Ph: (229)249-0940 • Fax: (229)249-9840 • Toll Free: (877)949-0940
Employee Health is a priority. The Plan has partnered with Chancy Drugs to create an innovative approach to manage chronic disease and promote healthy lifestyles.
Members of a multi-disciplinary team will maintain contact and provide education information and support to meet mutually agreed upon goals for Covered Persons who have:
Participation is free and completely voluntary and program participants are eligible for reduced medication copays. This program does not change or modify any other condition, limitation or exclusion of your Plan.
| Disease Management Pharmacy Benefits | |||
|---|---|---|---|
| The following benefits apply to medications that treat the following conditions: Hypertension (high blood pressure), Hyperlipidemia (high cholesterol), Asthma, and Cardiovascular Disease; and you are not Diabetic. | |||
| Preferred Network 34 Day Supply | Non-Preferred Network 34 Day Supply | ||
| Co-payment | Co-payment | ||
| Tier 1 - Generics* | $10 | Tier 1 - Generics | $25 |
| Tier 2 - Preferred Brands (Formulary Brands) | $30 or 20% (Greater Amount) | Tier 2 - Preferred Brands (Formulary Brands) | $50 or 20% (Greater Amount) |
| Tier 3 - Non-Preferred Brands (Non Formulary Brands) | $75 or 30% (Greater Amount) | Tier 3 - Non-Preferred Brands (Non Formulary Brands) | $90 or 30% (Greater Amount) |
| Compound Drugs** | $25 | Compound Drugs | Not Covered |
| Preferred Network 90 Day Supply | Non-Preferred Network 90 Day Supply | ||
| Co-payment | Co-payment | ||
| Tier 1 - Generics | $30 | Tier 1 - Generics | Not Covered |
| Tier 2 - Preferred Brands (Formulary Brands) | $90 or 20% (Greater Amount) | Tier 2 - Preferred Brands (Formulary Brands) | Not Covered |
| Tier 3 - Non-Preferred Brands (Non Formulary Brands) | $225 or 30% (Greater Amount) | Tier 3 - Non-Preferred Brands (Non Formulary Brands) | Not Covered |
| * All Generics exceeding $400 in drug cost will adjudicate at 20% coinsurance, not to exceed $250. ** Not to exceed $250 in drug cost. Must be filled at Chancy Drugs pharmacy stores. | |||
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Please Note: Flexible Spending Accounts and Vision Insurance are not administered by TLC.
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