ProCare assumed the pharmacy benefit manager role 1/1/2018. You received new coverage cards prior to 1/1/2018.
Non-Preferred Pharmacy Providers are listed below. All other pharmacy providers will be considered preferred. See the SBC included in the Open Enrollment packet for additional information.
Employees have two options to fill a 90 day supply of medication:
Participation in the Diabetic Management Program implemented on September 1, 2014 is required for all diabetics covered by the health plan. Participants who opt out of the program will be assessed an additional premium of $40.00 per month. Medication co-pays are reduced for program participants. Please contact TLC Benefit Solutions at 229-249-0940 for additional information.
Chancy Drugs is the only approved Compounding Pharmacy for the Health Plan.
Beginning January 1, the following services are covered at 100% under preventive care: screening for preeclampsia in pregnant women, screening for cervical cancer with human papilloma virus (HPV), preventive Statin, and additional Tobacco cessation products are available at no cost. For details, please refer to Benefits Summary: What’s New for 2018.
Out of Pocket Expense remains at $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.
Remember: there is no Out-of-Pocket limit for Out-Of-Network providers and services.
Wellness Program – Please review The Langdale Company Wellness Program information included in the 2017 The Langdale Company Summary Plan Description. The 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. Qualified members are automatically enrolled in the program. Lower medication copays and care management are a few of the benefits offered. If you choose not to participate, you will pay higher health plan premiums.
Quest/Solstas Lab is the sole Network provider for lab screening services, including specialty drug screens. Exceptions are lab services performed by Network Hospitals during a member’s hospitalization or emergency room visit. The Plan reserves the right to add a second network lab during year, at which time you will be notified.
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.
Emergency Room Visits are subject to a $200 copayment.
Adult children who turn 26 will be covered under the Plan until the end of the month in which they turn 26.
The Health Plan premium for Single coverage increases 10% in 2018.
New Medical/Pharmacy cards were distributed prior to January 1, 2018. Please dispose of your old cards securely.
Benefits Summary: What’s New for 2018 was distributed prior to January 1, 2018, and is available under “Forms” on this website.
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.