the plan to pay benefits.
Understanding How the Plans Work
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PPO vs. HDHP Plans
If you are deciding between a Preferred Provider Organization (PPO) plan, or our Choice HSA High-Deductible Health Plan (HDHP), it’s important that you understand the basic components of each plan type. Use this comparison chart to help you identify which plan type may be best for you and your family.
Which plan may be right for me?
- PPO if: You prefer predictable, fixed costs at the doctor’s office and want individual deductibles for your family because a member needs more care.
- Choice HSA if: You generally only visit the doctor for annual check-ups and want to build long-term savings for healthcare.
| Basic PPO, Enhanced PPO, and 360 Protect Plan | BCBSTX Choice HSA (HDHP) | |
|---|---|---|
| Premiums | Variable Premiums: There are four PPO plans available to choose from. The Basic PPO plan offers the lowest per-paycheck cost of all plans. | Moderate Premiums: Higher per-paycheck cost than the Basic PPO. Offers long-term savings opportunity with a health savings account (HSA). |
| Copays | Predictable Fees with Copays You pay flat fees for doctor visits and prescriptions from day one, without having to first meet a deductible. | No Copays: You pay for services and prescriptions until your deductible is met; then the plan will pay a portion of the cost. |
| Deductibles | Individual-Focused: Once one person on the plan meets their deductible, the plan coinsurance starts paying for that person. Best for those with chronic conditions or frequent specialist visits. | Family-Focused: The entire family deductible must be met before the plan coinsurance begins sharing costs. Best for those who mainly need preventive care and are generally healthy. |
| Coinsurance | Ongoing Care: Once deductibles are met, the plan (Michaels) pays a portion of the cost for services. | Ongoing Care: Once deductibles are met, the plan pays a portion of the cost for services. |
| Out-of-Pocket Maximum | Total Protection: Once you hit your annual limit, the plan pays 100% of all eligible medical costs. Vary by PPO plan. | Total Protection: Once you hit this limit, the plan pays 100% of all eligible medical costs. |
| Pre-Tax Accounts | Healthcare FSA: Use-it-or-lose-it" account. Best for predictable, annual medical expenses. You contribute pre-tax dollars from your paycheck, Michaels does not. | HSA: Yours to keep. Michaels contributes funds and you can contribute pre-tax dollars from your paycheck to pay for eligible expenses, and the balance rolls over every year. |
| Basic PPO, Enhanced PPO y 360 Protect Plan | BCBSTX Choice HSA (HDHP) | |
|---|---|---|
| Primas | Primas variables: Hay cuatro planes PPO disponibles para elegir. El plan PPO básico ofrece el costo por nómina más bajo de todos los planes. | Primas moderadas: Costo por nómina más alto que el PPO básico. Ofrece la oportunidad de ahorrar a largo plazo con una cuenta de ahorros para la salud (HSA). |
| Copagos | Predictable Fees with Copays You pay flat fees for doctor visits and prescriptions from day one, without having to first meet a deductible. | Tarifas predecibles con copagos Usted paga tarifas fijas por las visitas al médico y las recetas desde el primer día, sin tener que cumplir primero con un deducible. |
| Deducible | Enfoque individual: Una vez que una persona en el plan alcanza su deducible, el coseguro del plan comienza a cubrir los gastos de esa persona. Ideal para quienes padecen enfermedades crónicas o realizan visitas frecuentes a especialistas. | Enfoque familiar: Se debe cubrir el deducible familiar completo antes de que el plan de coseguro comience a compartir los costos. Ideal para quienes necesitan principalmente atención preventiva y gozan de buena salud en general. |
| Coaseguro | Atención continua: Una vez que se alcanzan los deducibles, el plan (Michaels) paga una parte del costo de los servicios. | Atención continua: Una vez que se alcanzan los deducibles, el plan del país cubre una parte del costo de los servicios. |
| Gasto máximo de bolsillo | Protección total: Una vez que alcance su límite anual, el plan del país cubrirá el 100% de todos los gastos médicos elegibles. Varía según el plan PPO. | Protección total: Una vez que alcance este límite, el plan del país cubrirá el 100% de todos los gastos médicos elegibles. |
| Cuentas antes de impuestos | Cuenta de Gastos Médicos Flexibles (FSA): Cuenta de "úsala o piérdela". Ideal para gastos médicos anuales predecibles. Usted aporta dinero antes de impuestos de su nómina; Michaels no. | HSA: Es tuya para siempre. Michaels aporta fondos y tú puedes aportar dinero antes de impuestos de tu nómina para pagar gastos elegibles, y el saldo se acumula cada año. |
Deductibles & Coinsurance
Coinsurance and deductibles function differently depending on the plan you choose.
PPO & HRA Plans: If you enroll yourself and at least one (1) dependent, once you or one of your dependents meet the deductible, coinsurance applies for that member. Any additional family members must meet their own deductible before coinsurance applies, or until the family deductible is met, then coinsurance applies to all.
HSA Plan: If you enroll yourself and at least one (1) dependent, there is no individual deductible. The total family deductible must be met before coinsurance applies for any family member.
Michaels Contributions to HRA & HSA Plans
To help you pay for eligible health care expenses, Michaels contributes to either a Health Savings Account (HSA) if you enroll in the Choice 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 to help you choose.
For additional ways to contribute pretax dollars to pay for eligible healthcare expenses, visit our Spend & Save page.
Medicare Eligibility
Are you turning 65 and eligible for Medicare? Contact Medicare Transition Services for information and assistance.
Plan Costs & Coverage
What You'll Pay
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| Choice HSA | Basic PPO | Enhanced PPO | 360 Protect Plan | Kaiser HRA (Calif. Only) |
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|---|---|---|---|---|---|---|---|---|
| In-Network | CareWay Tier 1 Provider | CareWay Tier 2 or 3 Provider | CareWay Tier 1 Provider | CareWay Tier 2 or 3 Provider | Select Tier 1 Provider | National Tier 2 or 3 Provider | In-Network | |
| Plan Deductible | ||||||||
| Team Member Only | $2,500 | $3,000 | $1,500 | $1,000 | $1,500 | $1,500 | ||
| Team Member + Spouse/Child(ren) | $5,000 | $6,000 | $3,000 | $2,000 | $3,000 | $3,000 | ||
| Team Member + Family | $5,000 | $6,000 | $3,000 | $2,000 | $3,000 | $3,000 | ||
| Out-of-Pocket Maximum | ||||||||
| Team Member Only | $6,000 | $6,000 | $6,000 | $4,500 | $6,000 | $3,000 | ||
| Team Member + Spouse/Child(ren) | $12,000 | $12,000 | $12,000 | $9,000 | $12,000 | $6,000 | ||
| Team Member + Family | $14,500 | $14,500 | $14,500 | $11,500 | $14,500 | $6,000 | ||
| What You Pay for Medical Care | ||||||||
| Coinsurance (Team Member Share) | 20% | 20% | 40% | 20% | 40% | 10% | 20% | 20% |
| Preventive Care | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 |
| Primary Care Office Visit | 20%* | $25 copay | $60 copay | $30 copay | $75 copay | $15 copay | $30 copay | $20 copay* |
| Specialist Office Visit | 20%* | $50 copay | $120 copay | $50 copay | $125 copay | $30 copay | $50 copay | $20 copay* |
| Telehealth | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 |
| Urgent Care | 20%* | $75 copay | $75 copay | 20%* | 40%* | $50 copay | $20 copay* | |
| Emergency Room | 20%* | 20%* | 20%* | $250 copay + 20%* | $250 copay + 20%* | $250 copay + 10%* | $250 copay + 10%* | 20%* |
| Retail Clinic | 20%* | $25 copay | $60 copay | $30 copay | $75 copay | $15 copay | $30 copay | $20 copay* |
| Hospital Care & Mental Health | 20%* | 20%* | 40%* | 20%* | 40%* | 10% | 20% | 20% |
| Routine Prenatal Care | 20%* | $25 (PCP) $50 (SPC) | $60 (PCP) $120 (SPC) | $30 (PCP) $50 (SPC) | $75 (PCP) $125 (SPC) | 10% | 20% | $0 |
| Birth Delivery | 20%* | 20%* | 40% | 20%* | 40%* | 10% | 20% | 20% |
| Important: This table shows what you pay for services if you use incentive options and in-network providers. For full plan information, including cost information for out-of-network providers, please review the Summaries of Benefits and Coverage for each plan available in the Document Library. All maximums are indicated as plan year maximums. (*Indicates what you pay after the annual plan deductible is met.) | ||||||||
| Choice HSA | Basic PPO | Enhanced PPO | 360 Protect Plan | Kaiser HRA (Solo en Calif.) |
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|---|---|---|---|---|---|---|---|---|
| Dentro de la red | CareWay Proveedor de nivel 1 | CareWay Proveedor de nivel 2 o 3 | CareWay Proveedor de nivel 1 | CareWay Proveedor de nivel 2 o 3 | Seleccionar Proveedor de nivel 1 | Nacional Proveedor de nivel 2 o 3 | Dentro de la red | |
| Plan de deducible | ||||||||
| Solo para miembros del equipo | $2,500 | $3,000 | $1,500 | $1,000 | $1,500 | $1,500 | ||
| Miembro del equipo + Cónyuge/Hijo(s) | $5,000 | $6,000 | $3,000 | $2,000 | $3,000 | $3,000 | ||
| Miembro del equipo + Familia | $5,000 | $6,000 | $3,000 | $2,000 | $3,000 | $3,000 | ||
| Gasto máximo de bolsillo | ||||||||
| Solo para miembros del equipo | $6,000 | $6,000 | $6,000 | $4,500 | $6,000 | $3,000 | ||
| Miembro del equipo + Cónyuge/Hijo(s) | $12,000 | $12,000 | $12,000 | $9,000 | $12,000 | $6,000 | ||
| Miembro del equipo + Familia | $14,500 | $14,500 | $14,500 | $11,500 | $14,500 | $6,000 | ||
| Lo que pagas por la atención médica | ||||||||
| Coaseguro (Participación del miembro del equipo) | 20% | 20% | 40% | 20% | 40% | 10% | 20% | 20% |
| Atención preventiva | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 |
| Visita al consultorio de atención primaria | 20%* | Copago de $25 | Copago de $60 | Copago de $30 | Copago de $75 | Copago de $15 | Copago de $30 | Copago de $20* |
| Visita al consultorio del especialista | 20%* | Copago de $50 | Copago de $120 | Copago de $50 | Copago de $125 | Copago de $30 | Copago de $50 | Copago de $20* |
| Telesalud | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 |
| Atención de urgencias | 20%* | Copago de $75 | Copago de $75 | 20%* | 40%* | Copago de $50 | Copago de $20* | |
| Sala de emergencia | 20%* | 20%* | 20%* | Copago de $250 + 20%* | Copago de $250 + 20%* | Copago de $250 + 10%* | $250 copay + 10%* | 20%* |
| Clínica minorista | 20%* | Copago de $25 | Copago de $60 | Copago de $30 | Copago de $75 | Copago de $15 | $30 copay | Copago de $20* |
| Atención hospitalaria y salud mental | 20%* | 20%* | 40%* | 20%* | 40%* | 10% | 20% | 20% |
| Rutina de atención prenatal | 20%* | $25 (PCP) $50 (SPC) | $60 (PCP) $120 (SPC) | $30 (PCP) $50 (SPC) | $75 (PCP) $125 (SPC) | 10% | 20% | $0 |
| Parto | 20%* | 20%* | 40% | 20%* | 40%* | 10% | 20% | 20% |
| Importante: Esta tabla muestra lo que pagará por los servicios si utiliza opciones de incentivos y proveedores dentro de la red. Para obtener información completa sobre el plan, incluyendo información sobre costos para proveedores fuera de la red, consulte los Resúmenes de Beneficios y Cobertura de cada plan disponibles en la Biblioteca de Documentos. Todos los máximos se indican como máximos anuales del plan. (*Indica lo que pagará después de alcanzar el deducible anual del plan). | ||||||||
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| Choice HSA | Basic PPO | Enhanced PPO | 360 Protect Plan | Kaiser HRA (California Only) |
|
|---|---|---|---|---|---|
| Team Member Only | $72.11 | $52.14 | $138.10 | $110.48 | $89.15 |
| Team Member + Spouse1 | $193.45 | $140.63 | $347.16 | $277.73 | $213.24 |
| Team Member + Child(ren) | $142.45 | $94.81 | $264.68 | $211.74 | $168.58 |
| Team Member + Family | $239.17 | $164.32 | $421.97 | $337.58 | $251.38 |
| 1By law, if a domestic partner does not qualify as a tax dependent, the cost for their benefits cannot be paid pre-tax, and the “value” of Team Member and employer-provided domestic partner contributions is taxable. | |||||
| Choice HSA | Basic PPO | Enhanced PPO | 360 Protect Plan | Kaiser HRA (Solo en California) |
|
|---|---|---|---|---|---|
| Solo para miembros del equipo | $72.11 | $52.14 | $138.10 | $110.48 | $89.15 |
| Miembro del equipo + Cónyuge1 | $193.45 | $140.63 | $347.16 | $277.73 | $213.24 |
| Miembro del equipo + Hijo(s) | $142.45 | $94.81 | $264.68 | $211.74 | $168.58 |
| Miembro del equipo + Familia | $239.17 | $164.32 | $421.97 | $337.58 | $251.38 |
| 1Por ley, si una pareja de hecho no califica como dependiente fiscal, el costo de sus beneficios no puede pagarse antes de impuestos, y el «valor» de las contribuciones realizadas por el Miembro del Equipo y por el empleador para la pareja de hecho está sujeto a impuestos. | |||||
For more pharmacy information and resources included in each medical plan, visit the Pharmacy Benefits page.
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| Choice HSA | Basic PPO | Enhanced PPO | 360 Protect Plan | Kaiser HRA (California Only) |
|
|---|---|---|---|---|---|
| Preventative Drugs1 | |||||
| Retail & Mail Order | $0 copay | $0 copay | $0 copay | $0 copay | $0 copay |
| Retail2 | |||||
| Generic | 20%* | $14 copay | $10 copay | $10 copay | $10 copay |
| Preferred Brand | 20%* | 25% of cost ($50 min; $130 max) | $35 copay | $35 copay | $30 copay |
| Non-Preferred Brand* | 50%* ($100 min; $250 max) | 50%* ($100 min; $250 max) | 50%* ($100 min; $250 max) | 50%* ($100 min; $250 max) | $30 copay |
| Maintenance/Home Delivery3 | |||||
| Generic | 20%* | $35 copay | $20 copay | $20 copay | $20 copay |
| Preferred Brand | 20%* | $125 copay | $70 copay | $70 copay | $60 copay |
| Non-Preferred Brand* | 50%* ($100 min; $250 max) | 50%* ($100 min; $250 max) | 50%* ($100 min; $250 max) | 50%* ($100 min; $250 max) | $60 copay |
| Specialty Pharmacy4 | |||||
| Generic | 20%* ($200 max) | $14 copay | $10 copay | $10 copay | $30 copay |
| Preferred Brand | 20%* ($250 max) | 25% cost ($50 min; $130 max) | $35 copay | $35 copay | Not Covered |
| Non-Preferred Brand* | 20%* ($350 max) | 50% of cost ($350 max) | 50% of cost ($350 max) | 50% of cost ($350 max) | Not Covered |
| Out-of-Pocket Maximum5 | |||||
| Individual | Included in medical out-of-pocket max | $2,050 | Included in medical out-of-pocket max | Included in medical out-of-pocket max | Included in medical out-of-pocket max |
| Family | $4,100 | ||||
| 1For BCBSTX and Imagine360 plans: Up to 30-day supply for retail, and up to a 90-day supply for CVS mail order. For Kaiser plan: applies only to medications on ACA list. 2Up to a 30-day supply. 3For BCBSTX and Imagine360 plans: up to a 90-day supply through CVS. For Kaiser plan: up to a 100-day supply. 4Up to a 30-day supply. Costs apply toward out-of-pocket maximum. 5The out-of-pocket maximum is the most you'll pay before the plan covers 100% of the remaining eligible prescription drug costs for the remainder of the plan year. (*Indicates what you pay after the annual plan deductible is met.) |
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| Choice HSA | Basic PPO | Enhanced PPO | 360 Protect Plan | Kaiser HRA (Solo en California) |
|
|---|---|---|---|---|---|
| Medicamentos preventivos1 | |||||
| Venta minorista y por correo | Copago de $0 | Copago de $0 | Copago de $0 | Copago de $0 | Copago de $0 |
| Comercio minorista2 | |||||
| Genérico/a | 20%* | Copago de $14 | Copago de $10 | Copago de $10 | Copago de $10 |
| Marca preferida | 20%* | 25% del costo ($50 mín.; $130 máx.) | Copago de $35 | Copago de $35 | Copago de $30 |
| Marca no preferida* | 50%* ($100 min; $250 max) | 50%* (mínimo $100; máximo $250) | 50%* (mínimo $100; máximo $250) | 50%* (mínimo $100; máximo $250) | Copago de $30 |
| Mantenimiento / Entrega a domicilio3 | |||||
| Genérico/a | 20%* | Copago de $$35 | Copago de $20 | Copago de $20 | Copago de $20 |
| Marca preferida | 20%* | Copago de $$125 | Copago de $70 | Copago de $70 | Copago de $60 |
| Marca no preferida* | 50%* (mínimo $100; máximo $250) | 50%* (mínimo $100; máximo $250) | 50%* (mínimo $100; máximo $250) | 50%* (mínimo $100; máximo $250) | Copago de $60 |
| Farmacia especializada4 | |||||
| Genérico/a | 20%* (máximo $200) | Copago de $14 | Copago de $10 | Copago de $10 | Copago de $30 |
| Marca preferida | 20%* (máximo $200) | 25% del costo (mín. $50; máx. $130) | Copago de $35 | Copago de $35 | No cubierto |
| Marca no preferida* | 20%* (máximo $200) | 50% del costo (máx. $350) | 50% del costo (máx. $350) | 50% del costo (máx. $350) | No cubierto |
| Gasto máximo de bolsillo5 | |||||
| Individual | Incluido en el tope de gastos médicos de bolsillo | $2,050 | Incluido en el tope de gastos médicos de bolsillo | Incluido en el tope de gastos médicos de bolsillo | Incluido en el tope de gastos médicos de bolsillo |
| Familia | $4,100 | ||||
| 1Para los planes de BCBSTX e Imagine360: hasta un suministro para 30 días en farmacias minoristas, y hasta un suministro para 90 días mediante el servicio de pedidos por correo de CVS. Para el plan de Kaiser: se aplica únicamente a los medicamentos incluidos en la lista de la ACA. 2Hasta un suministro para 30 días. 3Para los planes de BCBSTX e Imagine360: hasta un suministro para 90 días a través de CVS. Para el plan de Kaiser: hasta un suministro para 100 días. 4Hasta un suministro para 30 días. Los costos se aplican al máximo de desembolso personal. 5El máximo de desembolso personal es la cantidad máxima que usted pagará antes de que el plan cubra el 100% de los costos elegibles restantes de medicamentos recetados durante el resto del año del plan. (*Indica lo que usted paga una vez que se ha cumplido el deducible anual del plan.) |
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To access more detailed benefits documentation, including plan summaries and required legal notices, head over to the Document Library.
Not sure which medical plan is right for you? The eValuate tool can help you choose the medical coverage that's best suited for you and your family.
Why use eValuate?
eValuate is a free resource to help full-time Team Members choose the best medical plan for their needs.
Let the eValuate Health Plan Selector help you decide which medical plan makes the most financial sense for you and your family. Just answer a few questions and eValuate will calculate the tax savings you can expect on premiums and Health Care FSA contributions for each medical plan. Then you’ll get a summary highlighting which option works best for you.
eValuate doesn’t store any of your personal information, or share it with Michaels or anyone else – it’s totally private and confidential.
You can access and utilize eValuate 24/7 from any smartphone, tablet, or computer.
Member Resources & Programs
Select your medical plan administrator below for access to the member resources available to you all year long.
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.
Blue Cross Blue Shield Select Networks
Michaels partners with BCBSTX for our high-quality medical plans and broad network of providers to choose from. Effective July 1, 2025, BCBSTX and Michaels will implement new networks in the locations listed below. The same Michaels benefit plans will continue to be offered across all networks.
Depending on your location, you’ll have access to either the BCBS Select Network or the BCBS BlueCard PPO Network. Team Members located in the below locations can go to the specific websites to search for your provider. While some providers may no longer be considered in network, a majority of Team Members should not experience disruption in their healthcare services. For Team Members located outside of the locations below you will continue to access the Michaels BCBSTX website to search for your provider.
BCBSTX Select Network Provider Finder Links:
California – Tandem PPO
Colorado – Pathway
Florida – Network Blue
Georgia – Blue Open Access POS
Illinois – Blue Choice PPO (BCS)
Minnesota – High Value Network
Kansas City, Missouri – Preferred Care
St. Louis, Missouri – Blue Access Choice
New Jersey – Horizon Managed Care Network
Wisconsin – Blue Preferred POS
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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 | Breast Cancer Screenings
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.
Provider
Blue Cross Blue Shield of Texas (BCBSTX)
Resources for Imagine360 Plan Members
Your Imagine360 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.
Search for Doctors & Specialists
After opening the link below, enter code OHNVR and your zip code to locate providers in the Imagine360 network.
Your Michaels 360 Protect Plan group number is V100013.
Plan Administrator
Imagine360
Resources for Kaiser Plan Members
Below are links to helpful resources and programs available to you as part of your Kaiser medical plan.
Plan Administrator
Kaiser Permanente
Medical
Choosing & Using Your Michaels Medical PlanMedical 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 Permanente |
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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. You must use a Kaiser provider for the plan to pay benefits. |
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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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Costs & Coverage
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What You'll Pay for Medical Care
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Tap or click the content below and scroll to access all the information.
| 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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| BCBSTX Basic PPO | BCBSTX Enhanced PPO | BCBSTX Choice HSA | Kaiser HRA (California Only) |
|
|---|---|---|---|---|
| Employee | $44.49 | $117.84 | $61.52 | $87.57 |
| Employee + Spouse/DP1 | $119.99 | $296.22 | $165.06 | $209.47 |
| Employee + Child(ren) | $80.89 | $225.84 | $121.55 | $165.60 |
| Employee + Family | $140.21 | $360.04 | $204.07 | $246.94 |
1By law, if a domestic partner does not qualify as a tax dependent, the cost for their benefits cannot be paid pre-tax, and the “value” of Team Member and employer-provided domestic partner contributions is taxable.
| 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) |
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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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Medicare Eligibility
Are you turning 65 and eligible for Medicare? Contact Medicare Transition Services for information and assistance.
Michaels Contributes to Your HSA or HRA Plan
To help you pay for eligible health care expenses, Michaels contributes to either a Health Savings Account (HSA) if you enroll in the Choice 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 to help you choose.
Understanding Deductibles & Coinsurance
Coinsurance and deductibles function differently depending on the plan you choose.
PPO & HRA Plans: If you enroll yourself and at least one (1) dependent, once you or one of your dependents meet the deductible, coinsurance applies for that member. Any additional family members must meet their own deductible before coinsurance applies, or until the family deductible is met, then coinsurance applies to all.
HSA Plan: If you enroll yourself and at least one (1) dependent, there is no individual deductible. The total family deductible must be met before coinsurance applies for any family member.
Not sure which medical plan is right for you? The eValuate tool can help you choose the medical coverage that's best suited for you and your family.
Why use eValuate?
eValuate is a free resource to help full-time Team Members choose the best medical plan for their needs.
Let the eValuate Health Plan Selector help you decide which medical plan makes the most financial sense for you and your family. Just answer a few questions and eValuate will calculate the tax savings you can expect on premiums and Health Care FSA contributions for each medical plan. Then you’ll get a summary highlighting which option works best for you.
eValuate doesn’t store any of your personal information, or share it with Michaels or anyone else – it’s totally private and confidential.
You can access and utilize eValuate 24/7 from any smartphone, tablet, or computer.
To access more detailed benefits documentation, including plan summaries and required legal notices, head over to the Document Library.
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.
Blue Cross Blue Shield Select Networks
Michaels partners with BCBSTX for our high-quality medical plans and broad network of providers to choose from. Effective July 1, 2025, BCBSTX and Michaels will implement new networks in the locations listed below. The same Michaels benefit plans will continue to be offered across all networks.
Depending on your location, you’ll have access to either the BCBS Select Network or the BCBS BlueCard PPO Network. Team Members located in the below locations can go to the specific websites to search for your provider. While some providers may no longer be considered in network, a majority of Team Members should not experience disruption in their healthcare services. For Team Members located outside of the locations below you will continue to access the Michaels BCBSTX website to search for your provider.
BCBSTX Select Network Provider Finder Links:
California – Tandem PPO
Colorado – Pathway
Florida – Network Blue
Georgia – Blue Open Access POS
Illinois – Blue Choice PPO (BCS)
Minnesota – High Value Network
Kansas City, Missouri – Preferred Care
St. Louis, Missouri – Blue Access Choice
New Jersey – Horizon Managed Care Network
Wisconsin – Blue Preferred POS
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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 | Breast Cancer Screenings
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.
Provider
Blue Cross Blue Shield of Texas (BCBSTX)
Resources for Kaiser Plan Members
Below are links to helpful resources and programs available to you as part of your Kaiser medical plan.
Provider