The Future of COVID-19
With vaccines against COVID-19 now becoming more readily available, we highly recommend getting your shot as soon as possible. As the virus becomes a largely preventable disease, as of May 1 TML Health is no longer providing 100% coverage of COVID-19 related treatment. We will cover these expenses as normal medical claims subject to the same deductible and out-of-pocket costs, as well as pre-authorization requirements as any other medical condition.  

If you are struggling to find available vaccination shots, we recommend going to Texas' official vaccine page to find the latest information on the different vaccines available and where they can be found locally.

If we all work together, we can reduce the spread of COVID-19 and bring back the Texas we know and love!
Updates on COBRA
TML Health will no longer be offering COBRA to groups under 20 members.

If you have any questions, here are the recommended FAQs and updates from the US Department of Labor. These changes are to help employers comply with the new federal COBRA premium subsidy put in place by the American Rescue Plan Act (ARPA).
Help with your Prescription Drug Costs
With the transition to Navitus, TML Health has updated the formulary (list of covered drugs), meaning there may be changes in the coverage for some drugs, or a change in the copay for certain drugs. If a drug you are taking is impacted, Navitus mailed you a letter to notify you about the upcoming change. These letters include the effective date of the change as well as a list of covered, lower-cost alternatives to discuss with your doctor. 
 
All benefits plans have limitations and cost-sharing requirements that affect what you will pay out-of-pocket, however the decision regarding what medication is best for you is always between you and your doctor. Navitus Customer Care is ready to help with any questions about the transition or lower cost alternative medications. 
 
If you have any questions about the changes, please call (866) 333-2757.
Friendly Reminder: The Appeal Deadline Is Changing
We are notifying you that TML Health is making a change to the benefit plan language regarding appeal timelines.  A copy of this notice will be provided to you in a separate email. The information will also be included on the front of future Explanation of Benefits (EOB) documents and in the plan booklets.  
 
NOTICE: Effective Tuesday, June 1, 2021, TML Health is amending the appeal deadline for all denials from twelve (12) months to 180 days. When a claim is denied, it will be reflected on the EOB. 

The EOB form will: 
- Explain the reasons for the denial. 
- Explain the steps you may take to submit the claim for appeal (review). 
 
The process for proceeding with an Appeal is outlined in the TML Health Medical Plan Booklet which is available for you on the TML Health Portal. Login at: tmlhealthbenefits.org. At the menu bar select: LOGIN > Login as a Member.  
 
If you have received a denial of claims prior to June 1, 2021, you will have twelve (12) months to appeal. Claims that are denied on June 1, 2021 and thereafter will have 180 days to appeal.  
 
If you have questions or concerns, please contact our Customer Care team at 1-800-282-5385 Monday-Friday 7:00am-6:00pm Central Time. 
TML Health Benefits Pool is a non-profit trust organization created by political subdivisions to provide group benefits services to participating political subdivisions and is not an insurance company. This contains proprietary and confidential information of TML Health.
Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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