Over-the-Counter (OTC) Catalog

2015

Over-the-Counter (OTC) Catalog

Get the OTC items you need.

-- Medicare Advantage Plans --

Y0070_NA026552_WCM_OTC_ENG_FINAL_02 CMS Accepted 07162014 ?WellCare 2014 HI_06_14

HI5OTCCAT60343E

The Benefits of `Ohana Add Up.

What is `Ohana's OTC benefit? Simply put, we give you a monthly dollar amount; you spend it on some of the over-the-counter (OTC) items you use every day. It's that easy. The OTC benefit is part of your health plan. Every month you can get brand-name or generic OTC medications and products like bandages, pain relievers, cold medicine, toothpaste, vitamins and much more. You even have a few ways to get your items. You can use this catalog, then order online or by phone and we'll ship your items right to your door. Or if you prefer, you can buy your selections at any retail store and we'll pay you back. Each plan offers different OTC benefit amounts. Check your Evidence of Coverage or Summary of Benefits for your specific benefit amount for your plan. Remember that your benefit and items are only for your use. Use your benefit each month. It does not roll over to the next month.

How Do I Use My OTC Benefit? There are several ways to get your items. No matter how you order them, we'll ship them right to your door. It's that easy. Allow 7-10 days to receive your order. Find the items you want in this catalog, then:

1. Give us a call. Find the Customer Service number for your state/plan in the back of this catalog, to place your order.

2. Order Online Visit us at medicare. Log on with your username and password. If you don't have a username, it's easy to sign up. Just follow the instructions. Once you've logged in, click on the OTC items link. Order items until they add up to your monthly benefit amount.

3. Buy your OTC items and we'll repay you. Go to any retail store and buy eligible OTC items. Then send us an OTC claim form and a copy of your itemized receipt. We'll pay you back for the costs up to your monthly OTC benefit amount. (You'll have to pay for anything over that.) There is a blank form and instructions on how to use it in this catalog.

Call Customer Service to order your OTC items | 1 HI5OTCCAT60343E

What Can I Order With My OTC Selection?

Eligible items On the next few pages, you'll find a list of products. These are the items that you can order from us and have mailed to your home. Or if you prefer, you can buy these and other items at a local store and have us repay you. Eligible items include but are not limited to: fiber supplements, first aid supplies, medicines, ointments, sprays with active medical ingredients that alleviate symptoms, topical sunscreen, supportive items for comfort such as knee braces and adult incontinence products, and mouth care such as dental floss and toothbrushes.

Dual-purpose items What are dual-purpose items? They're medicines and products that can be used for either a medical condition or for general health and well-being. You can get dual-purpose items as part of your OTC benefit if you use them to treat a specific medical condition and your doctor recommends the product or medicine. Talk with your doctor before buying dual-purpose items. For your convenience, we've marked dual-purpose items with a ().

Dual-purpose items include but are not limited to: ? Minerals and vitamins

? In-home testing and monitoring

? Hormone replacement

? Weight-loss items

Some items, under certain circumstances, may be covered under either Part B or Part D. For example, gauze may be covered under Part B when it is being used, as prescribed, to perform surgical wound dressing changes. For your convenience, we've marked these items with a (**).

What's not eligible? The following categories and items listed are not eligible for the OTC benefit. You cannot order them from us, and if you buy these items at a store, we can't repay you for them. Non-eligible items include but are not limited to:

? Alternative medicines such as botanicals, herbals, probiotics and nutraceuticals

? Baby items such as diapers and formula

? Contraceptives such as birth control pills and spermicides

? Convenience and comfort items such as scales, fans and magnifying glasses

? Cosmetic items such as mouthwash, bad breath remedies, deodorants and teeth whitening

? Food products or supplements

? Replacement items such as hearing aid batteries and contact lens containers

2 | Call Customer Service to order your OTC items

Items You Can Order From Us or Buy at a Retail Store Do you prefer lower-cost generics or familiar brand-name products? Your OTC benefit lets you make the choice! Look over the list of eligible items on the next few pages. You can order online or by calling us and telling us the ID numbers of the items you want. We'll send them to your home and deduct the amount from your monthly benefit.

Don't see your items? You can buy these and other items at a store near you and get reimbursed by sending us your itemized receipt and the enclosed OTC claim form.

OUR CATALOG ITEMS

ID# GENERIC NAME

QTY AMT ID# BRAND NAME

QTY AMT

ALLERGY PREVENTION AND TREATMENT

1

Allergy Relief (Cetirizine) 10mg Tablets

30

$8

501 Zyrtec?

14 $15

2

Allergy Relief (Loratadine) 10mg Tablets

30

$7

502 Claritin?

10 $10

ANALGESICS / ANTIPYRETICS

3

Acetaminophen 325mg Tablets

4

Acetaminophen 500mg Tablets

100 $3 100 $4

503

Tylenol? 325mg Regular Strength Tablets

504

Tylenol? 500mg Extra Strength Tablets

5 Aspirin 325mg Tablets 100 $3 505 Bayer? Aspirin 325mg

6 Aspirin 81mg Chewable

7

Aspirin Enteric Coated 81mg Tablets

8

Aspirin Enteric Coated 325mg Tablets

36 $3 120 $3 100 $4

N/A

Bayer? Aspirin 81mg Chewable

507

Bayer? EC Aspirin 81mg (Adult Regimen)

508 Ecotrin? Tablets

ANTACIDS AND ACID REDUCERS

9

Acid Reducer (Famotidine) 10mg Tablets

30

$6

10

Acid Reducer (Omeprazole) 20mg

14 $10

11

Acid Reducer (Ranitidine) 75mg Tablets

30

$7

509 Pepcid? AC Tab 510 Prilosec? 511 Zantac? Tablets

100 $10 100 $16 100 $8 N/A N/A 32 $4 100 $6

30 $11 14 $12 30 $15

* = Quantities and brands may vary depending upon availability. = Dual-purpose items ** = Covered under either Part B or Part D

Call Customer Service to order your OTC items | 3

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