CareWay Tiered Provider Network
Finding the right doctor is about more than just a name on a list — it’s about balancing quality and costs.
That’s why Michaels is introducing the Blue Cross Blue Shield of Texas (BCBSTX) CareWay Tiered Network for those enrolled in the Basic PPO and Enhanced PPO medical plans. It takes the guesswork out of the process by vetting providers for you, looking at everything from medical expertise to efficiency, so you can focus on staying healthy.
How It Works
- Providers are grouped into four tiers based on quality, results, and efficiency – as illustrated in the “CareWay Tiering Structure” table below.
- Choosing Tier 1 providers means you’ll get high-quality care with lower copays and coinsurance.
- Regardless of the tier your provider(s) are in, your out-of-pocket eligible expenses accumulate to your annual deductible and out-of-pocket maximums.
- To compare benefit tiers and find out what you can save on copayments and coinsurance when choosing a Tier 1 provider, review the “What You Pay For Medical Care” table below.
- You can use the “Search for Providers” link below to confirm whether your physician is in the CareWay network and what tier they fall under.
CareWay Tiering Structure
|
Tier 1 (Pay Lower Copays & Coinsurance) |
Tier 2 | Tier 3 |
|---|---|---|
| Physicians in this tier meet a predetermined upper score threshold for Qualify of Care, Medical Appropriateness, and Cost Efficiency, resulting in a lower in-network member cost share. (Tier 1 also includes unscored in-network PPO behavioral health providers.) | Physicians in this tier include professionals with average scores for the same measurements and unscored in-network PPO providers. | Physicians in this tier are comprised of the lower scored professionals for the same measurements. |
What You Pay for Medical Care
Are you using a device with a small screen?
Tap or click the content below and scroll to access all the information.
| Choice HSA | Basic PPO | Enhanced PPO | 360 Protect Plan | Kaiser HRA (Calif. Only) |
||||
|---|---|---|---|---|---|---|---|---|
| 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.) | ||||||||
*Indicates what you pay after the annual plan deductible is met. Visit the Medical page for more information.
Search for In-Network Physicians & Specialists
It’s easy to find high quality, cost-efficient physicians that are in the BCBSTX CareWay network. Use Provider Finder to get started.
Helpful Links
Plan Administrator
Blue Cross Blue Shield of Texas (BCBSTX)
Beginning July 1, 2026, Michaels is introducing the Blue Cross Blue Shield of Texas (BCBSTX) CareWay Tiered Network for those enrolled in the Basic PPO and Enhanced PPO medical plans. Use the toggle below to display information about this new program for 2026–2027 and visit the Open Enrollment page for guidance on enrolling in benefits beginning May 11, 2026.