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.
There will be no changes to the dental benefits. Remember the annual maximum is now $1,500.
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.
Marriage and/or Family Counseling - Marriage and/or family therapy will be a covered benefit, effective January 1, 2020.
Wellness and Pregnancy-related Wellness – The wellness benefit was expanded, please refer to the restated Summary Plan Document which will be mailed to your house in December 2019.
Orthospinology - Chiropractic care benefit is subject to $25 copayment per visit, there is no annual limit on the number of visits.
Hearing aids for children age 18 and under - New benefit limited to $2,500 per ear every 48 months, any amount over $2,500 is the member’s responsibility and will not apply towards out-of-pocket.
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.
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 (when available), (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 - Labcorp and Quest/Solstas are the preferred Network providers for lab screening services, including specialty drug screens.
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 is available at https://www.sleepcharge.com/langdale/ and the NEW SleepCharge App. Members must average 70% compliance in order to qualify for annual renewal. If your compliance is below 70% within 90 days of your renewal date, you will be required to meet with a technician prior to the renewal being paid.
Reminder: Adult children who turn 26 will be covered under the Plan until the end of the month in which they turn 26.
Health Premiums will increase 5%.
The updated Summary Plan Description (SPD) books will be mailed to employee households in December. They are also available through the TLC Benefits’ website under Forms - http://www.tlcbenefitsolutions.net/new/forms.html.
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.