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. All patients must fill their medications through the FiveStar Telehealth Clinic. Medications are at no charge 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.
New Orthodontia benefit will be available effective January 1, 2024, up to $2,000 lifetime limit.
Remember the annual maximum for dental benefits (excluding orthodontia) is $1,500
.
There will be no changes to the vision benefits.
Out of Pocket Expense will remain the same at $7,100 (Single); $14,200 (Family) which breaks down to ($1,325 – single and $2,650 – family) for pharmacy expense and ($5,775 – single and $11,550 – family) for medical expense.
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.
*Mayo Clinic is reimbursed at 80% coinsurance
Wellness Programs – The Langdale Company Wellness Program has following components: (1) tobacco cessation, (2) a diabetes management program, and (3) a (chronic) disease management program and (4) annual health assessments (when offered). Lower medication copays, educational opportunities and care management are a few of the benefits offered.
Preferred Lab - Labcorp and Quest Diagnostics are the preferred Network provider for all lab services.
Bariatric Surgery, Limited to Gastric Sleeve - Treatment of severe obesity with surgical weight loss tools, limited to gastric sleeve, is now a covered benefit. The program offering gastric sleeve procedure must require pre-surgery diet and lifestyle changes. The procedure must be approved in advance by Utilization Management.
Sleep Apnea Program – Provides home sleep testing, treatment, supplies, and care management support at no cost to you. Annual participation fees are $200 for the initial year, and $100 a year, thereafter. Visit https://www.sleepcharge.com/langdale/ for a free evaluation. NEW SleepCharge members must average 70% compliance 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.
The Telehealth Clinic is now available to all employees and their dependents over 12 years of age at all Company facilities. A schedule of clinic times and locations will be posted at each facility. The clinic is a partnership between The Langdale Company, Miller County Hospital, Chancy Drugs, and the Global Partnership for Telehealth (GPT). Benefits include, but are not limited to:
Reminder: Adult children who turn 26 will be covered under the Plan until the end of the month in which they turn 26.
Health Plan premiums will increase by 7%.
There will be no change to dental premiums.
Summary of Material Modifications is included in this booklet. Electronic copies of Health and Dental Summary Plan Descriptions (SPDs) are available on the TLC Benefit Solutions’ website: http://www.tlcbenefitsolutions.net/forms.html
Updated Health Insurance Cards will be mailed in December 2023.
The Langdale Company Health Portal - The Portal allows you to assess your health information, track your online health history, use calculators and trackers, identify drug interactions, and communicate with the Health Advocate http://tlcbenefitsolutions.net/diamanagement.html.
MyCare Choices Portal - Patient Education about surgery and alternative treatments with an option to initiate a virtual Second Opinion consultation. This benefit is free to covered members. Second opinion requests must be approved by the Utilization Management.
Log in to the Member Portal to access:
Please Note: Flexible Spending Accounts and Vision Insurance are not administered by TLC.
Download the BENEFITS AND CLAIM PORTAL step-by-step guide.