Prueba
Página de Pruebas de Contenido
Atención: Esta página refleja el contenido del nuevo año del plan 2024-2025, que comienza el 1 de julio. Selecciona el botón para pasar a la información del año del plan actual.
¿Estás utilizando un dispositivo con una pantalla pequeña?
Toca o haz clic en el contenido de abajo y desplázate para acceder a toda la información.
| 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) |
||||
| 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) |
||||
| 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) |
||||
| 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) |
||||
| 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. |
||||
Costes médicos quincenales y anuales para 2024-2025
¿Estás utilizando un dispositivo con una pantalla pequeña?
Toca o haz clic en el contenido de abajo y desplázate para acceder a toda la información.
| 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. | ||||
Costes dentales quincenales y anuales para 2024-2025
¿Estás utilizando un dispositivo con una pantalla pequeña?
Toca o haz clic en el contenido de abajo y desplázate para acceder a toda la información.
| Cigna PPO | Cigna DHMO | |
|---|---|---|
| You | ||
| Biweekly | $15 | $5.77 |
| Annually | $390 | $150.02 |
| You + Spouse/Domestic Partner1 | ||
| Biweekly | $34.27 | $10.54 |
| Annually | $891.02 | $274.04 |
| You + Child(ren) | ||
| Biweekly | $32.13 | $10.80 |
| Annually | $835.38 | $280.80 |
| You + Family | ||
| Biweekly | $54.62 | $16.86 |
| Annually | $1,420.12 | $438.36 |
| 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. | ||
Atención Esta página refleja el contenido del año del plan actual que cambiará el 1 de julio. Selecciona el botón para pasar a la información del nuevo año del plan.
Prueba