Page 12 - Example
P. 12
Medical Beneits
Prescription Drugs
If you enroll in a medical plan, you will automatically receive prescription drug coverage.
Coverage is provided through Aetna for both retail and mail order prescriptions. If you have your prescription
illed at a participating retail pharmacy, you may purchase up to a 30-day supply of covered drugs. At the
participating pharmacy, you will need to present your ID card and make the required copayment.
You may obtain information regarding participating pharmacies by visiting www.aetna.com/docind and
selecting the Managed Choice POS (Open Access) network. You also have to select the pharmacy plan
“Aetna National Pharmacy Network.”
The plan also includes a mail order service through Aetna. If you are taking a medication for an extended
period of time, you can purchase up to a 90-day supply of covered drugs through Aetna’s mail order service.
To use the program ask your doctor to give you a new prescription for up to a 90-day supply of your regular
medication, plus reills, if appropriate.
For more information call Aetna at +1 800.238.6716. You will receive forms for reills and future prescription
orders each time you receive a prescription from the mail order service.
Who pays for your medical beneits?
You and GLG share the cost of healthcare beneits. Your contribution depends upon the medical plan you
choose and whether you cover dependents. Your contribution is made by paying premiums through payroll
deductions. Your contribution band is based on your salary as of November 1, 2018, or your Date of Hire, if
you were hired after November 1, for the 2019 beneit year.
Medical Plan Rates— You and GLG share the cost of many of your beneits, with GLG paying most of the
total cost.
Monthly Contributions—Effective January 1, 2019
Annual Base Salary PPO 500 Plan HSA 1350 Plan EPO 1500 Plan
Employee Only Under $75,000 $162.00 $44.00 $88.00
$75,000–$149,999 $191.00 $53.00 $106.00
$150,000+ $206.00 $62.00 $124.00
Employee + Spouse Under $75,000 $341.00 $92.00 $184.00
$75,000–$149,999 $402.00 $111.00 $222.00
$150,000+ $432.00 $129.00 $258.00
Employee + Child(ren) Under $75,000 $284.00 $77.00 $154.00
$75,000–$149,999 $335.00 $92.00 $184.00
$150,000+ $360.00 $108.00 $216.00
Family Under $75,000 $494.00 $134.00 $268.00
$75,000–$149,999 $583.00 $161.00 $322.00
$150,000+ $627.00 $188.00 $376.00
8
Prescription Drugs
If you enroll in a medical plan, you will automatically receive prescription drug coverage.
Coverage is provided through Aetna for both retail and mail order prescriptions. If you have your prescription
illed at a participating retail pharmacy, you may purchase up to a 30-day supply of covered drugs. At the
participating pharmacy, you will need to present your ID card and make the required copayment.
You may obtain information regarding participating pharmacies by visiting www.aetna.com/docind and
selecting the Managed Choice POS (Open Access) network. You also have to select the pharmacy plan
“Aetna National Pharmacy Network.”
The plan also includes a mail order service through Aetna. If you are taking a medication for an extended
period of time, you can purchase up to a 90-day supply of covered drugs through Aetna’s mail order service.
To use the program ask your doctor to give you a new prescription for up to a 90-day supply of your regular
medication, plus reills, if appropriate.
For more information call Aetna at +1 800.238.6716. You will receive forms for reills and future prescription
orders each time you receive a prescription from the mail order service.
Who pays for your medical beneits?
You and GLG share the cost of healthcare beneits. Your contribution depends upon the medical plan you
choose and whether you cover dependents. Your contribution is made by paying premiums through payroll
deductions. Your contribution band is based on your salary as of November 1, 2018, or your Date of Hire, if
you were hired after November 1, for the 2019 beneit year.
Medical Plan Rates— You and GLG share the cost of many of your beneits, with GLG paying most of the
total cost.
Monthly Contributions—Effective January 1, 2019
Annual Base Salary PPO 500 Plan HSA 1350 Plan EPO 1500 Plan
Employee Only Under $75,000 $162.00 $44.00 $88.00
$75,000–$149,999 $191.00 $53.00 $106.00
$150,000+ $206.00 $62.00 $124.00
Employee + Spouse Under $75,000 $341.00 $92.00 $184.00
$75,000–$149,999 $402.00 $111.00 $222.00
$150,000+ $432.00 $129.00 $258.00
Employee + Child(ren) Under $75,000 $284.00 $77.00 $154.00
$75,000–$149,999 $335.00 $92.00 $184.00
$150,000+ $360.00 $108.00 $216.00
Family Under $75,000 $494.00 $134.00 $268.00
$75,000–$149,999 $583.00 $161.00 $322.00
$150,000+ $627.00 $188.00 $376.00
8
