Over-the-Counter Catalog

2019

Over-the-Counter Catalog

RiverSpring Star

(HMO SNP)

For more information, call us 1-877-715-9398 (TTY 711)

9:30 a.m. to 11:00 p.m. EST. ? 7 days a week.



H6776_2019OTCCatalog001_M_File & Use 11/09/2018

RiverSpring Star

(HMO SNP)

2019 Over-the-Counter Product Catalog

With RiverSpring Star (HMO SNP), one of your key benefits is coverage for many over-thecounter (OTC) products. Each month, you are able to purchase products and their cost is covered by the Plan. There is no out-of-pocket cost to you, up to the maximum benefit amount. This packet contains important information about how you will use this benefit. Please save this information in a convenient place, so you can refer to it when you need to purchase additional products each month. This packet includes the following information: maximum benefit amount, how to order your OTC products and a list of products that is covered by RiverSpring Star (HMO SNP).

What is an OTC Benefit?

You are able to purchase certain health products, and the cost is covered by our Plan. Some examples are first aid products, ointments, dental products, and pain relievers. There is no outof-pocket cost to you, up to the maximum benefit amount. For a complete list of approved OTC products, please see the list in our Over-the-Counter Products Catalog, or call Member Services at 1-800-580-7000 (TTY 711).

How Much Is My Monthly Benefit?

RiverSpring Star (HMO SNP) will pay for up to $25 a month for over-the-counter products. OTC products may only be purchased for the member. On the first of every month, your OTC benefit will automatically replenish with $25 for you to use towards OTC products. At the end of the month, any remaining balance rolls over to the following month. Please note, at the end of every calendar year, your benefits will expire, and they may not be carried over to future years.

H6776_2019OTCCatalog001_M_File & Use 11/09/2018

How Do I Use My Benefit?

There are two ways for you to take advantage of your OTC Benefit.

You can call OTC Member Services at 1-877-715-9398, 9:30 a.m. to 11 p.m., EST. TTY Users can call 711. Have your Participant ID Card ready, and the names of the products you wish to order, and any other information about the product you are ordering (for example, whether you prefer tablets or capsules). Your products will be delivered to your door. You do not have to pay for shipping.

You can also order your OTC products online by visiting . Have your member number and birth date ready so you can sign in and start buying the products you need to stay healthy and well. Your products will be delivered to your door. You do not have to pay for shipping.

Please note that orders can only be placed once a month. You do not have to use your full benefit amount at one time, but remember that any unused benefit amount will carry over to the next month.

Requesting Reimbursement for Products Purchased On Your Own

You can also purchase OTC products that are available through this benefit at any local store, and ask RiverSpring Star to reimburse you for the costs. You are still limited to the total amount available in your benefit. To request reimbursement, please follow the steps below.

? Submit an original itemized receipt showing the products you purchased. The receipt must show: store where purchase was made, date of purchase, the specific name of the product(s) that were purchased, and the price paid.

? Your request must also include information about you. Please include in your request: Member's name and ID number, the complete mailing address where your reimbursement should be sent, and your phone number so we can contact you if we have any questions.

All requests should be sent to:

RiverSpring Star Attn: OTC Card Services 80 West 225th Street Bronx, New York 10463

All requests must be submitted within 30 days of purchase. Please allow up to 30 days to process your request and mail you a check.

ACNE TREATMENT ANTI-ARTHRITIC ANTI-FUNGAL

ANTI-ITCH

ANTI-INFECTIVE

Generic Benzoyl Peroxide Gel 10% 45gm Brand Clean & Clear Advantage Acne Spot Treatment .75oz Clean & Clear Essential Foam Facial Cleanser 8oz Neutrogena Clear Pore Oil-Eliminating Astringent 8oz

SKU 540-8570

SKU 148-2967 410-6050 113-3560

Price 3.61 Price 9.65 6.16 6.94

Generic Glucosamine Chondroitin 500/400mg 60 Capsules

SKU 1043399

Price 12.36

Generic Athletes Antifungal Foot Cream 0.5oz Clotrimazole 1% Cream 1oz Clotrimazole 1% Cream 0.5oz Miconazole Nitrate Cream 2% 30gm Tolnaftate 1% Cream 1oz Tolnaftate 1% Cream 0.5oz Tolnaftate 1% Powder 1.5oz Brand Fungi Nail Tincture 30ml Lamisil At Athletes Foot Cream 12gm Lotrimin AF Cream 0.5oz Lotrimin AF Cream 30gm

SKU 221-5952 148-1258 904-1955 099-1265 105-4352 354-0051 536-3387

SKU 316-0017 102-3407 550-3818

19150

Price 12.11 7.21 5.67 6.70 5.98 4.12 4.64 Price 19.50 12.36 11.58 18.70

Generic Calamine Lotion 6oz Diphenhydramine Cream 2% 1oz Hydrocortisone 1% Anti-Itch Cream 1oz Hydrocortisone 1% Ointment 1oz Brand After Bite Extra Gel 0.5oz Benadryl Extra Strength Itch Stopping 2% Cream 1oz Benadryl Regular Strength Itch Relief 1% Cream 1oz Cortizone 10 Creme 1oz Cortizone 10 Ointment 1oz Cortizone-10 Intensive Healing Formula Anti-Itch Creme 1oz Gold Bond Medicated Body Powder 10oz Gold Bond Medicated Maximum Strength Cream 1oz Psoriasin Ointment 4oz

SKU 359-1146 150-6468 099-0994 099-0978

SKU 376-1616 735-7791 735-7783 455-5561 455-5587 211-7380 799-0955 799-0930 572-1857

Price 4.12 5.00 5.15 5.67 Price 4.45 6.43 6.02 6.70 6.94 6.98 8.84 5.15 12.69

Generic Triple Antibiotic Ointment 1oz Brand Bactine Liquid 4oz Neosporin Original Antibiotic Ointment 1oz Neosporin Plus Maximum Strength Ointment 0.5oz Neosporin Plus Ointment Max/Strength 1oz

SKU 155-2405

SKU 472-0132 735-6389 735-6405 735-6413

Price 7.73 Price 5.67 10.55 7.79 12.65

BATH SAFETY COLD & ALLERGY

Brand Adjustable Transfer Bench Bath Seat Bath Seat with Back Bath Seat with Back, Aluminum Bathroom Safety Shower Tub Bench Chair Bathtub Mat, 28' x 16' Economy Elevated Toilet Seat Raised Toilet Seat with Arms and Lock, 5 Inches Safety Treads Suction Cup Grab Bar with 180 Swivel Action, 19 Inch Suction Tub and Shower Bar 16 Inch Toilet Safety Frame Toilet Seat Raised Lock 500lbs

SKU 147-9856 121-4162 170-1622 350-0873 618-2356 149-1760 7000404 7000101 356-3277 261-0822 261-0814 618-2943 232-5348

Price 98.99 50.85 49.00 42.07 41.57 15.95 16.99 33.99 5.00 39.99 17.95 35.00 52.99

Generic Cetirizine 10mg Tablets 30ct Cough Drops Black Cherry Sugar Free 25ct Cough Drops Cherry 30ct Cough Drops Honey Lemon 30ct Diphenhydramine 25mg Capsules 100ct Diphenhydramine 25mg Tablet 24ct Effervescent Cold Relief Tablets 20ct Loratadine 10mg Tablet 30ct Loratadine 10mg Tablets 100ct Medicated Chest Rub 3.53oz Mucus Relief Tablets 60ct Nasal Spray 1oz Saline Nasal Spray 1.5oz Sudogest PE Tab 10mg 36ct Tussin Dm Sugar Free Liquid Clear 4oz Tussin Form CF 8oz Tussin Form DM 8oz Brand Afrin Nasal Spray Original 0.5oz Afrin Nasal Spray Sinus 0.5oz Airborne Immune Support Chewable Tablets Berry 32ct Airborne Immune Support Chewable Tablets Citrus 32ct Alka-Seltzer Plus Cold 20ct Effervescent Tablet Original Alka-Seltzer Plus Cold Formula Effervescent Tablets Original 36ct Allegra OTC 180mg Tablets 24 Hour 15ct Allegra OTC 180mg Tablets 24 Hour 30ct Allegra OTC 60mg Tablets 12 Hour 12ct Benadryl Allergy Softgels Dye Free 24ct Breathe Right Nasal Strips Clear Large 30ct Breathe Right Nasal Strips Tan Small/Medium 30ct Cepacol Maximum Strength Lozenge Honey Lemon 16ct

SKU 221-2652 133-8839 133-8805 133-8813 904-0981 155-2694 565-5683 149-7379 234-1964 162-4311 244-3901 163-1522 904-1468 172-4897 565-5501 565-5519 565-5527

SKU 525-4941 525-6821 566-4149 566-4156 567-2217 567-2225

563-7806 235-5113 235-5139 362-5738 146-8883 814-0097 361-6034

Price 11.85 2.06 2.06 2.06 4.64 4.12 7.50 4.12 12.36 4.12 5.15 6.70 3.61 6.18 4.12 5.15 6.11 Price 8.13 8.13 10.90 10.90 7.70 11.12

20.73 27.74 14.80 7.17 16.48 17.78 4.37

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