2024 Plan Design

There is no change to the plan design of the for 2024. Premiums will increase 7%.

Review the 2024 Medical Summary of Benefits & Coverage to see deductibles, copays, limits, etc. Premiums and Surcharges are listed on the Rates tab.

TLC Benefits Claim Portal

Langdale employees can login to the TLC Benefits portal for information about claims, EOBs, and plan information for medical and dental plans.

Rates

Weekly Rates – Single Coverage

Life Ins. Class Salary Range Premium w/ Tobacco Surcharge w/ Diabetes Surcharge w/ Tobacco & Diabetes Surcharges
30,000 $15,000-$21,999 $25.67 $44.13 $34.90 $53.36
40,000 $22,000-$29,999 $27.10 $45.56 $36.33 $54.79
50,000 $30,000+ $28.49 $46.95 $37.72 $56.18

Weekly Rates – Family Coverage

Life Ins. Class Salary Range Premium w/ Tobacco Surcharge w/ Diabetes Surcharge w/ Tobacco & Diabetes Surcharges
30,000 $15,000-$21,999 $111.21 $129.67 $120.44 $138.90
40,000 $22,000-$29,999 $113.83 $132.29 $123.06 $141.52
50,000 $30,000+ $116.33 $134.79 $125.56 $144.02

Semi-Monthly Rates – Single Coverage

Life Ins. Class Salary Range Premium w/ Tobacco Surcharge w/ Diabetes Surcharge w/ Tobacco & Diabetes Surcharges
30,000 $15,000-$21,999 $55.62 $95.62 $75.62 $115.62
40,000 $22,000-$29,999 $58.72 $98.72 $78.72 $118.72
50,000 $30,000+ $61.74 $101.74 $81.74 $121.74

Semi-Monthly Rates – Family Coverage

Life Ins. Class Salary Range Premium w/ Tobacco Surcharge w/ Diabetes Surcharge w/ Tobacco & Diabetes Surcharges
30,000 $15,000-$21,999 $240.94 $280.94 $260.94 $300.94
40,000 $22,000-$29,999 $246.62 $286.62 $266.62 $306.62
50,000 $30,000+ $252.05 $292.05 $272.05 $312.05

Pharmacy Plan

ProCare Rx 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.

  • You may fill a 90-day prescription at any Chancy Drugs location (Lake Park, Valdosta, Hahira, Adel, and Moultrie)
  • Chancy Drugs is the Plan’s only approved Compounding Pharmacy

Specialty Drugs

Specialty Drugs are excluded from coverage under the Plan because Specialty Concierge Services are offered to offset specialty drug cost. Covered Persons are required to provide certain documentation to access and qualify for these services.

The International Drug Program

Your Plan has an International Drug Formulary for certain medications. Drugs obtained through this program are at no cost to the Covered Person. If these medications are obtained outside of the International Drug Program, the Covered Person is responsible for 50% of the Allowed Amount, non-applicable to your Out-of-Pocket.