Download the Employee Benefit Plan.
Download the Employee Dental Plan.
Download the Employee Benefit Plan Summary of Material Modifications for 2018.
Download the Summary of Benefits and Coverage 2018.
Download the Uniform Glossary of Coverage and Medical Terms.
Download the Summary of Benefits and Coverage 2018 – Español.
Download the Glosario de cobertura de salud y términos médicos.
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.