Ph: (229)249-0940 • Fax: (229)249-9840 • Toll Free: (877)949-0940
ProCare will continue as the pharmacy benefit manager.
Non-Preferred Pharmacy Providers include the following pharmacies at which you will pay a higher copayment: CVS, Walgreens, Rite-Aid, Wal-Mart, Target, and SAM’S.
Chancy Drugs is the Health Plan’s preferred pharmacy.
Participation in the Diabetic Management Program is required for all diabetics covered by the health plan. Medication co-pays are reduced for program participants. Participants who opt out of the program will be assessed an additional premium of $40.00 per month. Please contact TLC Benefit Solutions at 229-249-0940 for additional information.
Annual Maximum – Increase from $1,000 to $1,500.
New Benefit – Periodontal Maintenance every 3-4 months which includes antibiotic coverage for treatment of gum disease.
Out of Pocket Expense will remain $6,850 (Single); $13,700 (Family) which breaks down to ($1,325 – single and $2,650 – family) for pharmacy expense and ($5,525 – single and $11,050 – family) for medical expense.
Colorectal Screening - Age lowered from 50 to 45 for Initial Preventative Screening (covered at 100%).
Pregnancy/Maternity Benefit – Office visits will be subject to a $50.00 specialty copayment instead of deductible. All tests and scans will be subject to deductible. There is no maternity benefit for Dependent Children.
3D Mammograms - 3D mammograms are covered by the Plan when used as an alternative to the standard 2D mammogram. If 2D and 3D are performed on the same day, the 3D will be denied as use of both is considered experimental and investigational.
Centers of Excellence – The following facilities are reimbursed at 90% coinsurance and qualify for hotel reimbursements of no more than $100.00 per night in connection with surgery at these centers.
Wellness Programs – The Langdale Company Wellness Program has four components: (1) tobacco cessation, (2) annual health assessments and biometric screenings, (3) a diabetes management program, and (4) a (chronic) disease management program. Lower medication copays, educational opportunities and care management are a few of the benefits offered.
Preferred Lab - Quest/Solstas is the preferred Network provider for lab screening services, including specialty drug screens. LabCorp is expected to become a preferred provider in 2019. The Plan reserves the right to add a second network lab during year.
Sleep Apnea Program – Provides home sleep testing, treatment, equipment, supplies, care management support throughout therapy at no cost to you. Annual participation fees are $200 for the initial year, and $100 a year, thereafter. Free Sleep Apnea Evaluation and Health Risk Assessment are available through the website: https://www.sleepcharge.com/langdale/ and the NEW SleepCharge App.
Reminder: Adult children who turn 26 will be covered under the Plan until the end of the month in which they turn 26.
Dental Premiums will increase 10%.
The updated Summary Plan Description (SPD) books will be available through the TLC Benefits’ website under Forms - http://www.tlcbenefitsolutions.net/new/forms.html. The Open Enrollment packets contain a Summary of Changes only.
New Medical Cards will be mailed when there are changes to the Preferred Laboratory, either in December or later in 2019.
ELAPulse portal where members can submit and track progress of their Balance Bills from Facilities - http://www.tlcbenefitsolutions.net/new/members.html.
Pharmacy Member Portal allows you access to your Pharmacy Claims and Benefits and locate Pharmacies, as well as look up your cost and medication alternatives - http://www.tlcbenefitsolutions.net/new/members.html.
Log in to the Member Portal to access:
Please Note: Flexible Spending Accounts and Vision Insurance are not administered by TLC.
View a summary of your benefits and coverage.
All new dependents and employees added at Open Enrollment will be required to complete a verification process. All new employees hired after the Open Enrollment will be required to verify. (Enrollers will also provide a list of these documents)
View this Document to learn how to verify the eligibility of your dependents.
Employee’s Spouse who is eligible for employer-sponsored health coverage through the Spouse’s own employer is not eligible for coverage under the Medical Plan, unless the coverage is not affordable and/or minimum value as defined by PPACA.
Employees can continue to cover their Spouses on Dental and Vision plans.
Adult children who turn 26 will be able to stay covered under the Plan until the end of the month in which they turn 26.