Download the Employee Benefit Plan.
Download the Employee Dental Plan.
Download the HIPAA Authorization Form.
Download the Medical &Dental Card Request Form.
Download the Dependent Verification Form.
Download the Tobacco Use Affidavit.
For additional forms go to www.houze.org/langdale.
Download a Request for Taxpayer Identification Number and Certification Form.
Download a Preauthorization Form.
Log in to the Member Portal to access:
Please Note: Flexible Spending Accounts and Vision Insurance are not administered by TLC.
Register New User