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OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS
Your 2020 catalog
MY OVER-THE-COUNTER ALLOWANCE 3
$30 quarterly allowance toward OTC items
H8423_20_75983 Approved 928946
YOUR OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS
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Use your rollover $30 allowance toward OTC items each quarter
Choose from the list of covered medications and health products in this catalog
Three easy ways to order
CALL 1-866-575-3744 (TTY 7-1-1) Monday to Friday 7 am to 10 pm Central Time
COMPLETE and mail the order form within
CLICK to order through our OTC products website at wwwCignaHealthSpringOTCcom
Its easy to
bull Create a personal log-in profile Its quick and secure bull View your balance Unused funds roll over during a calendar year bull Track your available funds in real time as you add items
to your cart bull Review your order history throughout the year bull Get an email with a tracking number when your order ships
Address change Call to check that we have your current mailing address
Away from home Your OTC order can be shipped to a temporary address anywhere within the continental US if needed
CALL 1-866-575-3744 (TTY 7-1-1) Monday to Friday 7 am to 10 pm Central Time
SAVE MONEY AND TIME You can get OTC items sent right to your door ndash with FREE delivery
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QAamp Common questions about
your OTC benefit
Q What can I use my $30 quarterly allowance toward
A You can use your allowance to help pay for medicine and health items such as aspirin vitamins dental care products bandages and much more See OTC Medications and Health Products on page 5
Q Can I use my $30 OTC allowance toward prescription drugs
A No Your $30 quarterly allowance is for items that can be bought without a prescription
Q Can a family member use my $30 OTC allowance
A No An OTC allowance can only be used by a Member If two people in a house are Members each will have their own OTC allowance
Q Does my allowance add up if I donrsquot use it
A Yes Unused funds will roll over each quarter beginning January 1 2020 and ending on December 31 2020
Q Can I use parts of my allowance to order at different times throughout a month
A No You can use your $30 quarterly allowance to order items once a quarter
Q Can my total order be more than $30
A The total cost of your order should be equal to or less than your rollover allowance amount
Q How long will my order take A Your order will take up to 5 to 7
business days to arrive If you have any questions about your order call 1-866-575-3744 (TTY 7-1-1) Monday to Friday 7 am to 10 pm Central Time
Q Can I return my items A No Received items cannot be returned
Three ways to order
CALL 1-866-575-3744 (TTY 7-1-1) Monday to Friday 7 am to 10 pm Central Time
COMPLETE and mail the order form within
CLICK to order at wwwCignaHealthSpringOTCcom
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CATEGORY INDEX Please use the index below for ease in locating available OTC items
Category Products include Page
Allergy Antihistamines decongestants cough suppressantsexpectorants and nasal sprays Antacids amp Acid Reducers Anticandidal (yeast)
Products to treat symptoms of stomach upset heartburn and acid indigestion Vaginal cream with applicator
6 7
Anti-diarrheal Laxatives amp Digestive Health
Products to treat symptoms of constipation upset stomach bloating cramping gas and diarrhea 7
Anti-fungal Topical creams and powders to treat symptoms of athletes foot jock itch and other applications 9
Bathroom Safety amp Fall Prevention Bath benches mats safety rails grab bars raised toilet seats canes gait belts night light and other products 9
Cold amp Flu Cough drops throat lozenges and other products Cold Sore amp Medicated Lip Products Lip balmscream to treat cold sores fever blisters and chapped lips 12
Daily Living Aids Cushions humidifier medical ID bracelets pill case crushercutter CPAP pillows and other products 12
Dental amp Denture Care Mouthwash toothbrushes cleaning tablets and creams adhesive cream dental floss and oral pain relief gel 13
Diabetic Foot Care Foot cream and socks for people with diabetes circulatory problems edema and neuropathy 14
Diagnostic Equipment Scales blood pressure monitors heart rate monitors and thermometers
Diagnostic Tests Tests for colon cancer and cholesterol 16 Ear Care Cotton swabs drops for ear aches and wax removal treatments 16 Eye Care Eye drops for lubricating and cleansing 16 First Aid Products for wound care and insect bites 17 Foot Care Pads to remove calluses and corns
Hemorrhoid Relief Products for temporary relief from hemorrhoids 20 Incontinence Supplies Wipes bed pads pads disposable briefsunderwear cleanser and skin protectant 20 Lice Treatment (Pediculicide) Kit shampoo and conditioning treatment 23 Motion Sickness Tablets used to prevent and treat nausea vomiting dizziness and vertigo 23
Pain Relief Aids Patches heating pads and wraps to temporarily relieve pain 23
Pain Relievers amp Fever Reducers Tablets and capsules to temporarily relieve pain and reduce fever Skin amp Sun Care Products to moisturize and protect skin 26 Sleep Aids Nasal strips and tablets 26 Smoking Cessation Nicotine gum lozenges and patches 27 Supports amp Braces Bracessupports for ankle knee and back gloves and compression socks 27 Vitamins amp Minerals Dietary supplements 29 Wart Remover Systems and liquid to remove warts 33
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OTC MEDICATIONS AND HEALTH PRODUCTS Talk with your doctor before starting a new product regimen
Allergy
Benadrylreg Allergy Liqui-Gels Dye-Free Item No 1927 $1200
- 24 ct25 mg
Cetirizine HCL Cetirizine HCL Chlorpheniramine (Allergy Tablets) (Allergy Tablets) Maleate Antihistamine Item No 1090 Item No 2003 (Allergy Tablets)
Item No 1008 $500 $1000 $500
- Compare to Zyrtecreg - Compare to Zyrtecreg
- 14 ct10 mg - 45 ct10 mg - 100 ct4 mg
Cromolyn Sodium (Allergy Nasal Spray) Item No 1356 $1800
- Compare to Nasalcromreg
- 26 ml
DiphenhydramineAntihistamine (Allergy Tablets) Item No 1009 $500
- Compare to Benadry- 24 ct25 mg
Diphenhydramine Antihistamine (Allergy Tablets) Item No 1308 $600
lreg - Compare to Benadry- 100 ct25 mg
Diphenhydramine Antihistamine (Allergy Tablets) Item No 2021 $1500
lreg - Compare to Benadrylreg
- 400 ct25 mg
Fexofenadine Fluticasone Propionate Loratadine (Allergy Tablets) Loratadine (Allergy Tablets) (Allergy Tablets) (Allergy Nasal Item No 2033 Item No 1611 Item No 1804 Spray 24-hour) $550 $1800Item No 1946 $1600
- Compare to Claritinreg - Compare to Claritinreg$2500 - Compare to Allegrareg - 10 ct 10 mg - 100 ct10 mg
- 30 ct180 mg - Compare to Flonasereg
- 120 spray50 mcg
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OTC MEDICATIONS AND HEALTH PRODUCTS Talk with your doctor before starting a new product regimen
Allergy continued
Nasal Decongestant Nasal Decongestant Nasal Spray Saline Loratadine (Allergy Tablets) Nasacortreg
Inhaler - Spray 12-Hour Item No 1052 Item No 2020 Item No 1881 Levmetamfetamine Item No 1091 $500$2500 $2200 Item No 1922 $500 - 15 oz065 - Compare to Claritinreg - 60 spray $700
- Compare to Afrinreg - 365 ct10 mg - Compare to Vicksreg - 1 oz005
VapoInhaler - 007 oz50 mg
Antacids amp Acid Reducers
Effervescent Antacid Esomeprazole Magnesium Alka-Seltzerreg Antacid Anti- Antacid Chewables amp Pain Relief (Acid Reducer Item No 1313 Gas Liquid Item No 1346 Item No 1314 Delayed Release) Item No 1006 $600$1100 Item No 1949 $800$600
- 36 ct - Compare to Tumsreg $2300 - Compare to- Compare to Maaloxreg - 150 ct500 mg
- 12 oz Alka-Seltzerreg - Compare to Nexiumreg
- 36 ct - 42 ct20 mg
Famotidine (AcidReducer) Item No 1108 $600
- Compare toPepcid ACreg
- 30 ct10 mg
Omeprazole (Acid Reducer Delayed Release) Item No 1970 $2500
- Compare toPrilosecreg
- 42 ct20 mg
Omeprazole (Acid Ranitidine (Acid Reducer) Reducer Delayed Item No 1900 Release Dissolvable) $800Item No 1966
- Compare to Zantacreg $2500 - 30 ct75 mg - Compare to
Prilosecreg
- 42 ct20 mg
Simethicone (Gas Relief) Item No 1800 $900
- Compareto Gas-Xreg
Chewables - 100 ct80 mg
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Allergy continued
Famotidine (AcidReducer)Item No 1108$600
- Compare toPepcid ACreg
- 30 ct10 mg
Omeprazole(Acid ReducerDelayed Release)Item No 1970$2500
- Compare toPrilosecreg
- 42 ct20 mg
Omeprazole (AcidReducer DelayedRelease Dissolvable)Item No 1966$2500
- Compare toPrilosecreg
- 42 ct20 mg
Ranitidine (Acid Reducer)Item No 1900$800
- Compare to Zantacreg
- 30 ct75 mg
Esomeprazole Magnesium(Acid ReducerDelayed Release)Item No 1949$2300
- Compare to Nexiumreg
- 42 ct20 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Antacids amp Acid Reducers continued
TUMSreg Extra Strength TUMSreg Ultra Strength Item No 2034 Item No 2019 $750 $1000
- 48 ct750 mg - 72 ct1000 mg
Anticandidal (yeast)
Clotrimazole (Vaginal Antifungal 7-Day Cream with Applicator) Item No 1115 $800
- Compare to Monistatreg 7 - 45 gm1
Miconazole (Vaginal Antifungal 3-Day Cream with Applicator)) Item No 1117 $1400
- Compare to Monistatreg 3 - 1 kit2
Tioconazole (Vaginal Antifungal 1-Day Cream with Applicator) Item No 1119 $2000
- Compare to Monistatreg 1 - 1 ct65
Anti-diarrheal Laxatives amp Digestive Health
Beanoreg
Item No 1316 $900
- 30 ct
Docusate Sodium (Stool Softener) Item No 1126 $600
- Compare toColacereg
- 100 ct100 mg
Docusate Sodium plus Sennosides (Natural Vegetable Laxative) Item No 1130 $800
- Compare toSenokot-Sreg
- 60 ct86 mg 50 mg
Enema Ex-Laxreg
Item No 1733 Item No 1124 $550 $800
- Compare to Fleetreg
- 45 oz - 8 ct15 mg
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OTC MEDICATIONS AND HEALTH PRODUCTSTalk with your doctor before starting a new product regimen
Anti-diarrheal Laxatives amp Digestive Health continued
Lactase Capsules Item No 1067 $1000
- Compare toLactaidreg
- 60 ct9000 FCC Units
Laxative Bisacodyl (Stimulant Enteric Coated) Item No 1128 $500
- Compare toDulcolaxreg
- 100 ct5 mg
Laxative MagnesiumCitrate (SalineLemon) Item No 1889 $550
- 296 ml
Laxative Natural Vegetable (Psyllium) Item No 1340 $1000
- Compare toMetamucilreg
- 13 oz
Laxative Calcium Polycarbophil (Fiber Tablets) Item No 1012 $1000
- Compare to FiberConreg
- 90 ct625 mg
Laxative Natural Vegetable (Psyllium) Item No 1967 $1600
- Compare to Metamuc- 304 oz
Laxative ClearLaxreg
Unflavored Powder Item No 1969 $1350
- Compare toMiraLA Xreg
- 83 oz17 g
Laxative Natural VegetabSugar Free (Psyllium) Item No 1968 $1300
ilreg - Compare to Metamucilreg
Sugar-Free - 15 oz
Laxative Glycerin Suppository Item No 1125 $500
- Compare to Fleetreg
- 25 ct2 gm
le Loperamide HCL (Anti-Diarrheal Tablets) Item No 1133 $500
- Compare toImodium A-Dreg
- 12 ct2 mg
Pink Bismuth Liquid Item No 1318 $600
- Compare toPepto-Bismolreg
- 8 oz525 mg 30 ml
Methylcellulose (Fiber Therapy) Item No 1354 $1200
- Compare to Citrucelreg
- 16 oz
Milk of Magnesia Item No 1011 $600
- Compare to Phillipsreg
- 12 oz400 mg
Pepto-Bismolreg Cherry Item No 1317 $1000
- 12 oz525 mg 30 ml
Pink Bismuth Chewable Tablets Item No 1045 $600
- Compare to Pepto-Bismolreg Chewable
- 30 ct262 mg
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Laxative GlycerinSuppositoryItem No 1125$500
- Compare to Fleetreg
- 25 ct2 gm
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Anti-fungal
Clotrimazole (Athletes Foot Cream) Item No 1047 $600
- Compare toLotriminreg AF
- 15 oz1
Miconazole Nitrate (Anti-fungal Cream) Item No 1135 $800
- Compare to Micatinreg
- 1 oz2
Miconazole Nitrate (Athletes Foot Spray) Item No 1874 $1000
- Compare toLotriminreg AF
- 46 oz2
Terbinafine HCL (Athletes Foot Cream) Item No 1046 $1200
- Compare toLamisilreg AT
- 5 oz1
Tolnaftate (Antishyfungal Cream) Item No 1064 $500
- Compare to Tinactinreg
- 125 oz1
Bathroom Safety amp Fall Prevention
Bath Bench Bath Tub Safety Rail Bed Assist Bar Bath Bench Bath Mat Non-Skid with Back Item No 1730 Item No 2009 without Back Item No 1459 Item No 1728 Item No 1727 $3700 $5500$1700 $6500 $5500 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
Cane Quad Fall Mat Bedside Commode Cane Folding Cane Quad Large Base Small Base Item No 2006 Item No 1984 Ergonomic Handle Item No 1776 Item No 1777 Item No 1726 $6500 $3000 $15000 $2500$2000 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
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Cold amp Flu
Bathroom Safety amp Fall Prevention continued
Gait Belt - 60 Item No 1790 $1600
- 1 ct
Grab Bar Knurled Chrome 12 Item No 1798 $1900
- 1 ct
Grab Bar Knurled Chrome 24 Item No 1797 $2200
- 1 ct
Grab Bar Knurled Chrome 32 Item No 2005 $3600
- 1 ct
Gait Belt - 72 Item No 1791 $1700
- 1 ct
Night Light Item No 1983 $1500
- 2 ct
Safety Treads Tub amp Stair Item No 1780 $1000
- 1 pack
Shower Head Handheld Item No 2007 $2500
- 1 ct
Shower Mat Non-Skid Item No 1460 $1400
- 1 ct
Safety Tread Aids Anti-Slip Item No 1793 $1700
- 1 roll
Slipper Socks One Size Fits Most Item No 2008 $700
- 1 pair
Toilet Seat Raised Item No 1729 $3500
- 1 ct
Toilet Seat Raised with Arms Item No 1950 $6500
- 1 ct
Transfer Bench Adjustable Item No 1764 $8000
- 1 ct
Toilet Safety Rails Item No 1779 $5000
- 1 set
Cough amp Cold for High Blood Pressure Item No 1166 $700
- Compare to Coricidinreg HBP - 16 ct
Cough DropsCherry Item No 1056 $400
- Compare to Hallsreg
- 30 ct58 mg
Cough DropsHoney Lemon Item No 1833 $400
- Compare to Hallsreg
- 30 ct
Cough DropsMenthol Item No 1834 $400
- Compare to Hallsreg
- 30 ct
Cough Drops SugarFree Cherry Item No 1182 $500
- Compare to Hallsreg Sugar Free - 25 ct58 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Grab Bar Knurled Chrome 32Item No 2005$3600
- 1 ct
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Cough SyrupExpectorant Item No 1054 $500
- Compare toRobitussinreg
- 4 oz200 mg 10 ml
Guaifenesin (CoughExpectorant) Item No 1180 $900
- 100 ct200 mg
Inhaler Personal Steam Item No 1792 $5000
- Vicksreg Personal Steam Inhaler
- 1 ct
Mucus Relief DM Expectorant amp Cough Suppressant Item No 1178 $1200
- Compare to Mucinexreg
- 30 ct400 mg 20 mg
Diabetic Tussinreg DM Item No 1323 $900
- Compare toRobitussinreg
Sugar Free DM - 4 oz
Mucus Relief DM Expectorant amp Cough SuppressantExtended Release Item No 1965 $1600
- Compare to Mucinexreg
- 14 ct1200 mg 60 mg
Nasal Rinse Kit Saline Item No 1931 $1800
- Compare to NeilMedreg
Sinus Rinse - 1 kit
Night Time Cold amp Flu Item No 1361 $600
- Compare toVicks NyQuilreg
- 4 oz125 mg 30 mg 650 mg
Phenylephrine HCL (Nasal Decongestant PE) Item No 1352 $500
- Compare toSudafedreg PE
- 36 ct10 mg
Multi-Symptom Cold Formula Item No 1357 $600
- Compare toTylenolreg Cold Multi-Symptom Daytime
- 24 ct10 mg5 mg 325 mg
Sore Throat Lozenges Cepacolreg
Item No 1360 $550
- 16 ct
Cold amp Flu continued
Sore Throat Lozenges Cherry Item No 1176 $700
- Compare to Cepacolreg
- 18 ct
Sore Throat Spray Cherry Item No 1904 $800
- Compare to Chlorasepticreg
- 6 oz
Vapor Rub Item No 1164 $750
- Compare to Vicks VapoRubreg
- 35 oz47 1
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Abrevareg
Item No 1152 $2600
- 2 gm10
Carmexreg
Item No 1255 $400
- 75 gm
Herpecin-Lreg Lip Balm Item No 1153 $800
- 1 oz1
Releevreg Cold Sore Treatment Item No 1359 $2400
- 6 ml13
Blistexreg Lip Ointment Item No 1256 $500
- 6 gm
Cushion Foam Ring Item No 1732 $2100
- 1 ct
Cushion Lumbar Item No 1731 $2700
- 1 ct
Humidifier Ultra-Sonic Cool Mist Item No 1795 $5800
- Compare to Vicksreg Ultrasonic Humidifier - 1 ct
Cushion Gel Foam Seat Item No 1466 $4000
- 1 ct
Cold Sore amp Medicated Lip Products
Daily Living Aids
Pill Case Weekly AMPM Item No 1934 $1100
- 1 ct
Pill Cutter with Safety Shield Item No 1932 $1000
- 1 ct
Pillow CPAP Fiber Filled Item No 1836 $6000
- 1 ct
Pillow CPAP Memory Foam Item No 1837 $9500
- 1 ct
Pillow Hypoallergenic Item No 1936 $5300
- 1 ct
Pill Crusher with Storage Item No 1933 $1000
- 1 ct
Medical ID Bracelet bull Blank Item No 1875 1 ct
$1650
bull Diabetic Item No 1877 1 ct bull Heart Item No 1876 1 ct
$1500
Medicine Bottle Opener with Magnifier Item No 2017 $1000
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
13
Dental amp Denture Care
Denture Cleaning Tablets Item No 1032 $600
- Compare to Polidentreg
- 40 ct
Efferdentreg Plus Mint Tablets Item No 1653 $800
- 36 ct
Effergripreg Denture Cream Adhesive Item No 1843 $900
- 25 oz
Biotenereg Dry Mouth Oral Rinse Item No 1817 $1400
- 16 oz
Denture Brush Item No 1747 $650
- Compare to G-U-Mreg
- 1 ct
Interdental Flossups Item No 1751 $500
- Compare to G-U-Mreg
- 90 ct
Orajelreg Pain Relief Item No 1454 $1100
- 25 oz20
Oral Pain Relief Item No 1286 $600
- Compareto Orajelreg
- 5 oz20
Polidentreg Overnight Item No 1892 $1250
- 84 ct
Fixodentreg
Item No 1187 $700
- 75 oz
Tongue Cleaner Item No 1746 $600
- 1 ct
Toothbrush Battery Powered Item No 2015 $2000
- 1 ct
Toothbrush Colgatereg Adult Soft Item No 1413 $300
- 1 ct
Reachreg Waxed Dental Floss - Mint Item No 1455 $500
- 55 yd
Polidentreg Denture Cream Item No 1324 $650
- 39 oz
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Toothpaste Crestreg Sensi-Relief Item No 1838 $950
- 41 oz
Toothpaste Fluoride Item No 1914 $550
- 64 oz
Toothpaste Pepsodentreg
Item No 1414 $500
- 55 oz
Toothbrush Tek Proreg Angled Soft Item No 1412 $300
- 1 ct
Toothpaste Colgatereg
Item No 1831 $600
- 4 oz
Toothbrush Rechargeable Item No 1450 $4000
- 1 ct
Toothbrush Soft 2-pack Item No 1948 $600
- 2 ct
Dental amp Denture Care continued
Toothpaste Ultrabritereg
Advanced Whitening Item No 1716 $700
- 6 oz
Toothpaste Sensitive Teeth Item No 1903 $600
- Compare to Sensodynereg
- 43 oz
Water Jet Item No 1744 $4200
- 1 ct
Water Jet Replacement Tips Item No 1743 $1700
- 5 ct
Diabetic Skin Relief Foot Cream Item No 1839 $1200
- Compare to Gold Bondreg
Skin Protectant Foot Cream - 34 oz
Diabetic Socks Black bull Medium Item No 1956 bull Large Item No 1957 bull X-Large Item No 1958 $900
- 3 pair
Diabetic Foot Care
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
15
Diabetic Foot Care continued
Diabetic Socks Ultra Soft Padded Black bull Medium Item No 1959 bull Large Item No 1960 bull X-Large Item No 1961 $1100
- 2 pair
Diabetic Socks Ultra Soft Padded White bull Medium Item No 1962 bull Large Item No 1963 bull X-Large Item No 1964 $1100
- 2 pair
Diabetic Socks White bull Medium Item No 1953 bull Large Item No 1954 bull X-Large Item No 1955 $900
- 3 pair
Bathroom Scale Talking Daggersect
Item No 1981 $5700
- 1 ct
Blood Pressure Monitor Desktop Replacement Cuff Dagger
Item No 1504 $1500
- 1 ct
Blood Pressure Monitor Desktop Talking Dagger
Item No 1503 $5500
- 1 ct
Bathroom Scale Daggersect
Item No 1935 $3500
- 1 ct
Activity Tracker Item No 1982 $5200
- 1 ct
Blood Pressure Monitor Desktop Automatic Dagger
Item No 1253 $5000
- 1 ct
Blood Pressure Monitor Wrist Dagger
Item No 1501 $3500
- 1 ct
Diagnostic Equipment
Blood Pressure Monitor Wrist Talking Dagger
Item No 1502 $4500
- 1 ct
Finger Pulse Oximeter Dagger
Item No 1505 $4200
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
16
Diagnostic Equipment continued
Peak Flow Meter Dagger
Item No 1789 $1700
- 1 ct
Thermometer Digital 60 seconds Item No 1063 $650
- 1 ct
Thermometer Digital Ear Item No 1285 $2700
- 1 ct
Thermometer Flexible Tip Digital 10 seconds Item No 1697 $1000
- 1 ct
Heart Rate Monitor Watch Dagger
Item No 1771 $4000
- 1 ct
Diagnostic Tests Ear Care
Eye Care
Thermometer Talking Ear and Forehead Item No 1925 $4500
- 1 ct
Home Access Cholesterol Test Dagger
Item No 1251 $3000
- 1 kit
Cotton Tipped Swabs Item No 1742 $600
- Compare to Johnson amp Johnsonreg
- 300 ct
EZ Detectreg Colon Cancer Test Kit Dagger
Item No 1416 $1300
- 1 ct
Ear Wax Removal Drops Item No 1190 $500
- Compare to Debroxreg
- 15 ml65
Ear Wax Removal System with Rubber Bulb Item No 1363 $700
- Compare toDebroxreg
- 15 ml65
Ear Pain Relief Ear Drops Item No 1841 $1300
- Compare to Hylands Ear Reliefreg
- 10 ml
Artificial Tears Drops Item No 1192 $600
- Compare toVisine Tearsreg
- 5 oz
Artificial Tears Ointment Item No 1194 $600
- Compare to Refresh PMreg
- 35 gm
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Artificial Tears OintmentItem No 1194$600
- Compare to Refresh PMreg
- 35 gm
17
Eye Care continued
First Aid
Contact Lens Solution Multi-Purpose Item No 1468 $800
- Compare to Renureg
Multipurpose Solution - 12 oz
Eye Drops Clear Eyesreg
Item No 1199 $600
- 2 oz
Eye Drops Irritation Relief Item No 1806 $950
- Compare toVisine ACreg
- 15 ml
Eye Drops Redness Relief Item No 1061 $500
- Compare to Visinereg
Original Redness Relief - 15 ml005
Eye Wash Solution Bausch + Lombreg
Item No 1196 $800
- 4 oz
Antiseptic Skin Cleanser Item No 1808 $1100
- Compare to Hibiclensreg
- 8 oz
Bactinereg Solution Item No 1142 $1000
- 4 oz
Adhesive Bandages Item No 1344 $500
- Compare to Band-Aidreg Plastic Strips
- 60 ct
Alcohol Pads Item No 1200 $550
- 100 ct70
After Bitereg
Relief Item No 1803 $900
- 5 oz
Antiseptic Towelettes Item No 1201 $700
- 100 ct
Bacitracin Ointment Item No 1020 $600
- 1 oz500 U gm
Bandage Elastic - 2 x 45 yd Item No 1207 $400
- Compare to Acereg
- 1 ct
Bandage Elastic - 3 x 5 yd Item No 1209 $400
- Compare to Acereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
YOUR OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS
1
2
3
4
5
Use your rollover $30 allowance toward OTC items each quarter
Choose from the list of covered medications and health products in this catalog
Three easy ways to order
CALL 1-866-575-3744 (TTY 7-1-1) Monday to Friday 7 am to 10 pm Central Time
COMPLETE and mail the order form within
CLICK to order through our OTC products website at wwwCignaHealthSpringOTCcom
Its easy to
bull Create a personal log-in profile Its quick and secure bull View your balance Unused funds roll over during a calendar year bull Track your available funds in real time as you add items
to your cart bull Review your order history throughout the year bull Get an email with a tracking number when your order ships
Address change Call to check that we have your current mailing address
Away from home Your OTC order can be shipped to a temporary address anywhere within the continental US if needed
CALL 1-866-575-3744 (TTY 7-1-1) Monday to Friday 7 am to 10 pm Central Time
SAVE MONEY AND TIME You can get OTC items sent right to your door ndash with FREE delivery
2
QAamp Common questions about
your OTC benefit
Q What can I use my $30 quarterly allowance toward
A You can use your allowance to help pay for medicine and health items such as aspirin vitamins dental care products bandages and much more See OTC Medications and Health Products on page 5
Q Can I use my $30 OTC allowance toward prescription drugs
A No Your $30 quarterly allowance is for items that can be bought without a prescription
Q Can a family member use my $30 OTC allowance
A No An OTC allowance can only be used by a Member If two people in a house are Members each will have their own OTC allowance
Q Does my allowance add up if I donrsquot use it
A Yes Unused funds will roll over each quarter beginning January 1 2020 and ending on December 31 2020
Q Can I use parts of my allowance to order at different times throughout a month
A No You can use your $30 quarterly allowance to order items once a quarter
Q Can my total order be more than $30
A The total cost of your order should be equal to or less than your rollover allowance amount
Q How long will my order take A Your order will take up to 5 to 7
business days to arrive If you have any questions about your order call 1-866-575-3744 (TTY 7-1-1) Monday to Friday 7 am to 10 pm Central Time
Q Can I return my items A No Received items cannot be returned
Three ways to order
CALL 1-866-575-3744 (TTY 7-1-1) Monday to Friday 7 am to 10 pm Central Time
COMPLETE and mail the order form within
CLICK to order at wwwCignaHealthSpringOTCcom
3
5
10
15
20
25
CATEGORY INDEX Please use the index below for ease in locating available OTC items
Category Products include Page
Allergy Antihistamines decongestants cough suppressantsexpectorants and nasal sprays Antacids amp Acid Reducers Anticandidal (yeast)
Products to treat symptoms of stomach upset heartburn and acid indigestion Vaginal cream with applicator
6 7
Anti-diarrheal Laxatives amp Digestive Health
Products to treat symptoms of constipation upset stomach bloating cramping gas and diarrhea 7
Anti-fungal Topical creams and powders to treat symptoms of athletes foot jock itch and other applications 9
Bathroom Safety amp Fall Prevention Bath benches mats safety rails grab bars raised toilet seats canes gait belts night light and other products 9
Cold amp Flu Cough drops throat lozenges and other products Cold Sore amp Medicated Lip Products Lip balmscream to treat cold sores fever blisters and chapped lips 12
Daily Living Aids Cushions humidifier medical ID bracelets pill case crushercutter CPAP pillows and other products 12
Dental amp Denture Care Mouthwash toothbrushes cleaning tablets and creams adhesive cream dental floss and oral pain relief gel 13
Diabetic Foot Care Foot cream and socks for people with diabetes circulatory problems edema and neuropathy 14
Diagnostic Equipment Scales blood pressure monitors heart rate monitors and thermometers
Diagnostic Tests Tests for colon cancer and cholesterol 16 Ear Care Cotton swabs drops for ear aches and wax removal treatments 16 Eye Care Eye drops for lubricating and cleansing 16 First Aid Products for wound care and insect bites 17 Foot Care Pads to remove calluses and corns
Hemorrhoid Relief Products for temporary relief from hemorrhoids 20 Incontinence Supplies Wipes bed pads pads disposable briefsunderwear cleanser and skin protectant 20 Lice Treatment (Pediculicide) Kit shampoo and conditioning treatment 23 Motion Sickness Tablets used to prevent and treat nausea vomiting dizziness and vertigo 23
Pain Relief Aids Patches heating pads and wraps to temporarily relieve pain 23
Pain Relievers amp Fever Reducers Tablets and capsules to temporarily relieve pain and reduce fever Skin amp Sun Care Products to moisturize and protect skin 26 Sleep Aids Nasal strips and tablets 26 Smoking Cessation Nicotine gum lozenges and patches 27 Supports amp Braces Bracessupports for ankle knee and back gloves and compression socks 27 Vitamins amp Minerals Dietary supplements 29 Wart Remover Systems and liquid to remove warts 33
4
OTC MEDICATIONS AND HEALTH PRODUCTS Talk with your doctor before starting a new product regimen
Allergy
Benadrylreg Allergy Liqui-Gels Dye-Free Item No 1927 $1200
- 24 ct25 mg
Cetirizine HCL Cetirizine HCL Chlorpheniramine (Allergy Tablets) (Allergy Tablets) Maleate Antihistamine Item No 1090 Item No 2003 (Allergy Tablets)
Item No 1008 $500 $1000 $500
- Compare to Zyrtecreg - Compare to Zyrtecreg
- 14 ct10 mg - 45 ct10 mg - 100 ct4 mg
Cromolyn Sodium (Allergy Nasal Spray) Item No 1356 $1800
- Compare to Nasalcromreg
- 26 ml
DiphenhydramineAntihistamine (Allergy Tablets) Item No 1009 $500
- Compare to Benadry- 24 ct25 mg
Diphenhydramine Antihistamine (Allergy Tablets) Item No 1308 $600
lreg - Compare to Benadry- 100 ct25 mg
Diphenhydramine Antihistamine (Allergy Tablets) Item No 2021 $1500
lreg - Compare to Benadrylreg
- 400 ct25 mg
Fexofenadine Fluticasone Propionate Loratadine (Allergy Tablets) Loratadine (Allergy Tablets) (Allergy Tablets) (Allergy Nasal Item No 2033 Item No 1611 Item No 1804 Spray 24-hour) $550 $1800Item No 1946 $1600
- Compare to Claritinreg - Compare to Claritinreg$2500 - Compare to Allegrareg - 10 ct 10 mg - 100 ct10 mg
- 30 ct180 mg - Compare to Flonasereg
- 120 spray50 mcg
5
OTC MEDICATIONS AND HEALTH PRODUCTS Talk with your doctor before starting a new product regimen
Allergy continued
Nasal Decongestant Nasal Decongestant Nasal Spray Saline Loratadine (Allergy Tablets) Nasacortreg
Inhaler - Spray 12-Hour Item No 1052 Item No 2020 Item No 1881 Levmetamfetamine Item No 1091 $500$2500 $2200 Item No 1922 $500 - 15 oz065 - Compare to Claritinreg - 60 spray $700
- Compare to Afrinreg - 365 ct10 mg - Compare to Vicksreg - 1 oz005
VapoInhaler - 007 oz50 mg
Antacids amp Acid Reducers
Effervescent Antacid Esomeprazole Magnesium Alka-Seltzerreg Antacid Anti- Antacid Chewables amp Pain Relief (Acid Reducer Item No 1313 Gas Liquid Item No 1346 Item No 1314 Delayed Release) Item No 1006 $600$1100 Item No 1949 $800$600
- 36 ct - Compare to Tumsreg $2300 - Compare to- Compare to Maaloxreg - 150 ct500 mg
- 12 oz Alka-Seltzerreg - Compare to Nexiumreg
- 36 ct - 42 ct20 mg
Famotidine (AcidReducer) Item No 1108 $600
- Compare toPepcid ACreg
- 30 ct10 mg
Omeprazole (Acid Reducer Delayed Release) Item No 1970 $2500
- Compare toPrilosecreg
- 42 ct20 mg
Omeprazole (Acid Ranitidine (Acid Reducer) Reducer Delayed Item No 1900 Release Dissolvable) $800Item No 1966
- Compare to Zantacreg $2500 - 30 ct75 mg - Compare to
Prilosecreg
- 42 ct20 mg
Simethicone (Gas Relief) Item No 1800 $900
- Compareto Gas-Xreg
Chewables - 100 ct80 mg
6
Allergy continued
Famotidine (AcidReducer)Item No 1108$600
- Compare toPepcid ACreg
- 30 ct10 mg
Omeprazole(Acid ReducerDelayed Release)Item No 1970$2500
- Compare toPrilosecreg
- 42 ct20 mg
Omeprazole (AcidReducer DelayedRelease Dissolvable)Item No 1966$2500
- Compare toPrilosecreg
- 42 ct20 mg
Ranitidine (Acid Reducer)Item No 1900$800
- Compare to Zantacreg
- 30 ct75 mg
Esomeprazole Magnesium(Acid ReducerDelayed Release)Item No 1949$2300
- Compare to Nexiumreg
- 42 ct20 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Antacids amp Acid Reducers continued
TUMSreg Extra Strength TUMSreg Ultra Strength Item No 2034 Item No 2019 $750 $1000
- 48 ct750 mg - 72 ct1000 mg
Anticandidal (yeast)
Clotrimazole (Vaginal Antifungal 7-Day Cream with Applicator) Item No 1115 $800
- Compare to Monistatreg 7 - 45 gm1
Miconazole (Vaginal Antifungal 3-Day Cream with Applicator)) Item No 1117 $1400
- Compare to Monistatreg 3 - 1 kit2
Tioconazole (Vaginal Antifungal 1-Day Cream with Applicator) Item No 1119 $2000
- Compare to Monistatreg 1 - 1 ct65
Anti-diarrheal Laxatives amp Digestive Health
Beanoreg
Item No 1316 $900
- 30 ct
Docusate Sodium (Stool Softener) Item No 1126 $600
- Compare toColacereg
- 100 ct100 mg
Docusate Sodium plus Sennosides (Natural Vegetable Laxative) Item No 1130 $800
- Compare toSenokot-Sreg
- 60 ct86 mg 50 mg
Enema Ex-Laxreg
Item No 1733 Item No 1124 $550 $800
- Compare to Fleetreg
- 45 oz - 8 ct15 mg
7
OTC MEDICATIONS AND HEALTH PRODUCTSTalk with your doctor before starting a new product regimen
Anti-diarrheal Laxatives amp Digestive Health continued
Lactase Capsules Item No 1067 $1000
- Compare toLactaidreg
- 60 ct9000 FCC Units
Laxative Bisacodyl (Stimulant Enteric Coated) Item No 1128 $500
- Compare toDulcolaxreg
- 100 ct5 mg
Laxative MagnesiumCitrate (SalineLemon) Item No 1889 $550
- 296 ml
Laxative Natural Vegetable (Psyllium) Item No 1340 $1000
- Compare toMetamucilreg
- 13 oz
Laxative Calcium Polycarbophil (Fiber Tablets) Item No 1012 $1000
- Compare to FiberConreg
- 90 ct625 mg
Laxative Natural Vegetable (Psyllium) Item No 1967 $1600
- Compare to Metamuc- 304 oz
Laxative ClearLaxreg
Unflavored Powder Item No 1969 $1350
- Compare toMiraLA Xreg
- 83 oz17 g
Laxative Natural VegetabSugar Free (Psyllium) Item No 1968 $1300
ilreg - Compare to Metamucilreg
Sugar-Free - 15 oz
Laxative Glycerin Suppository Item No 1125 $500
- Compare to Fleetreg
- 25 ct2 gm
le Loperamide HCL (Anti-Diarrheal Tablets) Item No 1133 $500
- Compare toImodium A-Dreg
- 12 ct2 mg
Pink Bismuth Liquid Item No 1318 $600
- Compare toPepto-Bismolreg
- 8 oz525 mg 30 ml
Methylcellulose (Fiber Therapy) Item No 1354 $1200
- Compare to Citrucelreg
- 16 oz
Milk of Magnesia Item No 1011 $600
- Compare to Phillipsreg
- 12 oz400 mg
Pepto-Bismolreg Cherry Item No 1317 $1000
- 12 oz525 mg 30 ml
Pink Bismuth Chewable Tablets Item No 1045 $600
- Compare to Pepto-Bismolreg Chewable
- 30 ct262 mg
8
Laxative GlycerinSuppositoryItem No 1125$500
- Compare to Fleetreg
- 25 ct2 gm
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Anti-fungal
Clotrimazole (Athletes Foot Cream) Item No 1047 $600
- Compare toLotriminreg AF
- 15 oz1
Miconazole Nitrate (Anti-fungal Cream) Item No 1135 $800
- Compare to Micatinreg
- 1 oz2
Miconazole Nitrate (Athletes Foot Spray) Item No 1874 $1000
- Compare toLotriminreg AF
- 46 oz2
Terbinafine HCL (Athletes Foot Cream) Item No 1046 $1200
- Compare toLamisilreg AT
- 5 oz1
Tolnaftate (Antishyfungal Cream) Item No 1064 $500
- Compare to Tinactinreg
- 125 oz1
Bathroom Safety amp Fall Prevention
Bath Bench Bath Tub Safety Rail Bed Assist Bar Bath Bench Bath Mat Non-Skid with Back Item No 1730 Item No 2009 without Back Item No 1459 Item No 1728 Item No 1727 $3700 $5500$1700 $6500 $5500 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
Cane Quad Fall Mat Bedside Commode Cane Folding Cane Quad Large Base Small Base Item No 2006 Item No 1984 Ergonomic Handle Item No 1776 Item No 1777 Item No 1726 $6500 $3000 $15000 $2500$2000 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
9
10
Cold amp Flu
Bathroom Safety amp Fall Prevention continued
Gait Belt - 60 Item No 1790 $1600
- 1 ct
Grab Bar Knurled Chrome 12 Item No 1798 $1900
- 1 ct
Grab Bar Knurled Chrome 24 Item No 1797 $2200
- 1 ct
Grab Bar Knurled Chrome 32 Item No 2005 $3600
- 1 ct
Gait Belt - 72 Item No 1791 $1700
- 1 ct
Night Light Item No 1983 $1500
- 2 ct
Safety Treads Tub amp Stair Item No 1780 $1000
- 1 pack
Shower Head Handheld Item No 2007 $2500
- 1 ct
Shower Mat Non-Skid Item No 1460 $1400
- 1 ct
Safety Tread Aids Anti-Slip Item No 1793 $1700
- 1 roll
Slipper Socks One Size Fits Most Item No 2008 $700
- 1 pair
Toilet Seat Raised Item No 1729 $3500
- 1 ct
Toilet Seat Raised with Arms Item No 1950 $6500
- 1 ct
Transfer Bench Adjustable Item No 1764 $8000
- 1 ct
Toilet Safety Rails Item No 1779 $5000
- 1 set
Cough amp Cold for High Blood Pressure Item No 1166 $700
- Compare to Coricidinreg HBP - 16 ct
Cough DropsCherry Item No 1056 $400
- Compare to Hallsreg
- 30 ct58 mg
Cough DropsHoney Lemon Item No 1833 $400
- Compare to Hallsreg
- 30 ct
Cough DropsMenthol Item No 1834 $400
- Compare to Hallsreg
- 30 ct
Cough Drops SugarFree Cherry Item No 1182 $500
- Compare to Hallsreg Sugar Free - 25 ct58 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Grab Bar Knurled Chrome 32Item No 2005$3600
- 1 ct
11
Cough SyrupExpectorant Item No 1054 $500
- Compare toRobitussinreg
- 4 oz200 mg 10 ml
Guaifenesin (CoughExpectorant) Item No 1180 $900
- 100 ct200 mg
Inhaler Personal Steam Item No 1792 $5000
- Vicksreg Personal Steam Inhaler
- 1 ct
Mucus Relief DM Expectorant amp Cough Suppressant Item No 1178 $1200
- Compare to Mucinexreg
- 30 ct400 mg 20 mg
Diabetic Tussinreg DM Item No 1323 $900
- Compare toRobitussinreg
Sugar Free DM - 4 oz
Mucus Relief DM Expectorant amp Cough SuppressantExtended Release Item No 1965 $1600
- Compare to Mucinexreg
- 14 ct1200 mg 60 mg
Nasal Rinse Kit Saline Item No 1931 $1800
- Compare to NeilMedreg
Sinus Rinse - 1 kit
Night Time Cold amp Flu Item No 1361 $600
- Compare toVicks NyQuilreg
- 4 oz125 mg 30 mg 650 mg
Phenylephrine HCL (Nasal Decongestant PE) Item No 1352 $500
- Compare toSudafedreg PE
- 36 ct10 mg
Multi-Symptom Cold Formula Item No 1357 $600
- Compare toTylenolreg Cold Multi-Symptom Daytime
- 24 ct10 mg5 mg 325 mg
Sore Throat Lozenges Cepacolreg
Item No 1360 $550
- 16 ct
Cold amp Flu continued
Sore Throat Lozenges Cherry Item No 1176 $700
- Compare to Cepacolreg
- 18 ct
Sore Throat Spray Cherry Item No 1904 $800
- Compare to Chlorasepticreg
- 6 oz
Vapor Rub Item No 1164 $750
- Compare to Vicks VapoRubreg
- 35 oz47 1
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Abrevareg
Item No 1152 $2600
- 2 gm10
Carmexreg
Item No 1255 $400
- 75 gm
Herpecin-Lreg Lip Balm Item No 1153 $800
- 1 oz1
Releevreg Cold Sore Treatment Item No 1359 $2400
- 6 ml13
Blistexreg Lip Ointment Item No 1256 $500
- 6 gm
Cushion Foam Ring Item No 1732 $2100
- 1 ct
Cushion Lumbar Item No 1731 $2700
- 1 ct
Humidifier Ultra-Sonic Cool Mist Item No 1795 $5800
- Compare to Vicksreg Ultrasonic Humidifier - 1 ct
Cushion Gel Foam Seat Item No 1466 $4000
- 1 ct
Cold Sore amp Medicated Lip Products
Daily Living Aids
Pill Case Weekly AMPM Item No 1934 $1100
- 1 ct
Pill Cutter with Safety Shield Item No 1932 $1000
- 1 ct
Pillow CPAP Fiber Filled Item No 1836 $6000
- 1 ct
Pillow CPAP Memory Foam Item No 1837 $9500
- 1 ct
Pillow Hypoallergenic Item No 1936 $5300
- 1 ct
Pill Crusher with Storage Item No 1933 $1000
- 1 ct
Medical ID Bracelet bull Blank Item No 1875 1 ct
$1650
bull Diabetic Item No 1877 1 ct bull Heart Item No 1876 1 ct
$1500
Medicine Bottle Opener with Magnifier Item No 2017 $1000
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
13
Dental amp Denture Care
Denture Cleaning Tablets Item No 1032 $600
- Compare to Polidentreg
- 40 ct
Efferdentreg Plus Mint Tablets Item No 1653 $800
- 36 ct
Effergripreg Denture Cream Adhesive Item No 1843 $900
- 25 oz
Biotenereg Dry Mouth Oral Rinse Item No 1817 $1400
- 16 oz
Denture Brush Item No 1747 $650
- Compare to G-U-Mreg
- 1 ct
Interdental Flossups Item No 1751 $500
- Compare to G-U-Mreg
- 90 ct
Orajelreg Pain Relief Item No 1454 $1100
- 25 oz20
Oral Pain Relief Item No 1286 $600
- Compareto Orajelreg
- 5 oz20
Polidentreg Overnight Item No 1892 $1250
- 84 ct
Fixodentreg
Item No 1187 $700
- 75 oz
Tongue Cleaner Item No 1746 $600
- 1 ct
Toothbrush Battery Powered Item No 2015 $2000
- 1 ct
Toothbrush Colgatereg Adult Soft Item No 1413 $300
- 1 ct
Reachreg Waxed Dental Floss - Mint Item No 1455 $500
- 55 yd
Polidentreg Denture Cream Item No 1324 $650
- 39 oz
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Toothpaste Crestreg Sensi-Relief Item No 1838 $950
- 41 oz
Toothpaste Fluoride Item No 1914 $550
- 64 oz
Toothpaste Pepsodentreg
Item No 1414 $500
- 55 oz
Toothbrush Tek Proreg Angled Soft Item No 1412 $300
- 1 ct
Toothpaste Colgatereg
Item No 1831 $600
- 4 oz
Toothbrush Rechargeable Item No 1450 $4000
- 1 ct
Toothbrush Soft 2-pack Item No 1948 $600
- 2 ct
Dental amp Denture Care continued
Toothpaste Ultrabritereg
Advanced Whitening Item No 1716 $700
- 6 oz
Toothpaste Sensitive Teeth Item No 1903 $600
- Compare to Sensodynereg
- 43 oz
Water Jet Item No 1744 $4200
- 1 ct
Water Jet Replacement Tips Item No 1743 $1700
- 5 ct
Diabetic Skin Relief Foot Cream Item No 1839 $1200
- Compare to Gold Bondreg
Skin Protectant Foot Cream - 34 oz
Diabetic Socks Black bull Medium Item No 1956 bull Large Item No 1957 bull X-Large Item No 1958 $900
- 3 pair
Diabetic Foot Care
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
15
Diabetic Foot Care continued
Diabetic Socks Ultra Soft Padded Black bull Medium Item No 1959 bull Large Item No 1960 bull X-Large Item No 1961 $1100
- 2 pair
Diabetic Socks Ultra Soft Padded White bull Medium Item No 1962 bull Large Item No 1963 bull X-Large Item No 1964 $1100
- 2 pair
Diabetic Socks White bull Medium Item No 1953 bull Large Item No 1954 bull X-Large Item No 1955 $900
- 3 pair
Bathroom Scale Talking Daggersect
Item No 1981 $5700
- 1 ct
Blood Pressure Monitor Desktop Replacement Cuff Dagger
Item No 1504 $1500
- 1 ct
Blood Pressure Monitor Desktop Talking Dagger
Item No 1503 $5500
- 1 ct
Bathroom Scale Daggersect
Item No 1935 $3500
- 1 ct
Activity Tracker Item No 1982 $5200
- 1 ct
Blood Pressure Monitor Desktop Automatic Dagger
Item No 1253 $5000
- 1 ct
Blood Pressure Monitor Wrist Dagger
Item No 1501 $3500
- 1 ct
Diagnostic Equipment
Blood Pressure Monitor Wrist Talking Dagger
Item No 1502 $4500
- 1 ct
Finger Pulse Oximeter Dagger
Item No 1505 $4200
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
16
Diagnostic Equipment continued
Peak Flow Meter Dagger
Item No 1789 $1700
- 1 ct
Thermometer Digital 60 seconds Item No 1063 $650
- 1 ct
Thermometer Digital Ear Item No 1285 $2700
- 1 ct
Thermometer Flexible Tip Digital 10 seconds Item No 1697 $1000
- 1 ct
Heart Rate Monitor Watch Dagger
Item No 1771 $4000
- 1 ct
Diagnostic Tests Ear Care
Eye Care
Thermometer Talking Ear and Forehead Item No 1925 $4500
- 1 ct
Home Access Cholesterol Test Dagger
Item No 1251 $3000
- 1 kit
Cotton Tipped Swabs Item No 1742 $600
- Compare to Johnson amp Johnsonreg
- 300 ct
EZ Detectreg Colon Cancer Test Kit Dagger
Item No 1416 $1300
- 1 ct
Ear Wax Removal Drops Item No 1190 $500
- Compare to Debroxreg
- 15 ml65
Ear Wax Removal System with Rubber Bulb Item No 1363 $700
- Compare toDebroxreg
- 15 ml65
Ear Pain Relief Ear Drops Item No 1841 $1300
- Compare to Hylands Ear Reliefreg
- 10 ml
Artificial Tears Drops Item No 1192 $600
- Compare toVisine Tearsreg
- 5 oz
Artificial Tears Ointment Item No 1194 $600
- Compare to Refresh PMreg
- 35 gm
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Artificial Tears OintmentItem No 1194$600
- Compare to Refresh PMreg
- 35 gm
17
Eye Care continued
First Aid
Contact Lens Solution Multi-Purpose Item No 1468 $800
- Compare to Renureg
Multipurpose Solution - 12 oz
Eye Drops Clear Eyesreg
Item No 1199 $600
- 2 oz
Eye Drops Irritation Relief Item No 1806 $950
- Compare toVisine ACreg
- 15 ml
Eye Drops Redness Relief Item No 1061 $500
- Compare to Visinereg
Original Redness Relief - 15 ml005
Eye Wash Solution Bausch + Lombreg
Item No 1196 $800
- 4 oz
Antiseptic Skin Cleanser Item No 1808 $1100
- Compare to Hibiclensreg
- 8 oz
Bactinereg Solution Item No 1142 $1000
- 4 oz
Adhesive Bandages Item No 1344 $500
- Compare to Band-Aidreg Plastic Strips
- 60 ct
Alcohol Pads Item No 1200 $550
- 100 ct70
After Bitereg
Relief Item No 1803 $900
- 5 oz
Antiseptic Towelettes Item No 1201 $700
- 100 ct
Bacitracin Ointment Item No 1020 $600
- 1 oz500 U gm
Bandage Elastic - 2 x 45 yd Item No 1207 $400
- Compare to Acereg
- 1 ct
Bandage Elastic - 3 x 5 yd Item No 1209 $400
- Compare to Acereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
QAamp Common questions about
your OTC benefit
Q What can I use my $30 quarterly allowance toward
A You can use your allowance to help pay for medicine and health items such as aspirin vitamins dental care products bandages and much more See OTC Medications and Health Products on page 5
Q Can I use my $30 OTC allowance toward prescription drugs
A No Your $30 quarterly allowance is for items that can be bought without a prescription
Q Can a family member use my $30 OTC allowance
A No An OTC allowance can only be used by a Member If two people in a house are Members each will have their own OTC allowance
Q Does my allowance add up if I donrsquot use it
A Yes Unused funds will roll over each quarter beginning January 1 2020 and ending on December 31 2020
Q Can I use parts of my allowance to order at different times throughout a month
A No You can use your $30 quarterly allowance to order items once a quarter
Q Can my total order be more than $30
A The total cost of your order should be equal to or less than your rollover allowance amount
Q How long will my order take A Your order will take up to 5 to 7
business days to arrive If you have any questions about your order call 1-866-575-3744 (TTY 7-1-1) Monday to Friday 7 am to 10 pm Central Time
Q Can I return my items A No Received items cannot be returned
Three ways to order
CALL 1-866-575-3744 (TTY 7-1-1) Monday to Friday 7 am to 10 pm Central Time
COMPLETE and mail the order form within
CLICK to order at wwwCignaHealthSpringOTCcom
3
5
10
15
20
25
CATEGORY INDEX Please use the index below for ease in locating available OTC items
Category Products include Page
Allergy Antihistamines decongestants cough suppressantsexpectorants and nasal sprays Antacids amp Acid Reducers Anticandidal (yeast)
Products to treat symptoms of stomach upset heartburn and acid indigestion Vaginal cream with applicator
6 7
Anti-diarrheal Laxatives amp Digestive Health
Products to treat symptoms of constipation upset stomach bloating cramping gas and diarrhea 7
Anti-fungal Topical creams and powders to treat symptoms of athletes foot jock itch and other applications 9
Bathroom Safety amp Fall Prevention Bath benches mats safety rails grab bars raised toilet seats canes gait belts night light and other products 9
Cold amp Flu Cough drops throat lozenges and other products Cold Sore amp Medicated Lip Products Lip balmscream to treat cold sores fever blisters and chapped lips 12
Daily Living Aids Cushions humidifier medical ID bracelets pill case crushercutter CPAP pillows and other products 12
Dental amp Denture Care Mouthwash toothbrushes cleaning tablets and creams adhesive cream dental floss and oral pain relief gel 13
Diabetic Foot Care Foot cream and socks for people with diabetes circulatory problems edema and neuropathy 14
Diagnostic Equipment Scales blood pressure monitors heart rate monitors and thermometers
Diagnostic Tests Tests for colon cancer and cholesterol 16 Ear Care Cotton swabs drops for ear aches and wax removal treatments 16 Eye Care Eye drops for lubricating and cleansing 16 First Aid Products for wound care and insect bites 17 Foot Care Pads to remove calluses and corns
Hemorrhoid Relief Products for temporary relief from hemorrhoids 20 Incontinence Supplies Wipes bed pads pads disposable briefsunderwear cleanser and skin protectant 20 Lice Treatment (Pediculicide) Kit shampoo and conditioning treatment 23 Motion Sickness Tablets used to prevent and treat nausea vomiting dizziness and vertigo 23
Pain Relief Aids Patches heating pads and wraps to temporarily relieve pain 23
Pain Relievers amp Fever Reducers Tablets and capsules to temporarily relieve pain and reduce fever Skin amp Sun Care Products to moisturize and protect skin 26 Sleep Aids Nasal strips and tablets 26 Smoking Cessation Nicotine gum lozenges and patches 27 Supports amp Braces Bracessupports for ankle knee and back gloves and compression socks 27 Vitamins amp Minerals Dietary supplements 29 Wart Remover Systems and liquid to remove warts 33
4
OTC MEDICATIONS AND HEALTH PRODUCTS Talk with your doctor before starting a new product regimen
Allergy
Benadrylreg Allergy Liqui-Gels Dye-Free Item No 1927 $1200
- 24 ct25 mg
Cetirizine HCL Cetirizine HCL Chlorpheniramine (Allergy Tablets) (Allergy Tablets) Maleate Antihistamine Item No 1090 Item No 2003 (Allergy Tablets)
Item No 1008 $500 $1000 $500
- Compare to Zyrtecreg - Compare to Zyrtecreg
- 14 ct10 mg - 45 ct10 mg - 100 ct4 mg
Cromolyn Sodium (Allergy Nasal Spray) Item No 1356 $1800
- Compare to Nasalcromreg
- 26 ml
DiphenhydramineAntihistamine (Allergy Tablets) Item No 1009 $500
- Compare to Benadry- 24 ct25 mg
Diphenhydramine Antihistamine (Allergy Tablets) Item No 1308 $600
lreg - Compare to Benadry- 100 ct25 mg
Diphenhydramine Antihistamine (Allergy Tablets) Item No 2021 $1500
lreg - Compare to Benadrylreg
- 400 ct25 mg
Fexofenadine Fluticasone Propionate Loratadine (Allergy Tablets) Loratadine (Allergy Tablets) (Allergy Tablets) (Allergy Nasal Item No 2033 Item No 1611 Item No 1804 Spray 24-hour) $550 $1800Item No 1946 $1600
- Compare to Claritinreg - Compare to Claritinreg$2500 - Compare to Allegrareg - 10 ct 10 mg - 100 ct10 mg
- 30 ct180 mg - Compare to Flonasereg
- 120 spray50 mcg
5
OTC MEDICATIONS AND HEALTH PRODUCTS Talk with your doctor before starting a new product regimen
Allergy continued
Nasal Decongestant Nasal Decongestant Nasal Spray Saline Loratadine (Allergy Tablets) Nasacortreg
Inhaler - Spray 12-Hour Item No 1052 Item No 2020 Item No 1881 Levmetamfetamine Item No 1091 $500$2500 $2200 Item No 1922 $500 - 15 oz065 - Compare to Claritinreg - 60 spray $700
- Compare to Afrinreg - 365 ct10 mg - Compare to Vicksreg - 1 oz005
VapoInhaler - 007 oz50 mg
Antacids amp Acid Reducers
Effervescent Antacid Esomeprazole Magnesium Alka-Seltzerreg Antacid Anti- Antacid Chewables amp Pain Relief (Acid Reducer Item No 1313 Gas Liquid Item No 1346 Item No 1314 Delayed Release) Item No 1006 $600$1100 Item No 1949 $800$600
- 36 ct - Compare to Tumsreg $2300 - Compare to- Compare to Maaloxreg - 150 ct500 mg
- 12 oz Alka-Seltzerreg - Compare to Nexiumreg
- 36 ct - 42 ct20 mg
Famotidine (AcidReducer) Item No 1108 $600
- Compare toPepcid ACreg
- 30 ct10 mg
Omeprazole (Acid Reducer Delayed Release) Item No 1970 $2500
- Compare toPrilosecreg
- 42 ct20 mg
Omeprazole (Acid Ranitidine (Acid Reducer) Reducer Delayed Item No 1900 Release Dissolvable) $800Item No 1966
- Compare to Zantacreg $2500 - 30 ct75 mg - Compare to
Prilosecreg
- 42 ct20 mg
Simethicone (Gas Relief) Item No 1800 $900
- Compareto Gas-Xreg
Chewables - 100 ct80 mg
6
Allergy continued
Famotidine (AcidReducer)Item No 1108$600
- Compare toPepcid ACreg
- 30 ct10 mg
Omeprazole(Acid ReducerDelayed Release)Item No 1970$2500
- Compare toPrilosecreg
- 42 ct20 mg
Omeprazole (AcidReducer DelayedRelease Dissolvable)Item No 1966$2500
- Compare toPrilosecreg
- 42 ct20 mg
Ranitidine (Acid Reducer)Item No 1900$800
- Compare to Zantacreg
- 30 ct75 mg
Esomeprazole Magnesium(Acid ReducerDelayed Release)Item No 1949$2300
- Compare to Nexiumreg
- 42 ct20 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Antacids amp Acid Reducers continued
TUMSreg Extra Strength TUMSreg Ultra Strength Item No 2034 Item No 2019 $750 $1000
- 48 ct750 mg - 72 ct1000 mg
Anticandidal (yeast)
Clotrimazole (Vaginal Antifungal 7-Day Cream with Applicator) Item No 1115 $800
- Compare to Monistatreg 7 - 45 gm1
Miconazole (Vaginal Antifungal 3-Day Cream with Applicator)) Item No 1117 $1400
- Compare to Monistatreg 3 - 1 kit2
Tioconazole (Vaginal Antifungal 1-Day Cream with Applicator) Item No 1119 $2000
- Compare to Monistatreg 1 - 1 ct65
Anti-diarrheal Laxatives amp Digestive Health
Beanoreg
Item No 1316 $900
- 30 ct
Docusate Sodium (Stool Softener) Item No 1126 $600
- Compare toColacereg
- 100 ct100 mg
Docusate Sodium plus Sennosides (Natural Vegetable Laxative) Item No 1130 $800
- Compare toSenokot-Sreg
- 60 ct86 mg 50 mg
Enema Ex-Laxreg
Item No 1733 Item No 1124 $550 $800
- Compare to Fleetreg
- 45 oz - 8 ct15 mg
7
OTC MEDICATIONS AND HEALTH PRODUCTSTalk with your doctor before starting a new product regimen
Anti-diarrheal Laxatives amp Digestive Health continued
Lactase Capsules Item No 1067 $1000
- Compare toLactaidreg
- 60 ct9000 FCC Units
Laxative Bisacodyl (Stimulant Enteric Coated) Item No 1128 $500
- Compare toDulcolaxreg
- 100 ct5 mg
Laxative MagnesiumCitrate (SalineLemon) Item No 1889 $550
- 296 ml
Laxative Natural Vegetable (Psyllium) Item No 1340 $1000
- Compare toMetamucilreg
- 13 oz
Laxative Calcium Polycarbophil (Fiber Tablets) Item No 1012 $1000
- Compare to FiberConreg
- 90 ct625 mg
Laxative Natural Vegetable (Psyllium) Item No 1967 $1600
- Compare to Metamuc- 304 oz
Laxative ClearLaxreg
Unflavored Powder Item No 1969 $1350
- Compare toMiraLA Xreg
- 83 oz17 g
Laxative Natural VegetabSugar Free (Psyllium) Item No 1968 $1300
ilreg - Compare to Metamucilreg
Sugar-Free - 15 oz
Laxative Glycerin Suppository Item No 1125 $500
- Compare to Fleetreg
- 25 ct2 gm
le Loperamide HCL (Anti-Diarrheal Tablets) Item No 1133 $500
- Compare toImodium A-Dreg
- 12 ct2 mg
Pink Bismuth Liquid Item No 1318 $600
- Compare toPepto-Bismolreg
- 8 oz525 mg 30 ml
Methylcellulose (Fiber Therapy) Item No 1354 $1200
- Compare to Citrucelreg
- 16 oz
Milk of Magnesia Item No 1011 $600
- Compare to Phillipsreg
- 12 oz400 mg
Pepto-Bismolreg Cherry Item No 1317 $1000
- 12 oz525 mg 30 ml
Pink Bismuth Chewable Tablets Item No 1045 $600
- Compare to Pepto-Bismolreg Chewable
- 30 ct262 mg
8
Laxative GlycerinSuppositoryItem No 1125$500
- Compare to Fleetreg
- 25 ct2 gm
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Anti-fungal
Clotrimazole (Athletes Foot Cream) Item No 1047 $600
- Compare toLotriminreg AF
- 15 oz1
Miconazole Nitrate (Anti-fungal Cream) Item No 1135 $800
- Compare to Micatinreg
- 1 oz2
Miconazole Nitrate (Athletes Foot Spray) Item No 1874 $1000
- Compare toLotriminreg AF
- 46 oz2
Terbinafine HCL (Athletes Foot Cream) Item No 1046 $1200
- Compare toLamisilreg AT
- 5 oz1
Tolnaftate (Antishyfungal Cream) Item No 1064 $500
- Compare to Tinactinreg
- 125 oz1
Bathroom Safety amp Fall Prevention
Bath Bench Bath Tub Safety Rail Bed Assist Bar Bath Bench Bath Mat Non-Skid with Back Item No 1730 Item No 2009 without Back Item No 1459 Item No 1728 Item No 1727 $3700 $5500$1700 $6500 $5500 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
Cane Quad Fall Mat Bedside Commode Cane Folding Cane Quad Large Base Small Base Item No 2006 Item No 1984 Ergonomic Handle Item No 1776 Item No 1777 Item No 1726 $6500 $3000 $15000 $2500$2000 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
9
10
Cold amp Flu
Bathroom Safety amp Fall Prevention continued
Gait Belt - 60 Item No 1790 $1600
- 1 ct
Grab Bar Knurled Chrome 12 Item No 1798 $1900
- 1 ct
Grab Bar Knurled Chrome 24 Item No 1797 $2200
- 1 ct
Grab Bar Knurled Chrome 32 Item No 2005 $3600
- 1 ct
Gait Belt - 72 Item No 1791 $1700
- 1 ct
Night Light Item No 1983 $1500
- 2 ct
Safety Treads Tub amp Stair Item No 1780 $1000
- 1 pack
Shower Head Handheld Item No 2007 $2500
- 1 ct
Shower Mat Non-Skid Item No 1460 $1400
- 1 ct
Safety Tread Aids Anti-Slip Item No 1793 $1700
- 1 roll
Slipper Socks One Size Fits Most Item No 2008 $700
- 1 pair
Toilet Seat Raised Item No 1729 $3500
- 1 ct
Toilet Seat Raised with Arms Item No 1950 $6500
- 1 ct
Transfer Bench Adjustable Item No 1764 $8000
- 1 ct
Toilet Safety Rails Item No 1779 $5000
- 1 set
Cough amp Cold for High Blood Pressure Item No 1166 $700
- Compare to Coricidinreg HBP - 16 ct
Cough DropsCherry Item No 1056 $400
- Compare to Hallsreg
- 30 ct58 mg
Cough DropsHoney Lemon Item No 1833 $400
- Compare to Hallsreg
- 30 ct
Cough DropsMenthol Item No 1834 $400
- Compare to Hallsreg
- 30 ct
Cough Drops SugarFree Cherry Item No 1182 $500
- Compare to Hallsreg Sugar Free - 25 ct58 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Grab Bar Knurled Chrome 32Item No 2005$3600
- 1 ct
11
Cough SyrupExpectorant Item No 1054 $500
- Compare toRobitussinreg
- 4 oz200 mg 10 ml
Guaifenesin (CoughExpectorant) Item No 1180 $900
- 100 ct200 mg
Inhaler Personal Steam Item No 1792 $5000
- Vicksreg Personal Steam Inhaler
- 1 ct
Mucus Relief DM Expectorant amp Cough Suppressant Item No 1178 $1200
- Compare to Mucinexreg
- 30 ct400 mg 20 mg
Diabetic Tussinreg DM Item No 1323 $900
- Compare toRobitussinreg
Sugar Free DM - 4 oz
Mucus Relief DM Expectorant amp Cough SuppressantExtended Release Item No 1965 $1600
- Compare to Mucinexreg
- 14 ct1200 mg 60 mg
Nasal Rinse Kit Saline Item No 1931 $1800
- Compare to NeilMedreg
Sinus Rinse - 1 kit
Night Time Cold amp Flu Item No 1361 $600
- Compare toVicks NyQuilreg
- 4 oz125 mg 30 mg 650 mg
Phenylephrine HCL (Nasal Decongestant PE) Item No 1352 $500
- Compare toSudafedreg PE
- 36 ct10 mg
Multi-Symptom Cold Formula Item No 1357 $600
- Compare toTylenolreg Cold Multi-Symptom Daytime
- 24 ct10 mg5 mg 325 mg
Sore Throat Lozenges Cepacolreg
Item No 1360 $550
- 16 ct
Cold amp Flu continued
Sore Throat Lozenges Cherry Item No 1176 $700
- Compare to Cepacolreg
- 18 ct
Sore Throat Spray Cherry Item No 1904 $800
- Compare to Chlorasepticreg
- 6 oz
Vapor Rub Item No 1164 $750
- Compare to Vicks VapoRubreg
- 35 oz47 1
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Abrevareg
Item No 1152 $2600
- 2 gm10
Carmexreg
Item No 1255 $400
- 75 gm
Herpecin-Lreg Lip Balm Item No 1153 $800
- 1 oz1
Releevreg Cold Sore Treatment Item No 1359 $2400
- 6 ml13
Blistexreg Lip Ointment Item No 1256 $500
- 6 gm
Cushion Foam Ring Item No 1732 $2100
- 1 ct
Cushion Lumbar Item No 1731 $2700
- 1 ct
Humidifier Ultra-Sonic Cool Mist Item No 1795 $5800
- Compare to Vicksreg Ultrasonic Humidifier - 1 ct
Cushion Gel Foam Seat Item No 1466 $4000
- 1 ct
Cold Sore amp Medicated Lip Products
Daily Living Aids
Pill Case Weekly AMPM Item No 1934 $1100
- 1 ct
Pill Cutter with Safety Shield Item No 1932 $1000
- 1 ct
Pillow CPAP Fiber Filled Item No 1836 $6000
- 1 ct
Pillow CPAP Memory Foam Item No 1837 $9500
- 1 ct
Pillow Hypoallergenic Item No 1936 $5300
- 1 ct
Pill Crusher with Storage Item No 1933 $1000
- 1 ct
Medical ID Bracelet bull Blank Item No 1875 1 ct
$1650
bull Diabetic Item No 1877 1 ct bull Heart Item No 1876 1 ct
$1500
Medicine Bottle Opener with Magnifier Item No 2017 $1000
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
13
Dental amp Denture Care
Denture Cleaning Tablets Item No 1032 $600
- Compare to Polidentreg
- 40 ct
Efferdentreg Plus Mint Tablets Item No 1653 $800
- 36 ct
Effergripreg Denture Cream Adhesive Item No 1843 $900
- 25 oz
Biotenereg Dry Mouth Oral Rinse Item No 1817 $1400
- 16 oz
Denture Brush Item No 1747 $650
- Compare to G-U-Mreg
- 1 ct
Interdental Flossups Item No 1751 $500
- Compare to G-U-Mreg
- 90 ct
Orajelreg Pain Relief Item No 1454 $1100
- 25 oz20
Oral Pain Relief Item No 1286 $600
- Compareto Orajelreg
- 5 oz20
Polidentreg Overnight Item No 1892 $1250
- 84 ct
Fixodentreg
Item No 1187 $700
- 75 oz
Tongue Cleaner Item No 1746 $600
- 1 ct
Toothbrush Battery Powered Item No 2015 $2000
- 1 ct
Toothbrush Colgatereg Adult Soft Item No 1413 $300
- 1 ct
Reachreg Waxed Dental Floss - Mint Item No 1455 $500
- 55 yd
Polidentreg Denture Cream Item No 1324 $650
- 39 oz
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Toothpaste Crestreg Sensi-Relief Item No 1838 $950
- 41 oz
Toothpaste Fluoride Item No 1914 $550
- 64 oz
Toothpaste Pepsodentreg
Item No 1414 $500
- 55 oz
Toothbrush Tek Proreg Angled Soft Item No 1412 $300
- 1 ct
Toothpaste Colgatereg
Item No 1831 $600
- 4 oz
Toothbrush Rechargeable Item No 1450 $4000
- 1 ct
Toothbrush Soft 2-pack Item No 1948 $600
- 2 ct
Dental amp Denture Care continued
Toothpaste Ultrabritereg
Advanced Whitening Item No 1716 $700
- 6 oz
Toothpaste Sensitive Teeth Item No 1903 $600
- Compare to Sensodynereg
- 43 oz
Water Jet Item No 1744 $4200
- 1 ct
Water Jet Replacement Tips Item No 1743 $1700
- 5 ct
Diabetic Skin Relief Foot Cream Item No 1839 $1200
- Compare to Gold Bondreg
Skin Protectant Foot Cream - 34 oz
Diabetic Socks Black bull Medium Item No 1956 bull Large Item No 1957 bull X-Large Item No 1958 $900
- 3 pair
Diabetic Foot Care
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
15
Diabetic Foot Care continued
Diabetic Socks Ultra Soft Padded Black bull Medium Item No 1959 bull Large Item No 1960 bull X-Large Item No 1961 $1100
- 2 pair
Diabetic Socks Ultra Soft Padded White bull Medium Item No 1962 bull Large Item No 1963 bull X-Large Item No 1964 $1100
- 2 pair
Diabetic Socks White bull Medium Item No 1953 bull Large Item No 1954 bull X-Large Item No 1955 $900
- 3 pair
Bathroom Scale Talking Daggersect
Item No 1981 $5700
- 1 ct
Blood Pressure Monitor Desktop Replacement Cuff Dagger
Item No 1504 $1500
- 1 ct
Blood Pressure Monitor Desktop Talking Dagger
Item No 1503 $5500
- 1 ct
Bathroom Scale Daggersect
Item No 1935 $3500
- 1 ct
Activity Tracker Item No 1982 $5200
- 1 ct
Blood Pressure Monitor Desktop Automatic Dagger
Item No 1253 $5000
- 1 ct
Blood Pressure Monitor Wrist Dagger
Item No 1501 $3500
- 1 ct
Diagnostic Equipment
Blood Pressure Monitor Wrist Talking Dagger
Item No 1502 $4500
- 1 ct
Finger Pulse Oximeter Dagger
Item No 1505 $4200
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
16
Diagnostic Equipment continued
Peak Flow Meter Dagger
Item No 1789 $1700
- 1 ct
Thermometer Digital 60 seconds Item No 1063 $650
- 1 ct
Thermometer Digital Ear Item No 1285 $2700
- 1 ct
Thermometer Flexible Tip Digital 10 seconds Item No 1697 $1000
- 1 ct
Heart Rate Monitor Watch Dagger
Item No 1771 $4000
- 1 ct
Diagnostic Tests Ear Care
Eye Care
Thermometer Talking Ear and Forehead Item No 1925 $4500
- 1 ct
Home Access Cholesterol Test Dagger
Item No 1251 $3000
- 1 kit
Cotton Tipped Swabs Item No 1742 $600
- Compare to Johnson amp Johnsonreg
- 300 ct
EZ Detectreg Colon Cancer Test Kit Dagger
Item No 1416 $1300
- 1 ct
Ear Wax Removal Drops Item No 1190 $500
- Compare to Debroxreg
- 15 ml65
Ear Wax Removal System with Rubber Bulb Item No 1363 $700
- Compare toDebroxreg
- 15 ml65
Ear Pain Relief Ear Drops Item No 1841 $1300
- Compare to Hylands Ear Reliefreg
- 10 ml
Artificial Tears Drops Item No 1192 $600
- Compare toVisine Tearsreg
- 5 oz
Artificial Tears Ointment Item No 1194 $600
- Compare to Refresh PMreg
- 35 gm
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Artificial Tears OintmentItem No 1194$600
- Compare to Refresh PMreg
- 35 gm
17
Eye Care continued
First Aid
Contact Lens Solution Multi-Purpose Item No 1468 $800
- Compare to Renureg
Multipurpose Solution - 12 oz
Eye Drops Clear Eyesreg
Item No 1199 $600
- 2 oz
Eye Drops Irritation Relief Item No 1806 $950
- Compare toVisine ACreg
- 15 ml
Eye Drops Redness Relief Item No 1061 $500
- Compare to Visinereg
Original Redness Relief - 15 ml005
Eye Wash Solution Bausch + Lombreg
Item No 1196 $800
- 4 oz
Antiseptic Skin Cleanser Item No 1808 $1100
- Compare to Hibiclensreg
- 8 oz
Bactinereg Solution Item No 1142 $1000
- 4 oz
Adhesive Bandages Item No 1344 $500
- Compare to Band-Aidreg Plastic Strips
- 60 ct
Alcohol Pads Item No 1200 $550
- 100 ct70
After Bitereg
Relief Item No 1803 $900
- 5 oz
Antiseptic Towelettes Item No 1201 $700
- 100 ct
Bacitracin Ointment Item No 1020 $600
- 1 oz500 U gm
Bandage Elastic - 2 x 45 yd Item No 1207 $400
- Compare to Acereg
- 1 ct
Bandage Elastic - 3 x 5 yd Item No 1209 $400
- Compare to Acereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
5
10
15
20
25
CATEGORY INDEX Please use the index below for ease in locating available OTC items
Category Products include Page
Allergy Antihistamines decongestants cough suppressantsexpectorants and nasal sprays Antacids amp Acid Reducers Anticandidal (yeast)
Products to treat symptoms of stomach upset heartburn and acid indigestion Vaginal cream with applicator
6 7
Anti-diarrheal Laxatives amp Digestive Health
Products to treat symptoms of constipation upset stomach bloating cramping gas and diarrhea 7
Anti-fungal Topical creams and powders to treat symptoms of athletes foot jock itch and other applications 9
Bathroom Safety amp Fall Prevention Bath benches mats safety rails grab bars raised toilet seats canes gait belts night light and other products 9
Cold amp Flu Cough drops throat lozenges and other products Cold Sore amp Medicated Lip Products Lip balmscream to treat cold sores fever blisters and chapped lips 12
Daily Living Aids Cushions humidifier medical ID bracelets pill case crushercutter CPAP pillows and other products 12
Dental amp Denture Care Mouthwash toothbrushes cleaning tablets and creams adhesive cream dental floss and oral pain relief gel 13
Diabetic Foot Care Foot cream and socks for people with diabetes circulatory problems edema and neuropathy 14
Diagnostic Equipment Scales blood pressure monitors heart rate monitors and thermometers
Diagnostic Tests Tests for colon cancer and cholesterol 16 Ear Care Cotton swabs drops for ear aches and wax removal treatments 16 Eye Care Eye drops for lubricating and cleansing 16 First Aid Products for wound care and insect bites 17 Foot Care Pads to remove calluses and corns
Hemorrhoid Relief Products for temporary relief from hemorrhoids 20 Incontinence Supplies Wipes bed pads pads disposable briefsunderwear cleanser and skin protectant 20 Lice Treatment (Pediculicide) Kit shampoo and conditioning treatment 23 Motion Sickness Tablets used to prevent and treat nausea vomiting dizziness and vertigo 23
Pain Relief Aids Patches heating pads and wraps to temporarily relieve pain 23
Pain Relievers amp Fever Reducers Tablets and capsules to temporarily relieve pain and reduce fever Skin amp Sun Care Products to moisturize and protect skin 26 Sleep Aids Nasal strips and tablets 26 Smoking Cessation Nicotine gum lozenges and patches 27 Supports amp Braces Bracessupports for ankle knee and back gloves and compression socks 27 Vitamins amp Minerals Dietary supplements 29 Wart Remover Systems and liquid to remove warts 33
4
OTC MEDICATIONS AND HEALTH PRODUCTS Talk with your doctor before starting a new product regimen
Allergy
Benadrylreg Allergy Liqui-Gels Dye-Free Item No 1927 $1200
- 24 ct25 mg
Cetirizine HCL Cetirizine HCL Chlorpheniramine (Allergy Tablets) (Allergy Tablets) Maleate Antihistamine Item No 1090 Item No 2003 (Allergy Tablets)
Item No 1008 $500 $1000 $500
- Compare to Zyrtecreg - Compare to Zyrtecreg
- 14 ct10 mg - 45 ct10 mg - 100 ct4 mg
Cromolyn Sodium (Allergy Nasal Spray) Item No 1356 $1800
- Compare to Nasalcromreg
- 26 ml
DiphenhydramineAntihistamine (Allergy Tablets) Item No 1009 $500
- Compare to Benadry- 24 ct25 mg
Diphenhydramine Antihistamine (Allergy Tablets) Item No 1308 $600
lreg - Compare to Benadry- 100 ct25 mg
Diphenhydramine Antihistamine (Allergy Tablets) Item No 2021 $1500
lreg - Compare to Benadrylreg
- 400 ct25 mg
Fexofenadine Fluticasone Propionate Loratadine (Allergy Tablets) Loratadine (Allergy Tablets) (Allergy Tablets) (Allergy Nasal Item No 2033 Item No 1611 Item No 1804 Spray 24-hour) $550 $1800Item No 1946 $1600
- Compare to Claritinreg - Compare to Claritinreg$2500 - Compare to Allegrareg - 10 ct 10 mg - 100 ct10 mg
- 30 ct180 mg - Compare to Flonasereg
- 120 spray50 mcg
5
OTC MEDICATIONS AND HEALTH PRODUCTS Talk with your doctor before starting a new product regimen
Allergy continued
Nasal Decongestant Nasal Decongestant Nasal Spray Saline Loratadine (Allergy Tablets) Nasacortreg
Inhaler - Spray 12-Hour Item No 1052 Item No 2020 Item No 1881 Levmetamfetamine Item No 1091 $500$2500 $2200 Item No 1922 $500 - 15 oz065 - Compare to Claritinreg - 60 spray $700
- Compare to Afrinreg - 365 ct10 mg - Compare to Vicksreg - 1 oz005
VapoInhaler - 007 oz50 mg
Antacids amp Acid Reducers
Effervescent Antacid Esomeprazole Magnesium Alka-Seltzerreg Antacid Anti- Antacid Chewables amp Pain Relief (Acid Reducer Item No 1313 Gas Liquid Item No 1346 Item No 1314 Delayed Release) Item No 1006 $600$1100 Item No 1949 $800$600
- 36 ct - Compare to Tumsreg $2300 - Compare to- Compare to Maaloxreg - 150 ct500 mg
- 12 oz Alka-Seltzerreg - Compare to Nexiumreg
- 36 ct - 42 ct20 mg
Famotidine (AcidReducer) Item No 1108 $600
- Compare toPepcid ACreg
- 30 ct10 mg
Omeprazole (Acid Reducer Delayed Release) Item No 1970 $2500
- Compare toPrilosecreg
- 42 ct20 mg
Omeprazole (Acid Ranitidine (Acid Reducer) Reducer Delayed Item No 1900 Release Dissolvable) $800Item No 1966
- Compare to Zantacreg $2500 - 30 ct75 mg - Compare to
Prilosecreg
- 42 ct20 mg
Simethicone (Gas Relief) Item No 1800 $900
- Compareto Gas-Xreg
Chewables - 100 ct80 mg
6
Allergy continued
Famotidine (AcidReducer)Item No 1108$600
- Compare toPepcid ACreg
- 30 ct10 mg
Omeprazole(Acid ReducerDelayed Release)Item No 1970$2500
- Compare toPrilosecreg
- 42 ct20 mg
Omeprazole (AcidReducer DelayedRelease Dissolvable)Item No 1966$2500
- Compare toPrilosecreg
- 42 ct20 mg
Ranitidine (Acid Reducer)Item No 1900$800
- Compare to Zantacreg
- 30 ct75 mg
Esomeprazole Magnesium(Acid ReducerDelayed Release)Item No 1949$2300
- Compare to Nexiumreg
- 42 ct20 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Antacids amp Acid Reducers continued
TUMSreg Extra Strength TUMSreg Ultra Strength Item No 2034 Item No 2019 $750 $1000
- 48 ct750 mg - 72 ct1000 mg
Anticandidal (yeast)
Clotrimazole (Vaginal Antifungal 7-Day Cream with Applicator) Item No 1115 $800
- Compare to Monistatreg 7 - 45 gm1
Miconazole (Vaginal Antifungal 3-Day Cream with Applicator)) Item No 1117 $1400
- Compare to Monistatreg 3 - 1 kit2
Tioconazole (Vaginal Antifungal 1-Day Cream with Applicator) Item No 1119 $2000
- Compare to Monistatreg 1 - 1 ct65
Anti-diarrheal Laxatives amp Digestive Health
Beanoreg
Item No 1316 $900
- 30 ct
Docusate Sodium (Stool Softener) Item No 1126 $600
- Compare toColacereg
- 100 ct100 mg
Docusate Sodium plus Sennosides (Natural Vegetable Laxative) Item No 1130 $800
- Compare toSenokot-Sreg
- 60 ct86 mg 50 mg
Enema Ex-Laxreg
Item No 1733 Item No 1124 $550 $800
- Compare to Fleetreg
- 45 oz - 8 ct15 mg
7
OTC MEDICATIONS AND HEALTH PRODUCTSTalk with your doctor before starting a new product regimen
Anti-diarrheal Laxatives amp Digestive Health continued
Lactase Capsules Item No 1067 $1000
- Compare toLactaidreg
- 60 ct9000 FCC Units
Laxative Bisacodyl (Stimulant Enteric Coated) Item No 1128 $500
- Compare toDulcolaxreg
- 100 ct5 mg
Laxative MagnesiumCitrate (SalineLemon) Item No 1889 $550
- 296 ml
Laxative Natural Vegetable (Psyllium) Item No 1340 $1000
- Compare toMetamucilreg
- 13 oz
Laxative Calcium Polycarbophil (Fiber Tablets) Item No 1012 $1000
- Compare to FiberConreg
- 90 ct625 mg
Laxative Natural Vegetable (Psyllium) Item No 1967 $1600
- Compare to Metamuc- 304 oz
Laxative ClearLaxreg
Unflavored Powder Item No 1969 $1350
- Compare toMiraLA Xreg
- 83 oz17 g
Laxative Natural VegetabSugar Free (Psyllium) Item No 1968 $1300
ilreg - Compare to Metamucilreg
Sugar-Free - 15 oz
Laxative Glycerin Suppository Item No 1125 $500
- Compare to Fleetreg
- 25 ct2 gm
le Loperamide HCL (Anti-Diarrheal Tablets) Item No 1133 $500
- Compare toImodium A-Dreg
- 12 ct2 mg
Pink Bismuth Liquid Item No 1318 $600
- Compare toPepto-Bismolreg
- 8 oz525 mg 30 ml
Methylcellulose (Fiber Therapy) Item No 1354 $1200
- Compare to Citrucelreg
- 16 oz
Milk of Magnesia Item No 1011 $600
- Compare to Phillipsreg
- 12 oz400 mg
Pepto-Bismolreg Cherry Item No 1317 $1000
- 12 oz525 mg 30 ml
Pink Bismuth Chewable Tablets Item No 1045 $600
- Compare to Pepto-Bismolreg Chewable
- 30 ct262 mg
8
Laxative GlycerinSuppositoryItem No 1125$500
- Compare to Fleetreg
- 25 ct2 gm
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Anti-fungal
Clotrimazole (Athletes Foot Cream) Item No 1047 $600
- Compare toLotriminreg AF
- 15 oz1
Miconazole Nitrate (Anti-fungal Cream) Item No 1135 $800
- Compare to Micatinreg
- 1 oz2
Miconazole Nitrate (Athletes Foot Spray) Item No 1874 $1000
- Compare toLotriminreg AF
- 46 oz2
Terbinafine HCL (Athletes Foot Cream) Item No 1046 $1200
- Compare toLamisilreg AT
- 5 oz1
Tolnaftate (Antishyfungal Cream) Item No 1064 $500
- Compare to Tinactinreg
- 125 oz1
Bathroom Safety amp Fall Prevention
Bath Bench Bath Tub Safety Rail Bed Assist Bar Bath Bench Bath Mat Non-Skid with Back Item No 1730 Item No 2009 without Back Item No 1459 Item No 1728 Item No 1727 $3700 $5500$1700 $6500 $5500 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
Cane Quad Fall Mat Bedside Commode Cane Folding Cane Quad Large Base Small Base Item No 2006 Item No 1984 Ergonomic Handle Item No 1776 Item No 1777 Item No 1726 $6500 $3000 $15000 $2500$2000 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
9
10
Cold amp Flu
Bathroom Safety amp Fall Prevention continued
Gait Belt - 60 Item No 1790 $1600
- 1 ct
Grab Bar Knurled Chrome 12 Item No 1798 $1900
- 1 ct
Grab Bar Knurled Chrome 24 Item No 1797 $2200
- 1 ct
Grab Bar Knurled Chrome 32 Item No 2005 $3600
- 1 ct
Gait Belt - 72 Item No 1791 $1700
- 1 ct
Night Light Item No 1983 $1500
- 2 ct
Safety Treads Tub amp Stair Item No 1780 $1000
- 1 pack
Shower Head Handheld Item No 2007 $2500
- 1 ct
Shower Mat Non-Skid Item No 1460 $1400
- 1 ct
Safety Tread Aids Anti-Slip Item No 1793 $1700
- 1 roll
Slipper Socks One Size Fits Most Item No 2008 $700
- 1 pair
Toilet Seat Raised Item No 1729 $3500
- 1 ct
Toilet Seat Raised with Arms Item No 1950 $6500
- 1 ct
Transfer Bench Adjustable Item No 1764 $8000
- 1 ct
Toilet Safety Rails Item No 1779 $5000
- 1 set
Cough amp Cold for High Blood Pressure Item No 1166 $700
- Compare to Coricidinreg HBP - 16 ct
Cough DropsCherry Item No 1056 $400
- Compare to Hallsreg
- 30 ct58 mg
Cough DropsHoney Lemon Item No 1833 $400
- Compare to Hallsreg
- 30 ct
Cough DropsMenthol Item No 1834 $400
- Compare to Hallsreg
- 30 ct
Cough Drops SugarFree Cherry Item No 1182 $500
- Compare to Hallsreg Sugar Free - 25 ct58 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Grab Bar Knurled Chrome 32Item No 2005$3600
- 1 ct
11
Cough SyrupExpectorant Item No 1054 $500
- Compare toRobitussinreg
- 4 oz200 mg 10 ml
Guaifenesin (CoughExpectorant) Item No 1180 $900
- 100 ct200 mg
Inhaler Personal Steam Item No 1792 $5000
- Vicksreg Personal Steam Inhaler
- 1 ct
Mucus Relief DM Expectorant amp Cough Suppressant Item No 1178 $1200
- Compare to Mucinexreg
- 30 ct400 mg 20 mg
Diabetic Tussinreg DM Item No 1323 $900
- Compare toRobitussinreg
Sugar Free DM - 4 oz
Mucus Relief DM Expectorant amp Cough SuppressantExtended Release Item No 1965 $1600
- Compare to Mucinexreg
- 14 ct1200 mg 60 mg
Nasal Rinse Kit Saline Item No 1931 $1800
- Compare to NeilMedreg
Sinus Rinse - 1 kit
Night Time Cold amp Flu Item No 1361 $600
- Compare toVicks NyQuilreg
- 4 oz125 mg 30 mg 650 mg
Phenylephrine HCL (Nasal Decongestant PE) Item No 1352 $500
- Compare toSudafedreg PE
- 36 ct10 mg
Multi-Symptom Cold Formula Item No 1357 $600
- Compare toTylenolreg Cold Multi-Symptom Daytime
- 24 ct10 mg5 mg 325 mg
Sore Throat Lozenges Cepacolreg
Item No 1360 $550
- 16 ct
Cold amp Flu continued
Sore Throat Lozenges Cherry Item No 1176 $700
- Compare to Cepacolreg
- 18 ct
Sore Throat Spray Cherry Item No 1904 $800
- Compare to Chlorasepticreg
- 6 oz
Vapor Rub Item No 1164 $750
- Compare to Vicks VapoRubreg
- 35 oz47 1
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Abrevareg
Item No 1152 $2600
- 2 gm10
Carmexreg
Item No 1255 $400
- 75 gm
Herpecin-Lreg Lip Balm Item No 1153 $800
- 1 oz1
Releevreg Cold Sore Treatment Item No 1359 $2400
- 6 ml13
Blistexreg Lip Ointment Item No 1256 $500
- 6 gm
Cushion Foam Ring Item No 1732 $2100
- 1 ct
Cushion Lumbar Item No 1731 $2700
- 1 ct
Humidifier Ultra-Sonic Cool Mist Item No 1795 $5800
- Compare to Vicksreg Ultrasonic Humidifier - 1 ct
Cushion Gel Foam Seat Item No 1466 $4000
- 1 ct
Cold Sore amp Medicated Lip Products
Daily Living Aids
Pill Case Weekly AMPM Item No 1934 $1100
- 1 ct
Pill Cutter with Safety Shield Item No 1932 $1000
- 1 ct
Pillow CPAP Fiber Filled Item No 1836 $6000
- 1 ct
Pillow CPAP Memory Foam Item No 1837 $9500
- 1 ct
Pillow Hypoallergenic Item No 1936 $5300
- 1 ct
Pill Crusher with Storage Item No 1933 $1000
- 1 ct
Medical ID Bracelet bull Blank Item No 1875 1 ct
$1650
bull Diabetic Item No 1877 1 ct bull Heart Item No 1876 1 ct
$1500
Medicine Bottle Opener with Magnifier Item No 2017 $1000
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
13
Dental amp Denture Care
Denture Cleaning Tablets Item No 1032 $600
- Compare to Polidentreg
- 40 ct
Efferdentreg Plus Mint Tablets Item No 1653 $800
- 36 ct
Effergripreg Denture Cream Adhesive Item No 1843 $900
- 25 oz
Biotenereg Dry Mouth Oral Rinse Item No 1817 $1400
- 16 oz
Denture Brush Item No 1747 $650
- Compare to G-U-Mreg
- 1 ct
Interdental Flossups Item No 1751 $500
- Compare to G-U-Mreg
- 90 ct
Orajelreg Pain Relief Item No 1454 $1100
- 25 oz20
Oral Pain Relief Item No 1286 $600
- Compareto Orajelreg
- 5 oz20
Polidentreg Overnight Item No 1892 $1250
- 84 ct
Fixodentreg
Item No 1187 $700
- 75 oz
Tongue Cleaner Item No 1746 $600
- 1 ct
Toothbrush Battery Powered Item No 2015 $2000
- 1 ct
Toothbrush Colgatereg Adult Soft Item No 1413 $300
- 1 ct
Reachreg Waxed Dental Floss - Mint Item No 1455 $500
- 55 yd
Polidentreg Denture Cream Item No 1324 $650
- 39 oz
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Toothpaste Crestreg Sensi-Relief Item No 1838 $950
- 41 oz
Toothpaste Fluoride Item No 1914 $550
- 64 oz
Toothpaste Pepsodentreg
Item No 1414 $500
- 55 oz
Toothbrush Tek Proreg Angled Soft Item No 1412 $300
- 1 ct
Toothpaste Colgatereg
Item No 1831 $600
- 4 oz
Toothbrush Rechargeable Item No 1450 $4000
- 1 ct
Toothbrush Soft 2-pack Item No 1948 $600
- 2 ct
Dental amp Denture Care continued
Toothpaste Ultrabritereg
Advanced Whitening Item No 1716 $700
- 6 oz
Toothpaste Sensitive Teeth Item No 1903 $600
- Compare to Sensodynereg
- 43 oz
Water Jet Item No 1744 $4200
- 1 ct
Water Jet Replacement Tips Item No 1743 $1700
- 5 ct
Diabetic Skin Relief Foot Cream Item No 1839 $1200
- Compare to Gold Bondreg
Skin Protectant Foot Cream - 34 oz
Diabetic Socks Black bull Medium Item No 1956 bull Large Item No 1957 bull X-Large Item No 1958 $900
- 3 pair
Diabetic Foot Care
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
15
Diabetic Foot Care continued
Diabetic Socks Ultra Soft Padded Black bull Medium Item No 1959 bull Large Item No 1960 bull X-Large Item No 1961 $1100
- 2 pair
Diabetic Socks Ultra Soft Padded White bull Medium Item No 1962 bull Large Item No 1963 bull X-Large Item No 1964 $1100
- 2 pair
Diabetic Socks White bull Medium Item No 1953 bull Large Item No 1954 bull X-Large Item No 1955 $900
- 3 pair
Bathroom Scale Talking Daggersect
Item No 1981 $5700
- 1 ct
Blood Pressure Monitor Desktop Replacement Cuff Dagger
Item No 1504 $1500
- 1 ct
Blood Pressure Monitor Desktop Talking Dagger
Item No 1503 $5500
- 1 ct
Bathroom Scale Daggersect
Item No 1935 $3500
- 1 ct
Activity Tracker Item No 1982 $5200
- 1 ct
Blood Pressure Monitor Desktop Automatic Dagger
Item No 1253 $5000
- 1 ct
Blood Pressure Monitor Wrist Dagger
Item No 1501 $3500
- 1 ct
Diagnostic Equipment
Blood Pressure Monitor Wrist Talking Dagger
Item No 1502 $4500
- 1 ct
Finger Pulse Oximeter Dagger
Item No 1505 $4200
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
16
Diagnostic Equipment continued
Peak Flow Meter Dagger
Item No 1789 $1700
- 1 ct
Thermometer Digital 60 seconds Item No 1063 $650
- 1 ct
Thermometer Digital Ear Item No 1285 $2700
- 1 ct
Thermometer Flexible Tip Digital 10 seconds Item No 1697 $1000
- 1 ct
Heart Rate Monitor Watch Dagger
Item No 1771 $4000
- 1 ct
Diagnostic Tests Ear Care
Eye Care
Thermometer Talking Ear and Forehead Item No 1925 $4500
- 1 ct
Home Access Cholesterol Test Dagger
Item No 1251 $3000
- 1 kit
Cotton Tipped Swabs Item No 1742 $600
- Compare to Johnson amp Johnsonreg
- 300 ct
EZ Detectreg Colon Cancer Test Kit Dagger
Item No 1416 $1300
- 1 ct
Ear Wax Removal Drops Item No 1190 $500
- Compare to Debroxreg
- 15 ml65
Ear Wax Removal System with Rubber Bulb Item No 1363 $700
- Compare toDebroxreg
- 15 ml65
Ear Pain Relief Ear Drops Item No 1841 $1300
- Compare to Hylands Ear Reliefreg
- 10 ml
Artificial Tears Drops Item No 1192 $600
- Compare toVisine Tearsreg
- 5 oz
Artificial Tears Ointment Item No 1194 $600
- Compare to Refresh PMreg
- 35 gm
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Artificial Tears OintmentItem No 1194$600
- Compare to Refresh PMreg
- 35 gm
17
Eye Care continued
First Aid
Contact Lens Solution Multi-Purpose Item No 1468 $800
- Compare to Renureg
Multipurpose Solution - 12 oz
Eye Drops Clear Eyesreg
Item No 1199 $600
- 2 oz
Eye Drops Irritation Relief Item No 1806 $950
- Compare toVisine ACreg
- 15 ml
Eye Drops Redness Relief Item No 1061 $500
- Compare to Visinereg
Original Redness Relief - 15 ml005
Eye Wash Solution Bausch + Lombreg
Item No 1196 $800
- 4 oz
Antiseptic Skin Cleanser Item No 1808 $1100
- Compare to Hibiclensreg
- 8 oz
Bactinereg Solution Item No 1142 $1000
- 4 oz
Adhesive Bandages Item No 1344 $500
- Compare to Band-Aidreg Plastic Strips
- 60 ct
Alcohol Pads Item No 1200 $550
- 100 ct70
After Bitereg
Relief Item No 1803 $900
- 5 oz
Antiseptic Towelettes Item No 1201 $700
- 100 ct
Bacitracin Ointment Item No 1020 $600
- 1 oz500 U gm
Bandage Elastic - 2 x 45 yd Item No 1207 $400
- Compare to Acereg
- 1 ct
Bandage Elastic - 3 x 5 yd Item No 1209 $400
- Compare to Acereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
OTC MEDICATIONS AND HEALTH PRODUCTS Talk with your doctor before starting a new product regimen
Allergy
Benadrylreg Allergy Liqui-Gels Dye-Free Item No 1927 $1200
- 24 ct25 mg
Cetirizine HCL Cetirizine HCL Chlorpheniramine (Allergy Tablets) (Allergy Tablets) Maleate Antihistamine Item No 1090 Item No 2003 (Allergy Tablets)
Item No 1008 $500 $1000 $500
- Compare to Zyrtecreg - Compare to Zyrtecreg
- 14 ct10 mg - 45 ct10 mg - 100 ct4 mg
Cromolyn Sodium (Allergy Nasal Spray) Item No 1356 $1800
- Compare to Nasalcromreg
- 26 ml
DiphenhydramineAntihistamine (Allergy Tablets) Item No 1009 $500
- Compare to Benadry- 24 ct25 mg
Diphenhydramine Antihistamine (Allergy Tablets) Item No 1308 $600
lreg - Compare to Benadry- 100 ct25 mg
Diphenhydramine Antihistamine (Allergy Tablets) Item No 2021 $1500
lreg - Compare to Benadrylreg
- 400 ct25 mg
Fexofenadine Fluticasone Propionate Loratadine (Allergy Tablets) Loratadine (Allergy Tablets) (Allergy Tablets) (Allergy Nasal Item No 2033 Item No 1611 Item No 1804 Spray 24-hour) $550 $1800Item No 1946 $1600
- Compare to Claritinreg - Compare to Claritinreg$2500 - Compare to Allegrareg - 10 ct 10 mg - 100 ct10 mg
- 30 ct180 mg - Compare to Flonasereg
- 120 spray50 mcg
5
OTC MEDICATIONS AND HEALTH PRODUCTS Talk with your doctor before starting a new product regimen
Allergy continued
Nasal Decongestant Nasal Decongestant Nasal Spray Saline Loratadine (Allergy Tablets) Nasacortreg
Inhaler - Spray 12-Hour Item No 1052 Item No 2020 Item No 1881 Levmetamfetamine Item No 1091 $500$2500 $2200 Item No 1922 $500 - 15 oz065 - Compare to Claritinreg - 60 spray $700
- Compare to Afrinreg - 365 ct10 mg - Compare to Vicksreg - 1 oz005
VapoInhaler - 007 oz50 mg
Antacids amp Acid Reducers
Effervescent Antacid Esomeprazole Magnesium Alka-Seltzerreg Antacid Anti- Antacid Chewables amp Pain Relief (Acid Reducer Item No 1313 Gas Liquid Item No 1346 Item No 1314 Delayed Release) Item No 1006 $600$1100 Item No 1949 $800$600
- 36 ct - Compare to Tumsreg $2300 - Compare to- Compare to Maaloxreg - 150 ct500 mg
- 12 oz Alka-Seltzerreg - Compare to Nexiumreg
- 36 ct - 42 ct20 mg
Famotidine (AcidReducer) Item No 1108 $600
- Compare toPepcid ACreg
- 30 ct10 mg
Omeprazole (Acid Reducer Delayed Release) Item No 1970 $2500
- Compare toPrilosecreg
- 42 ct20 mg
Omeprazole (Acid Ranitidine (Acid Reducer) Reducer Delayed Item No 1900 Release Dissolvable) $800Item No 1966
- Compare to Zantacreg $2500 - 30 ct75 mg - Compare to
Prilosecreg
- 42 ct20 mg
Simethicone (Gas Relief) Item No 1800 $900
- Compareto Gas-Xreg
Chewables - 100 ct80 mg
6
Allergy continued
Famotidine (AcidReducer)Item No 1108$600
- Compare toPepcid ACreg
- 30 ct10 mg
Omeprazole(Acid ReducerDelayed Release)Item No 1970$2500
- Compare toPrilosecreg
- 42 ct20 mg
Omeprazole (AcidReducer DelayedRelease Dissolvable)Item No 1966$2500
- Compare toPrilosecreg
- 42 ct20 mg
Ranitidine (Acid Reducer)Item No 1900$800
- Compare to Zantacreg
- 30 ct75 mg
Esomeprazole Magnesium(Acid ReducerDelayed Release)Item No 1949$2300
- Compare to Nexiumreg
- 42 ct20 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Antacids amp Acid Reducers continued
TUMSreg Extra Strength TUMSreg Ultra Strength Item No 2034 Item No 2019 $750 $1000
- 48 ct750 mg - 72 ct1000 mg
Anticandidal (yeast)
Clotrimazole (Vaginal Antifungal 7-Day Cream with Applicator) Item No 1115 $800
- Compare to Monistatreg 7 - 45 gm1
Miconazole (Vaginal Antifungal 3-Day Cream with Applicator)) Item No 1117 $1400
- Compare to Monistatreg 3 - 1 kit2
Tioconazole (Vaginal Antifungal 1-Day Cream with Applicator) Item No 1119 $2000
- Compare to Monistatreg 1 - 1 ct65
Anti-diarrheal Laxatives amp Digestive Health
Beanoreg
Item No 1316 $900
- 30 ct
Docusate Sodium (Stool Softener) Item No 1126 $600
- Compare toColacereg
- 100 ct100 mg
Docusate Sodium plus Sennosides (Natural Vegetable Laxative) Item No 1130 $800
- Compare toSenokot-Sreg
- 60 ct86 mg 50 mg
Enema Ex-Laxreg
Item No 1733 Item No 1124 $550 $800
- Compare to Fleetreg
- 45 oz - 8 ct15 mg
7
OTC MEDICATIONS AND HEALTH PRODUCTSTalk with your doctor before starting a new product regimen
Anti-diarrheal Laxatives amp Digestive Health continued
Lactase Capsules Item No 1067 $1000
- Compare toLactaidreg
- 60 ct9000 FCC Units
Laxative Bisacodyl (Stimulant Enteric Coated) Item No 1128 $500
- Compare toDulcolaxreg
- 100 ct5 mg
Laxative MagnesiumCitrate (SalineLemon) Item No 1889 $550
- 296 ml
Laxative Natural Vegetable (Psyllium) Item No 1340 $1000
- Compare toMetamucilreg
- 13 oz
Laxative Calcium Polycarbophil (Fiber Tablets) Item No 1012 $1000
- Compare to FiberConreg
- 90 ct625 mg
Laxative Natural Vegetable (Psyllium) Item No 1967 $1600
- Compare to Metamuc- 304 oz
Laxative ClearLaxreg
Unflavored Powder Item No 1969 $1350
- Compare toMiraLA Xreg
- 83 oz17 g
Laxative Natural VegetabSugar Free (Psyllium) Item No 1968 $1300
ilreg - Compare to Metamucilreg
Sugar-Free - 15 oz
Laxative Glycerin Suppository Item No 1125 $500
- Compare to Fleetreg
- 25 ct2 gm
le Loperamide HCL (Anti-Diarrheal Tablets) Item No 1133 $500
- Compare toImodium A-Dreg
- 12 ct2 mg
Pink Bismuth Liquid Item No 1318 $600
- Compare toPepto-Bismolreg
- 8 oz525 mg 30 ml
Methylcellulose (Fiber Therapy) Item No 1354 $1200
- Compare to Citrucelreg
- 16 oz
Milk of Magnesia Item No 1011 $600
- Compare to Phillipsreg
- 12 oz400 mg
Pepto-Bismolreg Cherry Item No 1317 $1000
- 12 oz525 mg 30 ml
Pink Bismuth Chewable Tablets Item No 1045 $600
- Compare to Pepto-Bismolreg Chewable
- 30 ct262 mg
8
Laxative GlycerinSuppositoryItem No 1125$500
- Compare to Fleetreg
- 25 ct2 gm
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Anti-fungal
Clotrimazole (Athletes Foot Cream) Item No 1047 $600
- Compare toLotriminreg AF
- 15 oz1
Miconazole Nitrate (Anti-fungal Cream) Item No 1135 $800
- Compare to Micatinreg
- 1 oz2
Miconazole Nitrate (Athletes Foot Spray) Item No 1874 $1000
- Compare toLotriminreg AF
- 46 oz2
Terbinafine HCL (Athletes Foot Cream) Item No 1046 $1200
- Compare toLamisilreg AT
- 5 oz1
Tolnaftate (Antishyfungal Cream) Item No 1064 $500
- Compare to Tinactinreg
- 125 oz1
Bathroom Safety amp Fall Prevention
Bath Bench Bath Tub Safety Rail Bed Assist Bar Bath Bench Bath Mat Non-Skid with Back Item No 1730 Item No 2009 without Back Item No 1459 Item No 1728 Item No 1727 $3700 $5500$1700 $6500 $5500 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
Cane Quad Fall Mat Bedside Commode Cane Folding Cane Quad Large Base Small Base Item No 2006 Item No 1984 Ergonomic Handle Item No 1776 Item No 1777 Item No 1726 $6500 $3000 $15000 $2500$2000 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
9
10
Cold amp Flu
Bathroom Safety amp Fall Prevention continued
Gait Belt - 60 Item No 1790 $1600
- 1 ct
Grab Bar Knurled Chrome 12 Item No 1798 $1900
- 1 ct
Grab Bar Knurled Chrome 24 Item No 1797 $2200
- 1 ct
Grab Bar Knurled Chrome 32 Item No 2005 $3600
- 1 ct
Gait Belt - 72 Item No 1791 $1700
- 1 ct
Night Light Item No 1983 $1500
- 2 ct
Safety Treads Tub amp Stair Item No 1780 $1000
- 1 pack
Shower Head Handheld Item No 2007 $2500
- 1 ct
Shower Mat Non-Skid Item No 1460 $1400
- 1 ct
Safety Tread Aids Anti-Slip Item No 1793 $1700
- 1 roll
Slipper Socks One Size Fits Most Item No 2008 $700
- 1 pair
Toilet Seat Raised Item No 1729 $3500
- 1 ct
Toilet Seat Raised with Arms Item No 1950 $6500
- 1 ct
Transfer Bench Adjustable Item No 1764 $8000
- 1 ct
Toilet Safety Rails Item No 1779 $5000
- 1 set
Cough amp Cold for High Blood Pressure Item No 1166 $700
- Compare to Coricidinreg HBP - 16 ct
Cough DropsCherry Item No 1056 $400
- Compare to Hallsreg
- 30 ct58 mg
Cough DropsHoney Lemon Item No 1833 $400
- Compare to Hallsreg
- 30 ct
Cough DropsMenthol Item No 1834 $400
- Compare to Hallsreg
- 30 ct
Cough Drops SugarFree Cherry Item No 1182 $500
- Compare to Hallsreg Sugar Free - 25 ct58 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Grab Bar Knurled Chrome 32Item No 2005$3600
- 1 ct
11
Cough SyrupExpectorant Item No 1054 $500
- Compare toRobitussinreg
- 4 oz200 mg 10 ml
Guaifenesin (CoughExpectorant) Item No 1180 $900
- 100 ct200 mg
Inhaler Personal Steam Item No 1792 $5000
- Vicksreg Personal Steam Inhaler
- 1 ct
Mucus Relief DM Expectorant amp Cough Suppressant Item No 1178 $1200
- Compare to Mucinexreg
- 30 ct400 mg 20 mg
Diabetic Tussinreg DM Item No 1323 $900
- Compare toRobitussinreg
Sugar Free DM - 4 oz
Mucus Relief DM Expectorant amp Cough SuppressantExtended Release Item No 1965 $1600
- Compare to Mucinexreg
- 14 ct1200 mg 60 mg
Nasal Rinse Kit Saline Item No 1931 $1800
- Compare to NeilMedreg
Sinus Rinse - 1 kit
Night Time Cold amp Flu Item No 1361 $600
- Compare toVicks NyQuilreg
- 4 oz125 mg 30 mg 650 mg
Phenylephrine HCL (Nasal Decongestant PE) Item No 1352 $500
- Compare toSudafedreg PE
- 36 ct10 mg
Multi-Symptom Cold Formula Item No 1357 $600
- Compare toTylenolreg Cold Multi-Symptom Daytime
- 24 ct10 mg5 mg 325 mg
Sore Throat Lozenges Cepacolreg
Item No 1360 $550
- 16 ct
Cold amp Flu continued
Sore Throat Lozenges Cherry Item No 1176 $700
- Compare to Cepacolreg
- 18 ct
Sore Throat Spray Cherry Item No 1904 $800
- Compare to Chlorasepticreg
- 6 oz
Vapor Rub Item No 1164 $750
- Compare to Vicks VapoRubreg
- 35 oz47 1
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Abrevareg
Item No 1152 $2600
- 2 gm10
Carmexreg
Item No 1255 $400
- 75 gm
Herpecin-Lreg Lip Balm Item No 1153 $800
- 1 oz1
Releevreg Cold Sore Treatment Item No 1359 $2400
- 6 ml13
Blistexreg Lip Ointment Item No 1256 $500
- 6 gm
Cushion Foam Ring Item No 1732 $2100
- 1 ct
Cushion Lumbar Item No 1731 $2700
- 1 ct
Humidifier Ultra-Sonic Cool Mist Item No 1795 $5800
- Compare to Vicksreg Ultrasonic Humidifier - 1 ct
Cushion Gel Foam Seat Item No 1466 $4000
- 1 ct
Cold Sore amp Medicated Lip Products
Daily Living Aids
Pill Case Weekly AMPM Item No 1934 $1100
- 1 ct
Pill Cutter with Safety Shield Item No 1932 $1000
- 1 ct
Pillow CPAP Fiber Filled Item No 1836 $6000
- 1 ct
Pillow CPAP Memory Foam Item No 1837 $9500
- 1 ct
Pillow Hypoallergenic Item No 1936 $5300
- 1 ct
Pill Crusher with Storage Item No 1933 $1000
- 1 ct
Medical ID Bracelet bull Blank Item No 1875 1 ct
$1650
bull Diabetic Item No 1877 1 ct bull Heart Item No 1876 1 ct
$1500
Medicine Bottle Opener with Magnifier Item No 2017 $1000
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
13
Dental amp Denture Care
Denture Cleaning Tablets Item No 1032 $600
- Compare to Polidentreg
- 40 ct
Efferdentreg Plus Mint Tablets Item No 1653 $800
- 36 ct
Effergripreg Denture Cream Adhesive Item No 1843 $900
- 25 oz
Biotenereg Dry Mouth Oral Rinse Item No 1817 $1400
- 16 oz
Denture Brush Item No 1747 $650
- Compare to G-U-Mreg
- 1 ct
Interdental Flossups Item No 1751 $500
- Compare to G-U-Mreg
- 90 ct
Orajelreg Pain Relief Item No 1454 $1100
- 25 oz20
Oral Pain Relief Item No 1286 $600
- Compareto Orajelreg
- 5 oz20
Polidentreg Overnight Item No 1892 $1250
- 84 ct
Fixodentreg
Item No 1187 $700
- 75 oz
Tongue Cleaner Item No 1746 $600
- 1 ct
Toothbrush Battery Powered Item No 2015 $2000
- 1 ct
Toothbrush Colgatereg Adult Soft Item No 1413 $300
- 1 ct
Reachreg Waxed Dental Floss - Mint Item No 1455 $500
- 55 yd
Polidentreg Denture Cream Item No 1324 $650
- 39 oz
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Toothpaste Crestreg Sensi-Relief Item No 1838 $950
- 41 oz
Toothpaste Fluoride Item No 1914 $550
- 64 oz
Toothpaste Pepsodentreg
Item No 1414 $500
- 55 oz
Toothbrush Tek Proreg Angled Soft Item No 1412 $300
- 1 ct
Toothpaste Colgatereg
Item No 1831 $600
- 4 oz
Toothbrush Rechargeable Item No 1450 $4000
- 1 ct
Toothbrush Soft 2-pack Item No 1948 $600
- 2 ct
Dental amp Denture Care continued
Toothpaste Ultrabritereg
Advanced Whitening Item No 1716 $700
- 6 oz
Toothpaste Sensitive Teeth Item No 1903 $600
- Compare to Sensodynereg
- 43 oz
Water Jet Item No 1744 $4200
- 1 ct
Water Jet Replacement Tips Item No 1743 $1700
- 5 ct
Diabetic Skin Relief Foot Cream Item No 1839 $1200
- Compare to Gold Bondreg
Skin Protectant Foot Cream - 34 oz
Diabetic Socks Black bull Medium Item No 1956 bull Large Item No 1957 bull X-Large Item No 1958 $900
- 3 pair
Diabetic Foot Care
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
15
Diabetic Foot Care continued
Diabetic Socks Ultra Soft Padded Black bull Medium Item No 1959 bull Large Item No 1960 bull X-Large Item No 1961 $1100
- 2 pair
Diabetic Socks Ultra Soft Padded White bull Medium Item No 1962 bull Large Item No 1963 bull X-Large Item No 1964 $1100
- 2 pair
Diabetic Socks White bull Medium Item No 1953 bull Large Item No 1954 bull X-Large Item No 1955 $900
- 3 pair
Bathroom Scale Talking Daggersect
Item No 1981 $5700
- 1 ct
Blood Pressure Monitor Desktop Replacement Cuff Dagger
Item No 1504 $1500
- 1 ct
Blood Pressure Monitor Desktop Talking Dagger
Item No 1503 $5500
- 1 ct
Bathroom Scale Daggersect
Item No 1935 $3500
- 1 ct
Activity Tracker Item No 1982 $5200
- 1 ct
Blood Pressure Monitor Desktop Automatic Dagger
Item No 1253 $5000
- 1 ct
Blood Pressure Monitor Wrist Dagger
Item No 1501 $3500
- 1 ct
Diagnostic Equipment
Blood Pressure Monitor Wrist Talking Dagger
Item No 1502 $4500
- 1 ct
Finger Pulse Oximeter Dagger
Item No 1505 $4200
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
16
Diagnostic Equipment continued
Peak Flow Meter Dagger
Item No 1789 $1700
- 1 ct
Thermometer Digital 60 seconds Item No 1063 $650
- 1 ct
Thermometer Digital Ear Item No 1285 $2700
- 1 ct
Thermometer Flexible Tip Digital 10 seconds Item No 1697 $1000
- 1 ct
Heart Rate Monitor Watch Dagger
Item No 1771 $4000
- 1 ct
Diagnostic Tests Ear Care
Eye Care
Thermometer Talking Ear and Forehead Item No 1925 $4500
- 1 ct
Home Access Cholesterol Test Dagger
Item No 1251 $3000
- 1 kit
Cotton Tipped Swabs Item No 1742 $600
- Compare to Johnson amp Johnsonreg
- 300 ct
EZ Detectreg Colon Cancer Test Kit Dagger
Item No 1416 $1300
- 1 ct
Ear Wax Removal Drops Item No 1190 $500
- Compare to Debroxreg
- 15 ml65
Ear Wax Removal System with Rubber Bulb Item No 1363 $700
- Compare toDebroxreg
- 15 ml65
Ear Pain Relief Ear Drops Item No 1841 $1300
- Compare to Hylands Ear Reliefreg
- 10 ml
Artificial Tears Drops Item No 1192 $600
- Compare toVisine Tearsreg
- 5 oz
Artificial Tears Ointment Item No 1194 $600
- Compare to Refresh PMreg
- 35 gm
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Artificial Tears OintmentItem No 1194$600
- Compare to Refresh PMreg
- 35 gm
17
Eye Care continued
First Aid
Contact Lens Solution Multi-Purpose Item No 1468 $800
- Compare to Renureg
Multipurpose Solution - 12 oz
Eye Drops Clear Eyesreg
Item No 1199 $600
- 2 oz
Eye Drops Irritation Relief Item No 1806 $950
- Compare toVisine ACreg
- 15 ml
Eye Drops Redness Relief Item No 1061 $500
- Compare to Visinereg
Original Redness Relief - 15 ml005
Eye Wash Solution Bausch + Lombreg
Item No 1196 $800
- 4 oz
Antiseptic Skin Cleanser Item No 1808 $1100
- Compare to Hibiclensreg
- 8 oz
Bactinereg Solution Item No 1142 $1000
- 4 oz
Adhesive Bandages Item No 1344 $500
- Compare to Band-Aidreg Plastic Strips
- 60 ct
Alcohol Pads Item No 1200 $550
- 100 ct70
After Bitereg
Relief Item No 1803 $900
- 5 oz
Antiseptic Towelettes Item No 1201 $700
- 100 ct
Bacitracin Ointment Item No 1020 $600
- 1 oz500 U gm
Bandage Elastic - 2 x 45 yd Item No 1207 $400
- Compare to Acereg
- 1 ct
Bandage Elastic - 3 x 5 yd Item No 1209 $400
- Compare to Acereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
OTC MEDICATIONS AND HEALTH PRODUCTS Talk with your doctor before starting a new product regimen
Allergy continued
Nasal Decongestant Nasal Decongestant Nasal Spray Saline Loratadine (Allergy Tablets) Nasacortreg
Inhaler - Spray 12-Hour Item No 1052 Item No 2020 Item No 1881 Levmetamfetamine Item No 1091 $500$2500 $2200 Item No 1922 $500 - 15 oz065 - Compare to Claritinreg - 60 spray $700
- Compare to Afrinreg - 365 ct10 mg - Compare to Vicksreg - 1 oz005
VapoInhaler - 007 oz50 mg
Antacids amp Acid Reducers
Effervescent Antacid Esomeprazole Magnesium Alka-Seltzerreg Antacid Anti- Antacid Chewables amp Pain Relief (Acid Reducer Item No 1313 Gas Liquid Item No 1346 Item No 1314 Delayed Release) Item No 1006 $600$1100 Item No 1949 $800$600
- 36 ct - Compare to Tumsreg $2300 - Compare to- Compare to Maaloxreg - 150 ct500 mg
- 12 oz Alka-Seltzerreg - Compare to Nexiumreg
- 36 ct - 42 ct20 mg
Famotidine (AcidReducer) Item No 1108 $600
- Compare toPepcid ACreg
- 30 ct10 mg
Omeprazole (Acid Reducer Delayed Release) Item No 1970 $2500
- Compare toPrilosecreg
- 42 ct20 mg
Omeprazole (Acid Ranitidine (Acid Reducer) Reducer Delayed Item No 1900 Release Dissolvable) $800Item No 1966
- Compare to Zantacreg $2500 - 30 ct75 mg - Compare to
Prilosecreg
- 42 ct20 mg
Simethicone (Gas Relief) Item No 1800 $900
- Compareto Gas-Xreg
Chewables - 100 ct80 mg
6
Allergy continued
Famotidine (AcidReducer)Item No 1108$600
- Compare toPepcid ACreg
- 30 ct10 mg
Omeprazole(Acid ReducerDelayed Release)Item No 1970$2500
- Compare toPrilosecreg
- 42 ct20 mg
Omeprazole (AcidReducer DelayedRelease Dissolvable)Item No 1966$2500
- Compare toPrilosecreg
- 42 ct20 mg
Ranitidine (Acid Reducer)Item No 1900$800
- Compare to Zantacreg
- 30 ct75 mg
Esomeprazole Magnesium(Acid ReducerDelayed Release)Item No 1949$2300
- Compare to Nexiumreg
- 42 ct20 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Antacids amp Acid Reducers continued
TUMSreg Extra Strength TUMSreg Ultra Strength Item No 2034 Item No 2019 $750 $1000
- 48 ct750 mg - 72 ct1000 mg
Anticandidal (yeast)
Clotrimazole (Vaginal Antifungal 7-Day Cream with Applicator) Item No 1115 $800
- Compare to Monistatreg 7 - 45 gm1
Miconazole (Vaginal Antifungal 3-Day Cream with Applicator)) Item No 1117 $1400
- Compare to Monistatreg 3 - 1 kit2
Tioconazole (Vaginal Antifungal 1-Day Cream with Applicator) Item No 1119 $2000
- Compare to Monistatreg 1 - 1 ct65
Anti-diarrheal Laxatives amp Digestive Health
Beanoreg
Item No 1316 $900
- 30 ct
Docusate Sodium (Stool Softener) Item No 1126 $600
- Compare toColacereg
- 100 ct100 mg
Docusate Sodium plus Sennosides (Natural Vegetable Laxative) Item No 1130 $800
- Compare toSenokot-Sreg
- 60 ct86 mg 50 mg
Enema Ex-Laxreg
Item No 1733 Item No 1124 $550 $800
- Compare to Fleetreg
- 45 oz - 8 ct15 mg
7
OTC MEDICATIONS AND HEALTH PRODUCTSTalk with your doctor before starting a new product regimen
Anti-diarrheal Laxatives amp Digestive Health continued
Lactase Capsules Item No 1067 $1000
- Compare toLactaidreg
- 60 ct9000 FCC Units
Laxative Bisacodyl (Stimulant Enteric Coated) Item No 1128 $500
- Compare toDulcolaxreg
- 100 ct5 mg
Laxative MagnesiumCitrate (SalineLemon) Item No 1889 $550
- 296 ml
Laxative Natural Vegetable (Psyllium) Item No 1340 $1000
- Compare toMetamucilreg
- 13 oz
Laxative Calcium Polycarbophil (Fiber Tablets) Item No 1012 $1000
- Compare to FiberConreg
- 90 ct625 mg
Laxative Natural Vegetable (Psyllium) Item No 1967 $1600
- Compare to Metamuc- 304 oz
Laxative ClearLaxreg
Unflavored Powder Item No 1969 $1350
- Compare toMiraLA Xreg
- 83 oz17 g
Laxative Natural VegetabSugar Free (Psyllium) Item No 1968 $1300
ilreg - Compare to Metamucilreg
Sugar-Free - 15 oz
Laxative Glycerin Suppository Item No 1125 $500
- Compare to Fleetreg
- 25 ct2 gm
le Loperamide HCL (Anti-Diarrheal Tablets) Item No 1133 $500
- Compare toImodium A-Dreg
- 12 ct2 mg
Pink Bismuth Liquid Item No 1318 $600
- Compare toPepto-Bismolreg
- 8 oz525 mg 30 ml
Methylcellulose (Fiber Therapy) Item No 1354 $1200
- Compare to Citrucelreg
- 16 oz
Milk of Magnesia Item No 1011 $600
- Compare to Phillipsreg
- 12 oz400 mg
Pepto-Bismolreg Cherry Item No 1317 $1000
- 12 oz525 mg 30 ml
Pink Bismuth Chewable Tablets Item No 1045 $600
- Compare to Pepto-Bismolreg Chewable
- 30 ct262 mg
8
Laxative GlycerinSuppositoryItem No 1125$500
- Compare to Fleetreg
- 25 ct2 gm
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Anti-fungal
Clotrimazole (Athletes Foot Cream) Item No 1047 $600
- Compare toLotriminreg AF
- 15 oz1
Miconazole Nitrate (Anti-fungal Cream) Item No 1135 $800
- Compare to Micatinreg
- 1 oz2
Miconazole Nitrate (Athletes Foot Spray) Item No 1874 $1000
- Compare toLotriminreg AF
- 46 oz2
Terbinafine HCL (Athletes Foot Cream) Item No 1046 $1200
- Compare toLamisilreg AT
- 5 oz1
Tolnaftate (Antishyfungal Cream) Item No 1064 $500
- Compare to Tinactinreg
- 125 oz1
Bathroom Safety amp Fall Prevention
Bath Bench Bath Tub Safety Rail Bed Assist Bar Bath Bench Bath Mat Non-Skid with Back Item No 1730 Item No 2009 without Back Item No 1459 Item No 1728 Item No 1727 $3700 $5500$1700 $6500 $5500 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
Cane Quad Fall Mat Bedside Commode Cane Folding Cane Quad Large Base Small Base Item No 2006 Item No 1984 Ergonomic Handle Item No 1776 Item No 1777 Item No 1726 $6500 $3000 $15000 $2500$2000 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
9
10
Cold amp Flu
Bathroom Safety amp Fall Prevention continued
Gait Belt - 60 Item No 1790 $1600
- 1 ct
Grab Bar Knurled Chrome 12 Item No 1798 $1900
- 1 ct
Grab Bar Knurled Chrome 24 Item No 1797 $2200
- 1 ct
Grab Bar Knurled Chrome 32 Item No 2005 $3600
- 1 ct
Gait Belt - 72 Item No 1791 $1700
- 1 ct
Night Light Item No 1983 $1500
- 2 ct
Safety Treads Tub amp Stair Item No 1780 $1000
- 1 pack
Shower Head Handheld Item No 2007 $2500
- 1 ct
Shower Mat Non-Skid Item No 1460 $1400
- 1 ct
Safety Tread Aids Anti-Slip Item No 1793 $1700
- 1 roll
Slipper Socks One Size Fits Most Item No 2008 $700
- 1 pair
Toilet Seat Raised Item No 1729 $3500
- 1 ct
Toilet Seat Raised with Arms Item No 1950 $6500
- 1 ct
Transfer Bench Adjustable Item No 1764 $8000
- 1 ct
Toilet Safety Rails Item No 1779 $5000
- 1 set
Cough amp Cold for High Blood Pressure Item No 1166 $700
- Compare to Coricidinreg HBP - 16 ct
Cough DropsCherry Item No 1056 $400
- Compare to Hallsreg
- 30 ct58 mg
Cough DropsHoney Lemon Item No 1833 $400
- Compare to Hallsreg
- 30 ct
Cough DropsMenthol Item No 1834 $400
- Compare to Hallsreg
- 30 ct
Cough Drops SugarFree Cherry Item No 1182 $500
- Compare to Hallsreg Sugar Free - 25 ct58 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Grab Bar Knurled Chrome 32Item No 2005$3600
- 1 ct
11
Cough SyrupExpectorant Item No 1054 $500
- Compare toRobitussinreg
- 4 oz200 mg 10 ml
Guaifenesin (CoughExpectorant) Item No 1180 $900
- 100 ct200 mg
Inhaler Personal Steam Item No 1792 $5000
- Vicksreg Personal Steam Inhaler
- 1 ct
Mucus Relief DM Expectorant amp Cough Suppressant Item No 1178 $1200
- Compare to Mucinexreg
- 30 ct400 mg 20 mg
Diabetic Tussinreg DM Item No 1323 $900
- Compare toRobitussinreg
Sugar Free DM - 4 oz
Mucus Relief DM Expectorant amp Cough SuppressantExtended Release Item No 1965 $1600
- Compare to Mucinexreg
- 14 ct1200 mg 60 mg
Nasal Rinse Kit Saline Item No 1931 $1800
- Compare to NeilMedreg
Sinus Rinse - 1 kit
Night Time Cold amp Flu Item No 1361 $600
- Compare toVicks NyQuilreg
- 4 oz125 mg 30 mg 650 mg
Phenylephrine HCL (Nasal Decongestant PE) Item No 1352 $500
- Compare toSudafedreg PE
- 36 ct10 mg
Multi-Symptom Cold Formula Item No 1357 $600
- Compare toTylenolreg Cold Multi-Symptom Daytime
- 24 ct10 mg5 mg 325 mg
Sore Throat Lozenges Cepacolreg
Item No 1360 $550
- 16 ct
Cold amp Flu continued
Sore Throat Lozenges Cherry Item No 1176 $700
- Compare to Cepacolreg
- 18 ct
Sore Throat Spray Cherry Item No 1904 $800
- Compare to Chlorasepticreg
- 6 oz
Vapor Rub Item No 1164 $750
- Compare to Vicks VapoRubreg
- 35 oz47 1
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Abrevareg
Item No 1152 $2600
- 2 gm10
Carmexreg
Item No 1255 $400
- 75 gm
Herpecin-Lreg Lip Balm Item No 1153 $800
- 1 oz1
Releevreg Cold Sore Treatment Item No 1359 $2400
- 6 ml13
Blistexreg Lip Ointment Item No 1256 $500
- 6 gm
Cushion Foam Ring Item No 1732 $2100
- 1 ct
Cushion Lumbar Item No 1731 $2700
- 1 ct
Humidifier Ultra-Sonic Cool Mist Item No 1795 $5800
- Compare to Vicksreg Ultrasonic Humidifier - 1 ct
Cushion Gel Foam Seat Item No 1466 $4000
- 1 ct
Cold Sore amp Medicated Lip Products
Daily Living Aids
Pill Case Weekly AMPM Item No 1934 $1100
- 1 ct
Pill Cutter with Safety Shield Item No 1932 $1000
- 1 ct
Pillow CPAP Fiber Filled Item No 1836 $6000
- 1 ct
Pillow CPAP Memory Foam Item No 1837 $9500
- 1 ct
Pillow Hypoallergenic Item No 1936 $5300
- 1 ct
Pill Crusher with Storage Item No 1933 $1000
- 1 ct
Medical ID Bracelet bull Blank Item No 1875 1 ct
$1650
bull Diabetic Item No 1877 1 ct bull Heart Item No 1876 1 ct
$1500
Medicine Bottle Opener with Magnifier Item No 2017 $1000
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
13
Dental amp Denture Care
Denture Cleaning Tablets Item No 1032 $600
- Compare to Polidentreg
- 40 ct
Efferdentreg Plus Mint Tablets Item No 1653 $800
- 36 ct
Effergripreg Denture Cream Adhesive Item No 1843 $900
- 25 oz
Biotenereg Dry Mouth Oral Rinse Item No 1817 $1400
- 16 oz
Denture Brush Item No 1747 $650
- Compare to G-U-Mreg
- 1 ct
Interdental Flossups Item No 1751 $500
- Compare to G-U-Mreg
- 90 ct
Orajelreg Pain Relief Item No 1454 $1100
- 25 oz20
Oral Pain Relief Item No 1286 $600
- Compareto Orajelreg
- 5 oz20
Polidentreg Overnight Item No 1892 $1250
- 84 ct
Fixodentreg
Item No 1187 $700
- 75 oz
Tongue Cleaner Item No 1746 $600
- 1 ct
Toothbrush Battery Powered Item No 2015 $2000
- 1 ct
Toothbrush Colgatereg Adult Soft Item No 1413 $300
- 1 ct
Reachreg Waxed Dental Floss - Mint Item No 1455 $500
- 55 yd
Polidentreg Denture Cream Item No 1324 $650
- 39 oz
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Toothpaste Crestreg Sensi-Relief Item No 1838 $950
- 41 oz
Toothpaste Fluoride Item No 1914 $550
- 64 oz
Toothpaste Pepsodentreg
Item No 1414 $500
- 55 oz
Toothbrush Tek Proreg Angled Soft Item No 1412 $300
- 1 ct
Toothpaste Colgatereg
Item No 1831 $600
- 4 oz
Toothbrush Rechargeable Item No 1450 $4000
- 1 ct
Toothbrush Soft 2-pack Item No 1948 $600
- 2 ct
Dental amp Denture Care continued
Toothpaste Ultrabritereg
Advanced Whitening Item No 1716 $700
- 6 oz
Toothpaste Sensitive Teeth Item No 1903 $600
- Compare to Sensodynereg
- 43 oz
Water Jet Item No 1744 $4200
- 1 ct
Water Jet Replacement Tips Item No 1743 $1700
- 5 ct
Diabetic Skin Relief Foot Cream Item No 1839 $1200
- Compare to Gold Bondreg
Skin Protectant Foot Cream - 34 oz
Diabetic Socks Black bull Medium Item No 1956 bull Large Item No 1957 bull X-Large Item No 1958 $900
- 3 pair
Diabetic Foot Care
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
15
Diabetic Foot Care continued
Diabetic Socks Ultra Soft Padded Black bull Medium Item No 1959 bull Large Item No 1960 bull X-Large Item No 1961 $1100
- 2 pair
Diabetic Socks Ultra Soft Padded White bull Medium Item No 1962 bull Large Item No 1963 bull X-Large Item No 1964 $1100
- 2 pair
Diabetic Socks White bull Medium Item No 1953 bull Large Item No 1954 bull X-Large Item No 1955 $900
- 3 pair
Bathroom Scale Talking Daggersect
Item No 1981 $5700
- 1 ct
Blood Pressure Monitor Desktop Replacement Cuff Dagger
Item No 1504 $1500
- 1 ct
Blood Pressure Monitor Desktop Talking Dagger
Item No 1503 $5500
- 1 ct
Bathroom Scale Daggersect
Item No 1935 $3500
- 1 ct
Activity Tracker Item No 1982 $5200
- 1 ct
Blood Pressure Monitor Desktop Automatic Dagger
Item No 1253 $5000
- 1 ct
Blood Pressure Monitor Wrist Dagger
Item No 1501 $3500
- 1 ct
Diagnostic Equipment
Blood Pressure Monitor Wrist Talking Dagger
Item No 1502 $4500
- 1 ct
Finger Pulse Oximeter Dagger
Item No 1505 $4200
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
16
Diagnostic Equipment continued
Peak Flow Meter Dagger
Item No 1789 $1700
- 1 ct
Thermometer Digital 60 seconds Item No 1063 $650
- 1 ct
Thermometer Digital Ear Item No 1285 $2700
- 1 ct
Thermometer Flexible Tip Digital 10 seconds Item No 1697 $1000
- 1 ct
Heart Rate Monitor Watch Dagger
Item No 1771 $4000
- 1 ct
Diagnostic Tests Ear Care
Eye Care
Thermometer Talking Ear and Forehead Item No 1925 $4500
- 1 ct
Home Access Cholesterol Test Dagger
Item No 1251 $3000
- 1 kit
Cotton Tipped Swabs Item No 1742 $600
- Compare to Johnson amp Johnsonreg
- 300 ct
EZ Detectreg Colon Cancer Test Kit Dagger
Item No 1416 $1300
- 1 ct
Ear Wax Removal Drops Item No 1190 $500
- Compare to Debroxreg
- 15 ml65
Ear Wax Removal System with Rubber Bulb Item No 1363 $700
- Compare toDebroxreg
- 15 ml65
Ear Pain Relief Ear Drops Item No 1841 $1300
- Compare to Hylands Ear Reliefreg
- 10 ml
Artificial Tears Drops Item No 1192 $600
- Compare toVisine Tearsreg
- 5 oz
Artificial Tears Ointment Item No 1194 $600
- Compare to Refresh PMreg
- 35 gm
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Artificial Tears OintmentItem No 1194$600
- Compare to Refresh PMreg
- 35 gm
17
Eye Care continued
First Aid
Contact Lens Solution Multi-Purpose Item No 1468 $800
- Compare to Renureg
Multipurpose Solution - 12 oz
Eye Drops Clear Eyesreg
Item No 1199 $600
- 2 oz
Eye Drops Irritation Relief Item No 1806 $950
- Compare toVisine ACreg
- 15 ml
Eye Drops Redness Relief Item No 1061 $500
- Compare to Visinereg
Original Redness Relief - 15 ml005
Eye Wash Solution Bausch + Lombreg
Item No 1196 $800
- 4 oz
Antiseptic Skin Cleanser Item No 1808 $1100
- Compare to Hibiclensreg
- 8 oz
Bactinereg Solution Item No 1142 $1000
- 4 oz
Adhesive Bandages Item No 1344 $500
- Compare to Band-Aidreg Plastic Strips
- 60 ct
Alcohol Pads Item No 1200 $550
- 100 ct70
After Bitereg
Relief Item No 1803 $900
- 5 oz
Antiseptic Towelettes Item No 1201 $700
- 100 ct
Bacitracin Ointment Item No 1020 $600
- 1 oz500 U gm
Bandage Elastic - 2 x 45 yd Item No 1207 $400
- Compare to Acereg
- 1 ct
Bandage Elastic - 3 x 5 yd Item No 1209 $400
- Compare to Acereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
Allergy continued
Famotidine (AcidReducer)Item No 1108$600
- Compare toPepcid ACreg
- 30 ct10 mg
Omeprazole(Acid ReducerDelayed Release)Item No 1970$2500
- Compare toPrilosecreg
- 42 ct20 mg
Omeprazole (AcidReducer DelayedRelease Dissolvable)Item No 1966$2500
- Compare toPrilosecreg
- 42 ct20 mg
Ranitidine (Acid Reducer)Item No 1900$800
- Compare to Zantacreg
- 30 ct75 mg
Esomeprazole Magnesium(Acid ReducerDelayed Release)Item No 1949$2300
- Compare to Nexiumreg
- 42 ct20 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Antacids amp Acid Reducers continued
TUMSreg Extra Strength TUMSreg Ultra Strength Item No 2034 Item No 2019 $750 $1000
- 48 ct750 mg - 72 ct1000 mg
Anticandidal (yeast)
Clotrimazole (Vaginal Antifungal 7-Day Cream with Applicator) Item No 1115 $800
- Compare to Monistatreg 7 - 45 gm1
Miconazole (Vaginal Antifungal 3-Day Cream with Applicator)) Item No 1117 $1400
- Compare to Monistatreg 3 - 1 kit2
Tioconazole (Vaginal Antifungal 1-Day Cream with Applicator) Item No 1119 $2000
- Compare to Monistatreg 1 - 1 ct65
Anti-diarrheal Laxatives amp Digestive Health
Beanoreg
Item No 1316 $900
- 30 ct
Docusate Sodium (Stool Softener) Item No 1126 $600
- Compare toColacereg
- 100 ct100 mg
Docusate Sodium plus Sennosides (Natural Vegetable Laxative) Item No 1130 $800
- Compare toSenokot-Sreg
- 60 ct86 mg 50 mg
Enema Ex-Laxreg
Item No 1733 Item No 1124 $550 $800
- Compare to Fleetreg
- 45 oz - 8 ct15 mg
7
OTC MEDICATIONS AND HEALTH PRODUCTSTalk with your doctor before starting a new product regimen
Anti-diarrheal Laxatives amp Digestive Health continued
Lactase Capsules Item No 1067 $1000
- Compare toLactaidreg
- 60 ct9000 FCC Units
Laxative Bisacodyl (Stimulant Enteric Coated) Item No 1128 $500
- Compare toDulcolaxreg
- 100 ct5 mg
Laxative MagnesiumCitrate (SalineLemon) Item No 1889 $550
- 296 ml
Laxative Natural Vegetable (Psyllium) Item No 1340 $1000
- Compare toMetamucilreg
- 13 oz
Laxative Calcium Polycarbophil (Fiber Tablets) Item No 1012 $1000
- Compare to FiberConreg
- 90 ct625 mg
Laxative Natural Vegetable (Psyllium) Item No 1967 $1600
- Compare to Metamuc- 304 oz
Laxative ClearLaxreg
Unflavored Powder Item No 1969 $1350
- Compare toMiraLA Xreg
- 83 oz17 g
Laxative Natural VegetabSugar Free (Psyllium) Item No 1968 $1300
ilreg - Compare to Metamucilreg
Sugar-Free - 15 oz
Laxative Glycerin Suppository Item No 1125 $500
- Compare to Fleetreg
- 25 ct2 gm
le Loperamide HCL (Anti-Diarrheal Tablets) Item No 1133 $500
- Compare toImodium A-Dreg
- 12 ct2 mg
Pink Bismuth Liquid Item No 1318 $600
- Compare toPepto-Bismolreg
- 8 oz525 mg 30 ml
Methylcellulose (Fiber Therapy) Item No 1354 $1200
- Compare to Citrucelreg
- 16 oz
Milk of Magnesia Item No 1011 $600
- Compare to Phillipsreg
- 12 oz400 mg
Pepto-Bismolreg Cherry Item No 1317 $1000
- 12 oz525 mg 30 ml
Pink Bismuth Chewable Tablets Item No 1045 $600
- Compare to Pepto-Bismolreg Chewable
- 30 ct262 mg
8
Laxative GlycerinSuppositoryItem No 1125$500
- Compare to Fleetreg
- 25 ct2 gm
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Anti-fungal
Clotrimazole (Athletes Foot Cream) Item No 1047 $600
- Compare toLotriminreg AF
- 15 oz1
Miconazole Nitrate (Anti-fungal Cream) Item No 1135 $800
- Compare to Micatinreg
- 1 oz2
Miconazole Nitrate (Athletes Foot Spray) Item No 1874 $1000
- Compare toLotriminreg AF
- 46 oz2
Terbinafine HCL (Athletes Foot Cream) Item No 1046 $1200
- Compare toLamisilreg AT
- 5 oz1
Tolnaftate (Antishyfungal Cream) Item No 1064 $500
- Compare to Tinactinreg
- 125 oz1
Bathroom Safety amp Fall Prevention
Bath Bench Bath Tub Safety Rail Bed Assist Bar Bath Bench Bath Mat Non-Skid with Back Item No 1730 Item No 2009 without Back Item No 1459 Item No 1728 Item No 1727 $3700 $5500$1700 $6500 $5500 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
Cane Quad Fall Mat Bedside Commode Cane Folding Cane Quad Large Base Small Base Item No 2006 Item No 1984 Ergonomic Handle Item No 1776 Item No 1777 Item No 1726 $6500 $3000 $15000 $2500$2000 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
9
10
Cold amp Flu
Bathroom Safety amp Fall Prevention continued
Gait Belt - 60 Item No 1790 $1600
- 1 ct
Grab Bar Knurled Chrome 12 Item No 1798 $1900
- 1 ct
Grab Bar Knurled Chrome 24 Item No 1797 $2200
- 1 ct
Grab Bar Knurled Chrome 32 Item No 2005 $3600
- 1 ct
Gait Belt - 72 Item No 1791 $1700
- 1 ct
Night Light Item No 1983 $1500
- 2 ct
Safety Treads Tub amp Stair Item No 1780 $1000
- 1 pack
Shower Head Handheld Item No 2007 $2500
- 1 ct
Shower Mat Non-Skid Item No 1460 $1400
- 1 ct
Safety Tread Aids Anti-Slip Item No 1793 $1700
- 1 roll
Slipper Socks One Size Fits Most Item No 2008 $700
- 1 pair
Toilet Seat Raised Item No 1729 $3500
- 1 ct
Toilet Seat Raised with Arms Item No 1950 $6500
- 1 ct
Transfer Bench Adjustable Item No 1764 $8000
- 1 ct
Toilet Safety Rails Item No 1779 $5000
- 1 set
Cough amp Cold for High Blood Pressure Item No 1166 $700
- Compare to Coricidinreg HBP - 16 ct
Cough DropsCherry Item No 1056 $400
- Compare to Hallsreg
- 30 ct58 mg
Cough DropsHoney Lemon Item No 1833 $400
- Compare to Hallsreg
- 30 ct
Cough DropsMenthol Item No 1834 $400
- Compare to Hallsreg
- 30 ct
Cough Drops SugarFree Cherry Item No 1182 $500
- Compare to Hallsreg Sugar Free - 25 ct58 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Grab Bar Knurled Chrome 32Item No 2005$3600
- 1 ct
11
Cough SyrupExpectorant Item No 1054 $500
- Compare toRobitussinreg
- 4 oz200 mg 10 ml
Guaifenesin (CoughExpectorant) Item No 1180 $900
- 100 ct200 mg
Inhaler Personal Steam Item No 1792 $5000
- Vicksreg Personal Steam Inhaler
- 1 ct
Mucus Relief DM Expectorant amp Cough Suppressant Item No 1178 $1200
- Compare to Mucinexreg
- 30 ct400 mg 20 mg
Diabetic Tussinreg DM Item No 1323 $900
- Compare toRobitussinreg
Sugar Free DM - 4 oz
Mucus Relief DM Expectorant amp Cough SuppressantExtended Release Item No 1965 $1600
- Compare to Mucinexreg
- 14 ct1200 mg 60 mg
Nasal Rinse Kit Saline Item No 1931 $1800
- Compare to NeilMedreg
Sinus Rinse - 1 kit
Night Time Cold amp Flu Item No 1361 $600
- Compare toVicks NyQuilreg
- 4 oz125 mg 30 mg 650 mg
Phenylephrine HCL (Nasal Decongestant PE) Item No 1352 $500
- Compare toSudafedreg PE
- 36 ct10 mg
Multi-Symptom Cold Formula Item No 1357 $600
- Compare toTylenolreg Cold Multi-Symptom Daytime
- 24 ct10 mg5 mg 325 mg
Sore Throat Lozenges Cepacolreg
Item No 1360 $550
- 16 ct
Cold amp Flu continued
Sore Throat Lozenges Cherry Item No 1176 $700
- Compare to Cepacolreg
- 18 ct
Sore Throat Spray Cherry Item No 1904 $800
- Compare to Chlorasepticreg
- 6 oz
Vapor Rub Item No 1164 $750
- Compare to Vicks VapoRubreg
- 35 oz47 1
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Abrevareg
Item No 1152 $2600
- 2 gm10
Carmexreg
Item No 1255 $400
- 75 gm
Herpecin-Lreg Lip Balm Item No 1153 $800
- 1 oz1
Releevreg Cold Sore Treatment Item No 1359 $2400
- 6 ml13
Blistexreg Lip Ointment Item No 1256 $500
- 6 gm
Cushion Foam Ring Item No 1732 $2100
- 1 ct
Cushion Lumbar Item No 1731 $2700
- 1 ct
Humidifier Ultra-Sonic Cool Mist Item No 1795 $5800
- Compare to Vicksreg Ultrasonic Humidifier - 1 ct
Cushion Gel Foam Seat Item No 1466 $4000
- 1 ct
Cold Sore amp Medicated Lip Products
Daily Living Aids
Pill Case Weekly AMPM Item No 1934 $1100
- 1 ct
Pill Cutter with Safety Shield Item No 1932 $1000
- 1 ct
Pillow CPAP Fiber Filled Item No 1836 $6000
- 1 ct
Pillow CPAP Memory Foam Item No 1837 $9500
- 1 ct
Pillow Hypoallergenic Item No 1936 $5300
- 1 ct
Pill Crusher with Storage Item No 1933 $1000
- 1 ct
Medical ID Bracelet bull Blank Item No 1875 1 ct
$1650
bull Diabetic Item No 1877 1 ct bull Heart Item No 1876 1 ct
$1500
Medicine Bottle Opener with Magnifier Item No 2017 $1000
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
13
Dental amp Denture Care
Denture Cleaning Tablets Item No 1032 $600
- Compare to Polidentreg
- 40 ct
Efferdentreg Plus Mint Tablets Item No 1653 $800
- 36 ct
Effergripreg Denture Cream Adhesive Item No 1843 $900
- 25 oz
Biotenereg Dry Mouth Oral Rinse Item No 1817 $1400
- 16 oz
Denture Brush Item No 1747 $650
- Compare to G-U-Mreg
- 1 ct
Interdental Flossups Item No 1751 $500
- Compare to G-U-Mreg
- 90 ct
Orajelreg Pain Relief Item No 1454 $1100
- 25 oz20
Oral Pain Relief Item No 1286 $600
- Compareto Orajelreg
- 5 oz20
Polidentreg Overnight Item No 1892 $1250
- 84 ct
Fixodentreg
Item No 1187 $700
- 75 oz
Tongue Cleaner Item No 1746 $600
- 1 ct
Toothbrush Battery Powered Item No 2015 $2000
- 1 ct
Toothbrush Colgatereg Adult Soft Item No 1413 $300
- 1 ct
Reachreg Waxed Dental Floss - Mint Item No 1455 $500
- 55 yd
Polidentreg Denture Cream Item No 1324 $650
- 39 oz
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Toothpaste Crestreg Sensi-Relief Item No 1838 $950
- 41 oz
Toothpaste Fluoride Item No 1914 $550
- 64 oz
Toothpaste Pepsodentreg
Item No 1414 $500
- 55 oz
Toothbrush Tek Proreg Angled Soft Item No 1412 $300
- 1 ct
Toothpaste Colgatereg
Item No 1831 $600
- 4 oz
Toothbrush Rechargeable Item No 1450 $4000
- 1 ct
Toothbrush Soft 2-pack Item No 1948 $600
- 2 ct
Dental amp Denture Care continued
Toothpaste Ultrabritereg
Advanced Whitening Item No 1716 $700
- 6 oz
Toothpaste Sensitive Teeth Item No 1903 $600
- Compare to Sensodynereg
- 43 oz
Water Jet Item No 1744 $4200
- 1 ct
Water Jet Replacement Tips Item No 1743 $1700
- 5 ct
Diabetic Skin Relief Foot Cream Item No 1839 $1200
- Compare to Gold Bondreg
Skin Protectant Foot Cream - 34 oz
Diabetic Socks Black bull Medium Item No 1956 bull Large Item No 1957 bull X-Large Item No 1958 $900
- 3 pair
Diabetic Foot Care
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
15
Diabetic Foot Care continued
Diabetic Socks Ultra Soft Padded Black bull Medium Item No 1959 bull Large Item No 1960 bull X-Large Item No 1961 $1100
- 2 pair
Diabetic Socks Ultra Soft Padded White bull Medium Item No 1962 bull Large Item No 1963 bull X-Large Item No 1964 $1100
- 2 pair
Diabetic Socks White bull Medium Item No 1953 bull Large Item No 1954 bull X-Large Item No 1955 $900
- 3 pair
Bathroom Scale Talking Daggersect
Item No 1981 $5700
- 1 ct
Blood Pressure Monitor Desktop Replacement Cuff Dagger
Item No 1504 $1500
- 1 ct
Blood Pressure Monitor Desktop Talking Dagger
Item No 1503 $5500
- 1 ct
Bathroom Scale Daggersect
Item No 1935 $3500
- 1 ct
Activity Tracker Item No 1982 $5200
- 1 ct
Blood Pressure Monitor Desktop Automatic Dagger
Item No 1253 $5000
- 1 ct
Blood Pressure Monitor Wrist Dagger
Item No 1501 $3500
- 1 ct
Diagnostic Equipment
Blood Pressure Monitor Wrist Talking Dagger
Item No 1502 $4500
- 1 ct
Finger Pulse Oximeter Dagger
Item No 1505 $4200
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
16
Diagnostic Equipment continued
Peak Flow Meter Dagger
Item No 1789 $1700
- 1 ct
Thermometer Digital 60 seconds Item No 1063 $650
- 1 ct
Thermometer Digital Ear Item No 1285 $2700
- 1 ct
Thermometer Flexible Tip Digital 10 seconds Item No 1697 $1000
- 1 ct
Heart Rate Monitor Watch Dagger
Item No 1771 $4000
- 1 ct
Diagnostic Tests Ear Care
Eye Care
Thermometer Talking Ear and Forehead Item No 1925 $4500
- 1 ct
Home Access Cholesterol Test Dagger
Item No 1251 $3000
- 1 kit
Cotton Tipped Swabs Item No 1742 $600
- Compare to Johnson amp Johnsonreg
- 300 ct
EZ Detectreg Colon Cancer Test Kit Dagger
Item No 1416 $1300
- 1 ct
Ear Wax Removal Drops Item No 1190 $500
- Compare to Debroxreg
- 15 ml65
Ear Wax Removal System with Rubber Bulb Item No 1363 $700
- Compare toDebroxreg
- 15 ml65
Ear Pain Relief Ear Drops Item No 1841 $1300
- Compare to Hylands Ear Reliefreg
- 10 ml
Artificial Tears Drops Item No 1192 $600
- Compare toVisine Tearsreg
- 5 oz
Artificial Tears Ointment Item No 1194 $600
- Compare to Refresh PMreg
- 35 gm
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Artificial Tears OintmentItem No 1194$600
- Compare to Refresh PMreg
- 35 gm
17
Eye Care continued
First Aid
Contact Lens Solution Multi-Purpose Item No 1468 $800
- Compare to Renureg
Multipurpose Solution - 12 oz
Eye Drops Clear Eyesreg
Item No 1199 $600
- 2 oz
Eye Drops Irritation Relief Item No 1806 $950
- Compare toVisine ACreg
- 15 ml
Eye Drops Redness Relief Item No 1061 $500
- Compare to Visinereg
Original Redness Relief - 15 ml005
Eye Wash Solution Bausch + Lombreg
Item No 1196 $800
- 4 oz
Antiseptic Skin Cleanser Item No 1808 $1100
- Compare to Hibiclensreg
- 8 oz
Bactinereg Solution Item No 1142 $1000
- 4 oz
Adhesive Bandages Item No 1344 $500
- Compare to Band-Aidreg Plastic Strips
- 60 ct
Alcohol Pads Item No 1200 $550
- 100 ct70
After Bitereg
Relief Item No 1803 $900
- 5 oz
Antiseptic Towelettes Item No 1201 $700
- 100 ct
Bacitracin Ointment Item No 1020 $600
- 1 oz500 U gm
Bandage Elastic - 2 x 45 yd Item No 1207 $400
- Compare to Acereg
- 1 ct
Bandage Elastic - 3 x 5 yd Item No 1209 $400
- Compare to Acereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
OTC MEDICATIONS AND HEALTH PRODUCTSTalk with your doctor before starting a new product regimen
Anti-diarrheal Laxatives amp Digestive Health continued
Lactase Capsules Item No 1067 $1000
- Compare toLactaidreg
- 60 ct9000 FCC Units
Laxative Bisacodyl (Stimulant Enteric Coated) Item No 1128 $500
- Compare toDulcolaxreg
- 100 ct5 mg
Laxative MagnesiumCitrate (SalineLemon) Item No 1889 $550
- 296 ml
Laxative Natural Vegetable (Psyllium) Item No 1340 $1000
- Compare toMetamucilreg
- 13 oz
Laxative Calcium Polycarbophil (Fiber Tablets) Item No 1012 $1000
- Compare to FiberConreg
- 90 ct625 mg
Laxative Natural Vegetable (Psyllium) Item No 1967 $1600
- Compare to Metamuc- 304 oz
Laxative ClearLaxreg
Unflavored Powder Item No 1969 $1350
- Compare toMiraLA Xreg
- 83 oz17 g
Laxative Natural VegetabSugar Free (Psyllium) Item No 1968 $1300
ilreg - Compare to Metamucilreg
Sugar-Free - 15 oz
Laxative Glycerin Suppository Item No 1125 $500
- Compare to Fleetreg
- 25 ct2 gm
le Loperamide HCL (Anti-Diarrheal Tablets) Item No 1133 $500
- Compare toImodium A-Dreg
- 12 ct2 mg
Pink Bismuth Liquid Item No 1318 $600
- Compare toPepto-Bismolreg
- 8 oz525 mg 30 ml
Methylcellulose (Fiber Therapy) Item No 1354 $1200
- Compare to Citrucelreg
- 16 oz
Milk of Magnesia Item No 1011 $600
- Compare to Phillipsreg
- 12 oz400 mg
Pepto-Bismolreg Cherry Item No 1317 $1000
- 12 oz525 mg 30 ml
Pink Bismuth Chewable Tablets Item No 1045 $600
- Compare to Pepto-Bismolreg Chewable
- 30 ct262 mg
8
Laxative GlycerinSuppositoryItem No 1125$500
- Compare to Fleetreg
- 25 ct2 gm
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Anti-fungal
Clotrimazole (Athletes Foot Cream) Item No 1047 $600
- Compare toLotriminreg AF
- 15 oz1
Miconazole Nitrate (Anti-fungal Cream) Item No 1135 $800
- Compare to Micatinreg
- 1 oz2
Miconazole Nitrate (Athletes Foot Spray) Item No 1874 $1000
- Compare toLotriminreg AF
- 46 oz2
Terbinafine HCL (Athletes Foot Cream) Item No 1046 $1200
- Compare toLamisilreg AT
- 5 oz1
Tolnaftate (Antishyfungal Cream) Item No 1064 $500
- Compare to Tinactinreg
- 125 oz1
Bathroom Safety amp Fall Prevention
Bath Bench Bath Tub Safety Rail Bed Assist Bar Bath Bench Bath Mat Non-Skid with Back Item No 1730 Item No 2009 without Back Item No 1459 Item No 1728 Item No 1727 $3700 $5500$1700 $6500 $5500 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
Cane Quad Fall Mat Bedside Commode Cane Folding Cane Quad Large Base Small Base Item No 2006 Item No 1984 Ergonomic Handle Item No 1776 Item No 1777 Item No 1726 $6500 $3000 $15000 $2500$2000 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
9
10
Cold amp Flu
Bathroom Safety amp Fall Prevention continued
Gait Belt - 60 Item No 1790 $1600
- 1 ct
Grab Bar Knurled Chrome 12 Item No 1798 $1900
- 1 ct
Grab Bar Knurled Chrome 24 Item No 1797 $2200
- 1 ct
Grab Bar Knurled Chrome 32 Item No 2005 $3600
- 1 ct
Gait Belt - 72 Item No 1791 $1700
- 1 ct
Night Light Item No 1983 $1500
- 2 ct
Safety Treads Tub amp Stair Item No 1780 $1000
- 1 pack
Shower Head Handheld Item No 2007 $2500
- 1 ct
Shower Mat Non-Skid Item No 1460 $1400
- 1 ct
Safety Tread Aids Anti-Slip Item No 1793 $1700
- 1 roll
Slipper Socks One Size Fits Most Item No 2008 $700
- 1 pair
Toilet Seat Raised Item No 1729 $3500
- 1 ct
Toilet Seat Raised with Arms Item No 1950 $6500
- 1 ct
Transfer Bench Adjustable Item No 1764 $8000
- 1 ct
Toilet Safety Rails Item No 1779 $5000
- 1 set
Cough amp Cold for High Blood Pressure Item No 1166 $700
- Compare to Coricidinreg HBP - 16 ct
Cough DropsCherry Item No 1056 $400
- Compare to Hallsreg
- 30 ct58 mg
Cough DropsHoney Lemon Item No 1833 $400
- Compare to Hallsreg
- 30 ct
Cough DropsMenthol Item No 1834 $400
- Compare to Hallsreg
- 30 ct
Cough Drops SugarFree Cherry Item No 1182 $500
- Compare to Hallsreg Sugar Free - 25 ct58 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Grab Bar Knurled Chrome 32Item No 2005$3600
- 1 ct
11
Cough SyrupExpectorant Item No 1054 $500
- Compare toRobitussinreg
- 4 oz200 mg 10 ml
Guaifenesin (CoughExpectorant) Item No 1180 $900
- 100 ct200 mg
Inhaler Personal Steam Item No 1792 $5000
- Vicksreg Personal Steam Inhaler
- 1 ct
Mucus Relief DM Expectorant amp Cough Suppressant Item No 1178 $1200
- Compare to Mucinexreg
- 30 ct400 mg 20 mg
Diabetic Tussinreg DM Item No 1323 $900
- Compare toRobitussinreg
Sugar Free DM - 4 oz
Mucus Relief DM Expectorant amp Cough SuppressantExtended Release Item No 1965 $1600
- Compare to Mucinexreg
- 14 ct1200 mg 60 mg
Nasal Rinse Kit Saline Item No 1931 $1800
- Compare to NeilMedreg
Sinus Rinse - 1 kit
Night Time Cold amp Flu Item No 1361 $600
- Compare toVicks NyQuilreg
- 4 oz125 mg 30 mg 650 mg
Phenylephrine HCL (Nasal Decongestant PE) Item No 1352 $500
- Compare toSudafedreg PE
- 36 ct10 mg
Multi-Symptom Cold Formula Item No 1357 $600
- Compare toTylenolreg Cold Multi-Symptom Daytime
- 24 ct10 mg5 mg 325 mg
Sore Throat Lozenges Cepacolreg
Item No 1360 $550
- 16 ct
Cold amp Flu continued
Sore Throat Lozenges Cherry Item No 1176 $700
- Compare to Cepacolreg
- 18 ct
Sore Throat Spray Cherry Item No 1904 $800
- Compare to Chlorasepticreg
- 6 oz
Vapor Rub Item No 1164 $750
- Compare to Vicks VapoRubreg
- 35 oz47 1
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Abrevareg
Item No 1152 $2600
- 2 gm10
Carmexreg
Item No 1255 $400
- 75 gm
Herpecin-Lreg Lip Balm Item No 1153 $800
- 1 oz1
Releevreg Cold Sore Treatment Item No 1359 $2400
- 6 ml13
Blistexreg Lip Ointment Item No 1256 $500
- 6 gm
Cushion Foam Ring Item No 1732 $2100
- 1 ct
Cushion Lumbar Item No 1731 $2700
- 1 ct
Humidifier Ultra-Sonic Cool Mist Item No 1795 $5800
- Compare to Vicksreg Ultrasonic Humidifier - 1 ct
Cushion Gel Foam Seat Item No 1466 $4000
- 1 ct
Cold Sore amp Medicated Lip Products
Daily Living Aids
Pill Case Weekly AMPM Item No 1934 $1100
- 1 ct
Pill Cutter with Safety Shield Item No 1932 $1000
- 1 ct
Pillow CPAP Fiber Filled Item No 1836 $6000
- 1 ct
Pillow CPAP Memory Foam Item No 1837 $9500
- 1 ct
Pillow Hypoallergenic Item No 1936 $5300
- 1 ct
Pill Crusher with Storage Item No 1933 $1000
- 1 ct
Medical ID Bracelet bull Blank Item No 1875 1 ct
$1650
bull Diabetic Item No 1877 1 ct bull Heart Item No 1876 1 ct
$1500
Medicine Bottle Opener with Magnifier Item No 2017 $1000
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
13
Dental amp Denture Care
Denture Cleaning Tablets Item No 1032 $600
- Compare to Polidentreg
- 40 ct
Efferdentreg Plus Mint Tablets Item No 1653 $800
- 36 ct
Effergripreg Denture Cream Adhesive Item No 1843 $900
- 25 oz
Biotenereg Dry Mouth Oral Rinse Item No 1817 $1400
- 16 oz
Denture Brush Item No 1747 $650
- Compare to G-U-Mreg
- 1 ct
Interdental Flossups Item No 1751 $500
- Compare to G-U-Mreg
- 90 ct
Orajelreg Pain Relief Item No 1454 $1100
- 25 oz20
Oral Pain Relief Item No 1286 $600
- Compareto Orajelreg
- 5 oz20
Polidentreg Overnight Item No 1892 $1250
- 84 ct
Fixodentreg
Item No 1187 $700
- 75 oz
Tongue Cleaner Item No 1746 $600
- 1 ct
Toothbrush Battery Powered Item No 2015 $2000
- 1 ct
Toothbrush Colgatereg Adult Soft Item No 1413 $300
- 1 ct
Reachreg Waxed Dental Floss - Mint Item No 1455 $500
- 55 yd
Polidentreg Denture Cream Item No 1324 $650
- 39 oz
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Toothpaste Crestreg Sensi-Relief Item No 1838 $950
- 41 oz
Toothpaste Fluoride Item No 1914 $550
- 64 oz
Toothpaste Pepsodentreg
Item No 1414 $500
- 55 oz
Toothbrush Tek Proreg Angled Soft Item No 1412 $300
- 1 ct
Toothpaste Colgatereg
Item No 1831 $600
- 4 oz
Toothbrush Rechargeable Item No 1450 $4000
- 1 ct
Toothbrush Soft 2-pack Item No 1948 $600
- 2 ct
Dental amp Denture Care continued
Toothpaste Ultrabritereg
Advanced Whitening Item No 1716 $700
- 6 oz
Toothpaste Sensitive Teeth Item No 1903 $600
- Compare to Sensodynereg
- 43 oz
Water Jet Item No 1744 $4200
- 1 ct
Water Jet Replacement Tips Item No 1743 $1700
- 5 ct
Diabetic Skin Relief Foot Cream Item No 1839 $1200
- Compare to Gold Bondreg
Skin Protectant Foot Cream - 34 oz
Diabetic Socks Black bull Medium Item No 1956 bull Large Item No 1957 bull X-Large Item No 1958 $900
- 3 pair
Diabetic Foot Care
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
15
Diabetic Foot Care continued
Diabetic Socks Ultra Soft Padded Black bull Medium Item No 1959 bull Large Item No 1960 bull X-Large Item No 1961 $1100
- 2 pair
Diabetic Socks Ultra Soft Padded White bull Medium Item No 1962 bull Large Item No 1963 bull X-Large Item No 1964 $1100
- 2 pair
Diabetic Socks White bull Medium Item No 1953 bull Large Item No 1954 bull X-Large Item No 1955 $900
- 3 pair
Bathroom Scale Talking Daggersect
Item No 1981 $5700
- 1 ct
Blood Pressure Monitor Desktop Replacement Cuff Dagger
Item No 1504 $1500
- 1 ct
Blood Pressure Monitor Desktop Talking Dagger
Item No 1503 $5500
- 1 ct
Bathroom Scale Daggersect
Item No 1935 $3500
- 1 ct
Activity Tracker Item No 1982 $5200
- 1 ct
Blood Pressure Monitor Desktop Automatic Dagger
Item No 1253 $5000
- 1 ct
Blood Pressure Monitor Wrist Dagger
Item No 1501 $3500
- 1 ct
Diagnostic Equipment
Blood Pressure Monitor Wrist Talking Dagger
Item No 1502 $4500
- 1 ct
Finger Pulse Oximeter Dagger
Item No 1505 $4200
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
16
Diagnostic Equipment continued
Peak Flow Meter Dagger
Item No 1789 $1700
- 1 ct
Thermometer Digital 60 seconds Item No 1063 $650
- 1 ct
Thermometer Digital Ear Item No 1285 $2700
- 1 ct
Thermometer Flexible Tip Digital 10 seconds Item No 1697 $1000
- 1 ct
Heart Rate Monitor Watch Dagger
Item No 1771 $4000
- 1 ct
Diagnostic Tests Ear Care
Eye Care
Thermometer Talking Ear and Forehead Item No 1925 $4500
- 1 ct
Home Access Cholesterol Test Dagger
Item No 1251 $3000
- 1 kit
Cotton Tipped Swabs Item No 1742 $600
- Compare to Johnson amp Johnsonreg
- 300 ct
EZ Detectreg Colon Cancer Test Kit Dagger
Item No 1416 $1300
- 1 ct
Ear Wax Removal Drops Item No 1190 $500
- Compare to Debroxreg
- 15 ml65
Ear Wax Removal System with Rubber Bulb Item No 1363 $700
- Compare toDebroxreg
- 15 ml65
Ear Pain Relief Ear Drops Item No 1841 $1300
- Compare to Hylands Ear Reliefreg
- 10 ml
Artificial Tears Drops Item No 1192 $600
- Compare toVisine Tearsreg
- 5 oz
Artificial Tears Ointment Item No 1194 $600
- Compare to Refresh PMreg
- 35 gm
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Artificial Tears OintmentItem No 1194$600
- Compare to Refresh PMreg
- 35 gm
17
Eye Care continued
First Aid
Contact Lens Solution Multi-Purpose Item No 1468 $800
- Compare to Renureg
Multipurpose Solution - 12 oz
Eye Drops Clear Eyesreg
Item No 1199 $600
- 2 oz
Eye Drops Irritation Relief Item No 1806 $950
- Compare toVisine ACreg
- 15 ml
Eye Drops Redness Relief Item No 1061 $500
- Compare to Visinereg
Original Redness Relief - 15 ml005
Eye Wash Solution Bausch + Lombreg
Item No 1196 $800
- 4 oz
Antiseptic Skin Cleanser Item No 1808 $1100
- Compare to Hibiclensreg
- 8 oz
Bactinereg Solution Item No 1142 $1000
- 4 oz
Adhesive Bandages Item No 1344 $500
- Compare to Band-Aidreg Plastic Strips
- 60 ct
Alcohol Pads Item No 1200 $550
- 100 ct70
After Bitereg
Relief Item No 1803 $900
- 5 oz
Antiseptic Towelettes Item No 1201 $700
- 100 ct
Bacitracin Ointment Item No 1020 $600
- 1 oz500 U gm
Bandage Elastic - 2 x 45 yd Item No 1207 $400
- Compare to Acereg
- 1 ct
Bandage Elastic - 3 x 5 yd Item No 1209 $400
- Compare to Acereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
Laxative GlycerinSuppositoryItem No 1125$500
- Compare to Fleetreg
- 25 ct2 gm
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Anti-fungal
Clotrimazole (Athletes Foot Cream) Item No 1047 $600
- Compare toLotriminreg AF
- 15 oz1
Miconazole Nitrate (Anti-fungal Cream) Item No 1135 $800
- Compare to Micatinreg
- 1 oz2
Miconazole Nitrate (Athletes Foot Spray) Item No 1874 $1000
- Compare toLotriminreg AF
- 46 oz2
Terbinafine HCL (Athletes Foot Cream) Item No 1046 $1200
- Compare toLamisilreg AT
- 5 oz1
Tolnaftate (Antishyfungal Cream) Item No 1064 $500
- Compare to Tinactinreg
- 125 oz1
Bathroom Safety amp Fall Prevention
Bath Bench Bath Tub Safety Rail Bed Assist Bar Bath Bench Bath Mat Non-Skid with Back Item No 1730 Item No 2009 without Back Item No 1459 Item No 1728 Item No 1727 $3700 $5500$1700 $6500 $5500 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
Cane Quad Fall Mat Bedside Commode Cane Folding Cane Quad Large Base Small Base Item No 2006 Item No 1984 Ergonomic Handle Item No 1776 Item No 1777 Item No 1726 $6500 $3000 $15000 $2500$2000 - 1 ct - 1 ct - 1 ct - 1 ct - 1 ct
9
10
Cold amp Flu
Bathroom Safety amp Fall Prevention continued
Gait Belt - 60 Item No 1790 $1600
- 1 ct
Grab Bar Knurled Chrome 12 Item No 1798 $1900
- 1 ct
Grab Bar Knurled Chrome 24 Item No 1797 $2200
- 1 ct
Grab Bar Knurled Chrome 32 Item No 2005 $3600
- 1 ct
Gait Belt - 72 Item No 1791 $1700
- 1 ct
Night Light Item No 1983 $1500
- 2 ct
Safety Treads Tub amp Stair Item No 1780 $1000
- 1 pack
Shower Head Handheld Item No 2007 $2500
- 1 ct
Shower Mat Non-Skid Item No 1460 $1400
- 1 ct
Safety Tread Aids Anti-Slip Item No 1793 $1700
- 1 roll
Slipper Socks One Size Fits Most Item No 2008 $700
- 1 pair
Toilet Seat Raised Item No 1729 $3500
- 1 ct
Toilet Seat Raised with Arms Item No 1950 $6500
- 1 ct
Transfer Bench Adjustable Item No 1764 $8000
- 1 ct
Toilet Safety Rails Item No 1779 $5000
- 1 set
Cough amp Cold for High Blood Pressure Item No 1166 $700
- Compare to Coricidinreg HBP - 16 ct
Cough DropsCherry Item No 1056 $400
- Compare to Hallsreg
- 30 ct58 mg
Cough DropsHoney Lemon Item No 1833 $400
- Compare to Hallsreg
- 30 ct
Cough DropsMenthol Item No 1834 $400
- Compare to Hallsreg
- 30 ct
Cough Drops SugarFree Cherry Item No 1182 $500
- Compare to Hallsreg Sugar Free - 25 ct58 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Grab Bar Knurled Chrome 32Item No 2005$3600
- 1 ct
11
Cough SyrupExpectorant Item No 1054 $500
- Compare toRobitussinreg
- 4 oz200 mg 10 ml
Guaifenesin (CoughExpectorant) Item No 1180 $900
- 100 ct200 mg
Inhaler Personal Steam Item No 1792 $5000
- Vicksreg Personal Steam Inhaler
- 1 ct
Mucus Relief DM Expectorant amp Cough Suppressant Item No 1178 $1200
- Compare to Mucinexreg
- 30 ct400 mg 20 mg
Diabetic Tussinreg DM Item No 1323 $900
- Compare toRobitussinreg
Sugar Free DM - 4 oz
Mucus Relief DM Expectorant amp Cough SuppressantExtended Release Item No 1965 $1600
- Compare to Mucinexreg
- 14 ct1200 mg 60 mg
Nasal Rinse Kit Saline Item No 1931 $1800
- Compare to NeilMedreg
Sinus Rinse - 1 kit
Night Time Cold amp Flu Item No 1361 $600
- Compare toVicks NyQuilreg
- 4 oz125 mg 30 mg 650 mg
Phenylephrine HCL (Nasal Decongestant PE) Item No 1352 $500
- Compare toSudafedreg PE
- 36 ct10 mg
Multi-Symptom Cold Formula Item No 1357 $600
- Compare toTylenolreg Cold Multi-Symptom Daytime
- 24 ct10 mg5 mg 325 mg
Sore Throat Lozenges Cepacolreg
Item No 1360 $550
- 16 ct
Cold amp Flu continued
Sore Throat Lozenges Cherry Item No 1176 $700
- Compare to Cepacolreg
- 18 ct
Sore Throat Spray Cherry Item No 1904 $800
- Compare to Chlorasepticreg
- 6 oz
Vapor Rub Item No 1164 $750
- Compare to Vicks VapoRubreg
- 35 oz47 1
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Abrevareg
Item No 1152 $2600
- 2 gm10
Carmexreg
Item No 1255 $400
- 75 gm
Herpecin-Lreg Lip Balm Item No 1153 $800
- 1 oz1
Releevreg Cold Sore Treatment Item No 1359 $2400
- 6 ml13
Blistexreg Lip Ointment Item No 1256 $500
- 6 gm
Cushion Foam Ring Item No 1732 $2100
- 1 ct
Cushion Lumbar Item No 1731 $2700
- 1 ct
Humidifier Ultra-Sonic Cool Mist Item No 1795 $5800
- Compare to Vicksreg Ultrasonic Humidifier - 1 ct
Cushion Gel Foam Seat Item No 1466 $4000
- 1 ct
Cold Sore amp Medicated Lip Products
Daily Living Aids
Pill Case Weekly AMPM Item No 1934 $1100
- 1 ct
Pill Cutter with Safety Shield Item No 1932 $1000
- 1 ct
Pillow CPAP Fiber Filled Item No 1836 $6000
- 1 ct
Pillow CPAP Memory Foam Item No 1837 $9500
- 1 ct
Pillow Hypoallergenic Item No 1936 $5300
- 1 ct
Pill Crusher with Storage Item No 1933 $1000
- 1 ct
Medical ID Bracelet bull Blank Item No 1875 1 ct
$1650
bull Diabetic Item No 1877 1 ct bull Heart Item No 1876 1 ct
$1500
Medicine Bottle Opener with Magnifier Item No 2017 $1000
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
13
Dental amp Denture Care
Denture Cleaning Tablets Item No 1032 $600
- Compare to Polidentreg
- 40 ct
Efferdentreg Plus Mint Tablets Item No 1653 $800
- 36 ct
Effergripreg Denture Cream Adhesive Item No 1843 $900
- 25 oz
Biotenereg Dry Mouth Oral Rinse Item No 1817 $1400
- 16 oz
Denture Brush Item No 1747 $650
- Compare to G-U-Mreg
- 1 ct
Interdental Flossups Item No 1751 $500
- Compare to G-U-Mreg
- 90 ct
Orajelreg Pain Relief Item No 1454 $1100
- 25 oz20
Oral Pain Relief Item No 1286 $600
- Compareto Orajelreg
- 5 oz20
Polidentreg Overnight Item No 1892 $1250
- 84 ct
Fixodentreg
Item No 1187 $700
- 75 oz
Tongue Cleaner Item No 1746 $600
- 1 ct
Toothbrush Battery Powered Item No 2015 $2000
- 1 ct
Toothbrush Colgatereg Adult Soft Item No 1413 $300
- 1 ct
Reachreg Waxed Dental Floss - Mint Item No 1455 $500
- 55 yd
Polidentreg Denture Cream Item No 1324 $650
- 39 oz
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Toothpaste Crestreg Sensi-Relief Item No 1838 $950
- 41 oz
Toothpaste Fluoride Item No 1914 $550
- 64 oz
Toothpaste Pepsodentreg
Item No 1414 $500
- 55 oz
Toothbrush Tek Proreg Angled Soft Item No 1412 $300
- 1 ct
Toothpaste Colgatereg
Item No 1831 $600
- 4 oz
Toothbrush Rechargeable Item No 1450 $4000
- 1 ct
Toothbrush Soft 2-pack Item No 1948 $600
- 2 ct
Dental amp Denture Care continued
Toothpaste Ultrabritereg
Advanced Whitening Item No 1716 $700
- 6 oz
Toothpaste Sensitive Teeth Item No 1903 $600
- Compare to Sensodynereg
- 43 oz
Water Jet Item No 1744 $4200
- 1 ct
Water Jet Replacement Tips Item No 1743 $1700
- 5 ct
Diabetic Skin Relief Foot Cream Item No 1839 $1200
- Compare to Gold Bondreg
Skin Protectant Foot Cream - 34 oz
Diabetic Socks Black bull Medium Item No 1956 bull Large Item No 1957 bull X-Large Item No 1958 $900
- 3 pair
Diabetic Foot Care
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
15
Diabetic Foot Care continued
Diabetic Socks Ultra Soft Padded Black bull Medium Item No 1959 bull Large Item No 1960 bull X-Large Item No 1961 $1100
- 2 pair
Diabetic Socks Ultra Soft Padded White bull Medium Item No 1962 bull Large Item No 1963 bull X-Large Item No 1964 $1100
- 2 pair
Diabetic Socks White bull Medium Item No 1953 bull Large Item No 1954 bull X-Large Item No 1955 $900
- 3 pair
Bathroom Scale Talking Daggersect
Item No 1981 $5700
- 1 ct
Blood Pressure Monitor Desktop Replacement Cuff Dagger
Item No 1504 $1500
- 1 ct
Blood Pressure Monitor Desktop Talking Dagger
Item No 1503 $5500
- 1 ct
Bathroom Scale Daggersect
Item No 1935 $3500
- 1 ct
Activity Tracker Item No 1982 $5200
- 1 ct
Blood Pressure Monitor Desktop Automatic Dagger
Item No 1253 $5000
- 1 ct
Blood Pressure Monitor Wrist Dagger
Item No 1501 $3500
- 1 ct
Diagnostic Equipment
Blood Pressure Monitor Wrist Talking Dagger
Item No 1502 $4500
- 1 ct
Finger Pulse Oximeter Dagger
Item No 1505 $4200
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
16
Diagnostic Equipment continued
Peak Flow Meter Dagger
Item No 1789 $1700
- 1 ct
Thermometer Digital 60 seconds Item No 1063 $650
- 1 ct
Thermometer Digital Ear Item No 1285 $2700
- 1 ct
Thermometer Flexible Tip Digital 10 seconds Item No 1697 $1000
- 1 ct
Heart Rate Monitor Watch Dagger
Item No 1771 $4000
- 1 ct
Diagnostic Tests Ear Care
Eye Care
Thermometer Talking Ear and Forehead Item No 1925 $4500
- 1 ct
Home Access Cholesterol Test Dagger
Item No 1251 $3000
- 1 kit
Cotton Tipped Swabs Item No 1742 $600
- Compare to Johnson amp Johnsonreg
- 300 ct
EZ Detectreg Colon Cancer Test Kit Dagger
Item No 1416 $1300
- 1 ct
Ear Wax Removal Drops Item No 1190 $500
- Compare to Debroxreg
- 15 ml65
Ear Wax Removal System with Rubber Bulb Item No 1363 $700
- Compare toDebroxreg
- 15 ml65
Ear Pain Relief Ear Drops Item No 1841 $1300
- Compare to Hylands Ear Reliefreg
- 10 ml
Artificial Tears Drops Item No 1192 $600
- Compare toVisine Tearsreg
- 5 oz
Artificial Tears Ointment Item No 1194 $600
- Compare to Refresh PMreg
- 35 gm
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Artificial Tears OintmentItem No 1194$600
- Compare to Refresh PMreg
- 35 gm
17
Eye Care continued
First Aid
Contact Lens Solution Multi-Purpose Item No 1468 $800
- Compare to Renureg
Multipurpose Solution - 12 oz
Eye Drops Clear Eyesreg
Item No 1199 $600
- 2 oz
Eye Drops Irritation Relief Item No 1806 $950
- Compare toVisine ACreg
- 15 ml
Eye Drops Redness Relief Item No 1061 $500
- Compare to Visinereg
Original Redness Relief - 15 ml005
Eye Wash Solution Bausch + Lombreg
Item No 1196 $800
- 4 oz
Antiseptic Skin Cleanser Item No 1808 $1100
- Compare to Hibiclensreg
- 8 oz
Bactinereg Solution Item No 1142 $1000
- 4 oz
Adhesive Bandages Item No 1344 $500
- Compare to Band-Aidreg Plastic Strips
- 60 ct
Alcohol Pads Item No 1200 $550
- 100 ct70
After Bitereg
Relief Item No 1803 $900
- 5 oz
Antiseptic Towelettes Item No 1201 $700
- 100 ct
Bacitracin Ointment Item No 1020 $600
- 1 oz500 U gm
Bandage Elastic - 2 x 45 yd Item No 1207 $400
- Compare to Acereg
- 1 ct
Bandage Elastic - 3 x 5 yd Item No 1209 $400
- Compare to Acereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
10
Cold amp Flu
Bathroom Safety amp Fall Prevention continued
Gait Belt - 60 Item No 1790 $1600
- 1 ct
Grab Bar Knurled Chrome 12 Item No 1798 $1900
- 1 ct
Grab Bar Knurled Chrome 24 Item No 1797 $2200
- 1 ct
Grab Bar Knurled Chrome 32 Item No 2005 $3600
- 1 ct
Gait Belt - 72 Item No 1791 $1700
- 1 ct
Night Light Item No 1983 $1500
- 2 ct
Safety Treads Tub amp Stair Item No 1780 $1000
- 1 pack
Shower Head Handheld Item No 2007 $2500
- 1 ct
Shower Mat Non-Skid Item No 1460 $1400
- 1 ct
Safety Tread Aids Anti-Slip Item No 1793 $1700
- 1 roll
Slipper Socks One Size Fits Most Item No 2008 $700
- 1 pair
Toilet Seat Raised Item No 1729 $3500
- 1 ct
Toilet Seat Raised with Arms Item No 1950 $6500
- 1 ct
Transfer Bench Adjustable Item No 1764 $8000
- 1 ct
Toilet Safety Rails Item No 1779 $5000
- 1 set
Cough amp Cold for High Blood Pressure Item No 1166 $700
- Compare to Coricidinreg HBP - 16 ct
Cough DropsCherry Item No 1056 $400
- Compare to Hallsreg
- 30 ct58 mg
Cough DropsHoney Lemon Item No 1833 $400
- Compare to Hallsreg
- 30 ct
Cough DropsMenthol Item No 1834 $400
- Compare to Hallsreg
- 30 ct
Cough Drops SugarFree Cherry Item No 1182 $500
- Compare to Hallsreg Sugar Free - 25 ct58 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Grab Bar Knurled Chrome 32Item No 2005$3600
- 1 ct
11
Cough SyrupExpectorant Item No 1054 $500
- Compare toRobitussinreg
- 4 oz200 mg 10 ml
Guaifenesin (CoughExpectorant) Item No 1180 $900
- 100 ct200 mg
Inhaler Personal Steam Item No 1792 $5000
- Vicksreg Personal Steam Inhaler
- 1 ct
Mucus Relief DM Expectorant amp Cough Suppressant Item No 1178 $1200
- Compare to Mucinexreg
- 30 ct400 mg 20 mg
Diabetic Tussinreg DM Item No 1323 $900
- Compare toRobitussinreg
Sugar Free DM - 4 oz
Mucus Relief DM Expectorant amp Cough SuppressantExtended Release Item No 1965 $1600
- Compare to Mucinexreg
- 14 ct1200 mg 60 mg
Nasal Rinse Kit Saline Item No 1931 $1800
- Compare to NeilMedreg
Sinus Rinse - 1 kit
Night Time Cold amp Flu Item No 1361 $600
- Compare toVicks NyQuilreg
- 4 oz125 mg 30 mg 650 mg
Phenylephrine HCL (Nasal Decongestant PE) Item No 1352 $500
- Compare toSudafedreg PE
- 36 ct10 mg
Multi-Symptom Cold Formula Item No 1357 $600
- Compare toTylenolreg Cold Multi-Symptom Daytime
- 24 ct10 mg5 mg 325 mg
Sore Throat Lozenges Cepacolreg
Item No 1360 $550
- 16 ct
Cold amp Flu continued
Sore Throat Lozenges Cherry Item No 1176 $700
- Compare to Cepacolreg
- 18 ct
Sore Throat Spray Cherry Item No 1904 $800
- Compare to Chlorasepticreg
- 6 oz
Vapor Rub Item No 1164 $750
- Compare to Vicks VapoRubreg
- 35 oz47 1
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Abrevareg
Item No 1152 $2600
- 2 gm10
Carmexreg
Item No 1255 $400
- 75 gm
Herpecin-Lreg Lip Balm Item No 1153 $800
- 1 oz1
Releevreg Cold Sore Treatment Item No 1359 $2400
- 6 ml13
Blistexreg Lip Ointment Item No 1256 $500
- 6 gm
Cushion Foam Ring Item No 1732 $2100
- 1 ct
Cushion Lumbar Item No 1731 $2700
- 1 ct
Humidifier Ultra-Sonic Cool Mist Item No 1795 $5800
- Compare to Vicksreg Ultrasonic Humidifier - 1 ct
Cushion Gel Foam Seat Item No 1466 $4000
- 1 ct
Cold Sore amp Medicated Lip Products
Daily Living Aids
Pill Case Weekly AMPM Item No 1934 $1100
- 1 ct
Pill Cutter with Safety Shield Item No 1932 $1000
- 1 ct
Pillow CPAP Fiber Filled Item No 1836 $6000
- 1 ct
Pillow CPAP Memory Foam Item No 1837 $9500
- 1 ct
Pillow Hypoallergenic Item No 1936 $5300
- 1 ct
Pill Crusher with Storage Item No 1933 $1000
- 1 ct
Medical ID Bracelet bull Blank Item No 1875 1 ct
$1650
bull Diabetic Item No 1877 1 ct bull Heart Item No 1876 1 ct
$1500
Medicine Bottle Opener with Magnifier Item No 2017 $1000
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
13
Dental amp Denture Care
Denture Cleaning Tablets Item No 1032 $600
- Compare to Polidentreg
- 40 ct
Efferdentreg Plus Mint Tablets Item No 1653 $800
- 36 ct
Effergripreg Denture Cream Adhesive Item No 1843 $900
- 25 oz
Biotenereg Dry Mouth Oral Rinse Item No 1817 $1400
- 16 oz
Denture Brush Item No 1747 $650
- Compare to G-U-Mreg
- 1 ct
Interdental Flossups Item No 1751 $500
- Compare to G-U-Mreg
- 90 ct
Orajelreg Pain Relief Item No 1454 $1100
- 25 oz20
Oral Pain Relief Item No 1286 $600
- Compareto Orajelreg
- 5 oz20
Polidentreg Overnight Item No 1892 $1250
- 84 ct
Fixodentreg
Item No 1187 $700
- 75 oz
Tongue Cleaner Item No 1746 $600
- 1 ct
Toothbrush Battery Powered Item No 2015 $2000
- 1 ct
Toothbrush Colgatereg Adult Soft Item No 1413 $300
- 1 ct
Reachreg Waxed Dental Floss - Mint Item No 1455 $500
- 55 yd
Polidentreg Denture Cream Item No 1324 $650
- 39 oz
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Toothpaste Crestreg Sensi-Relief Item No 1838 $950
- 41 oz
Toothpaste Fluoride Item No 1914 $550
- 64 oz
Toothpaste Pepsodentreg
Item No 1414 $500
- 55 oz
Toothbrush Tek Proreg Angled Soft Item No 1412 $300
- 1 ct
Toothpaste Colgatereg
Item No 1831 $600
- 4 oz
Toothbrush Rechargeable Item No 1450 $4000
- 1 ct
Toothbrush Soft 2-pack Item No 1948 $600
- 2 ct
Dental amp Denture Care continued
Toothpaste Ultrabritereg
Advanced Whitening Item No 1716 $700
- 6 oz
Toothpaste Sensitive Teeth Item No 1903 $600
- Compare to Sensodynereg
- 43 oz
Water Jet Item No 1744 $4200
- 1 ct
Water Jet Replacement Tips Item No 1743 $1700
- 5 ct
Diabetic Skin Relief Foot Cream Item No 1839 $1200
- Compare to Gold Bondreg
Skin Protectant Foot Cream - 34 oz
Diabetic Socks Black bull Medium Item No 1956 bull Large Item No 1957 bull X-Large Item No 1958 $900
- 3 pair
Diabetic Foot Care
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
15
Diabetic Foot Care continued
Diabetic Socks Ultra Soft Padded Black bull Medium Item No 1959 bull Large Item No 1960 bull X-Large Item No 1961 $1100
- 2 pair
Diabetic Socks Ultra Soft Padded White bull Medium Item No 1962 bull Large Item No 1963 bull X-Large Item No 1964 $1100
- 2 pair
Diabetic Socks White bull Medium Item No 1953 bull Large Item No 1954 bull X-Large Item No 1955 $900
- 3 pair
Bathroom Scale Talking Daggersect
Item No 1981 $5700
- 1 ct
Blood Pressure Monitor Desktop Replacement Cuff Dagger
Item No 1504 $1500
- 1 ct
Blood Pressure Monitor Desktop Talking Dagger
Item No 1503 $5500
- 1 ct
Bathroom Scale Daggersect
Item No 1935 $3500
- 1 ct
Activity Tracker Item No 1982 $5200
- 1 ct
Blood Pressure Monitor Desktop Automatic Dagger
Item No 1253 $5000
- 1 ct
Blood Pressure Monitor Wrist Dagger
Item No 1501 $3500
- 1 ct
Diagnostic Equipment
Blood Pressure Monitor Wrist Talking Dagger
Item No 1502 $4500
- 1 ct
Finger Pulse Oximeter Dagger
Item No 1505 $4200
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
16
Diagnostic Equipment continued
Peak Flow Meter Dagger
Item No 1789 $1700
- 1 ct
Thermometer Digital 60 seconds Item No 1063 $650
- 1 ct
Thermometer Digital Ear Item No 1285 $2700
- 1 ct
Thermometer Flexible Tip Digital 10 seconds Item No 1697 $1000
- 1 ct
Heart Rate Monitor Watch Dagger
Item No 1771 $4000
- 1 ct
Diagnostic Tests Ear Care
Eye Care
Thermometer Talking Ear and Forehead Item No 1925 $4500
- 1 ct
Home Access Cholesterol Test Dagger
Item No 1251 $3000
- 1 kit
Cotton Tipped Swabs Item No 1742 $600
- Compare to Johnson amp Johnsonreg
- 300 ct
EZ Detectreg Colon Cancer Test Kit Dagger
Item No 1416 $1300
- 1 ct
Ear Wax Removal Drops Item No 1190 $500
- Compare to Debroxreg
- 15 ml65
Ear Wax Removal System with Rubber Bulb Item No 1363 $700
- Compare toDebroxreg
- 15 ml65
Ear Pain Relief Ear Drops Item No 1841 $1300
- Compare to Hylands Ear Reliefreg
- 10 ml
Artificial Tears Drops Item No 1192 $600
- Compare toVisine Tearsreg
- 5 oz
Artificial Tears Ointment Item No 1194 $600
- Compare to Refresh PMreg
- 35 gm
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Artificial Tears OintmentItem No 1194$600
- Compare to Refresh PMreg
- 35 gm
17
Eye Care continued
First Aid
Contact Lens Solution Multi-Purpose Item No 1468 $800
- Compare to Renureg
Multipurpose Solution - 12 oz
Eye Drops Clear Eyesreg
Item No 1199 $600
- 2 oz
Eye Drops Irritation Relief Item No 1806 $950
- Compare toVisine ACreg
- 15 ml
Eye Drops Redness Relief Item No 1061 $500
- Compare to Visinereg
Original Redness Relief - 15 ml005
Eye Wash Solution Bausch + Lombreg
Item No 1196 $800
- 4 oz
Antiseptic Skin Cleanser Item No 1808 $1100
- Compare to Hibiclensreg
- 8 oz
Bactinereg Solution Item No 1142 $1000
- 4 oz
Adhesive Bandages Item No 1344 $500
- Compare to Band-Aidreg Plastic Strips
- 60 ct
Alcohol Pads Item No 1200 $550
- 100 ct70
After Bitereg
Relief Item No 1803 $900
- 5 oz
Antiseptic Towelettes Item No 1201 $700
- 100 ct
Bacitracin Ointment Item No 1020 $600
- 1 oz500 U gm
Bandage Elastic - 2 x 45 yd Item No 1207 $400
- Compare to Acereg
- 1 ct
Bandage Elastic - 3 x 5 yd Item No 1209 $400
- Compare to Acereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
Grab Bar Knurled Chrome 32Item No 2005$3600
- 1 ct
11
Cough SyrupExpectorant Item No 1054 $500
- Compare toRobitussinreg
- 4 oz200 mg 10 ml
Guaifenesin (CoughExpectorant) Item No 1180 $900
- 100 ct200 mg
Inhaler Personal Steam Item No 1792 $5000
- Vicksreg Personal Steam Inhaler
- 1 ct
Mucus Relief DM Expectorant amp Cough Suppressant Item No 1178 $1200
- Compare to Mucinexreg
- 30 ct400 mg 20 mg
Diabetic Tussinreg DM Item No 1323 $900
- Compare toRobitussinreg
Sugar Free DM - 4 oz
Mucus Relief DM Expectorant amp Cough SuppressantExtended Release Item No 1965 $1600
- Compare to Mucinexreg
- 14 ct1200 mg 60 mg
Nasal Rinse Kit Saline Item No 1931 $1800
- Compare to NeilMedreg
Sinus Rinse - 1 kit
Night Time Cold amp Flu Item No 1361 $600
- Compare toVicks NyQuilreg
- 4 oz125 mg 30 mg 650 mg
Phenylephrine HCL (Nasal Decongestant PE) Item No 1352 $500
- Compare toSudafedreg PE
- 36 ct10 mg
Multi-Symptom Cold Formula Item No 1357 $600
- Compare toTylenolreg Cold Multi-Symptom Daytime
- 24 ct10 mg5 mg 325 mg
Sore Throat Lozenges Cepacolreg
Item No 1360 $550
- 16 ct
Cold amp Flu continued
Sore Throat Lozenges Cherry Item No 1176 $700
- Compare to Cepacolreg
- 18 ct
Sore Throat Spray Cherry Item No 1904 $800
- Compare to Chlorasepticreg
- 6 oz
Vapor Rub Item No 1164 $750
- Compare to Vicks VapoRubreg
- 35 oz47 1
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Abrevareg
Item No 1152 $2600
- 2 gm10
Carmexreg
Item No 1255 $400
- 75 gm
Herpecin-Lreg Lip Balm Item No 1153 $800
- 1 oz1
Releevreg Cold Sore Treatment Item No 1359 $2400
- 6 ml13
Blistexreg Lip Ointment Item No 1256 $500
- 6 gm
Cushion Foam Ring Item No 1732 $2100
- 1 ct
Cushion Lumbar Item No 1731 $2700
- 1 ct
Humidifier Ultra-Sonic Cool Mist Item No 1795 $5800
- Compare to Vicksreg Ultrasonic Humidifier - 1 ct
Cushion Gel Foam Seat Item No 1466 $4000
- 1 ct
Cold Sore amp Medicated Lip Products
Daily Living Aids
Pill Case Weekly AMPM Item No 1934 $1100
- 1 ct
Pill Cutter with Safety Shield Item No 1932 $1000
- 1 ct
Pillow CPAP Fiber Filled Item No 1836 $6000
- 1 ct
Pillow CPAP Memory Foam Item No 1837 $9500
- 1 ct
Pillow Hypoallergenic Item No 1936 $5300
- 1 ct
Pill Crusher with Storage Item No 1933 $1000
- 1 ct
Medical ID Bracelet bull Blank Item No 1875 1 ct
$1650
bull Diabetic Item No 1877 1 ct bull Heart Item No 1876 1 ct
$1500
Medicine Bottle Opener with Magnifier Item No 2017 $1000
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
13
Dental amp Denture Care
Denture Cleaning Tablets Item No 1032 $600
- Compare to Polidentreg
- 40 ct
Efferdentreg Plus Mint Tablets Item No 1653 $800
- 36 ct
Effergripreg Denture Cream Adhesive Item No 1843 $900
- 25 oz
Biotenereg Dry Mouth Oral Rinse Item No 1817 $1400
- 16 oz
Denture Brush Item No 1747 $650
- Compare to G-U-Mreg
- 1 ct
Interdental Flossups Item No 1751 $500
- Compare to G-U-Mreg
- 90 ct
Orajelreg Pain Relief Item No 1454 $1100
- 25 oz20
Oral Pain Relief Item No 1286 $600
- Compareto Orajelreg
- 5 oz20
Polidentreg Overnight Item No 1892 $1250
- 84 ct
Fixodentreg
Item No 1187 $700
- 75 oz
Tongue Cleaner Item No 1746 $600
- 1 ct
Toothbrush Battery Powered Item No 2015 $2000
- 1 ct
Toothbrush Colgatereg Adult Soft Item No 1413 $300
- 1 ct
Reachreg Waxed Dental Floss - Mint Item No 1455 $500
- 55 yd
Polidentreg Denture Cream Item No 1324 $650
- 39 oz
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Toothpaste Crestreg Sensi-Relief Item No 1838 $950
- 41 oz
Toothpaste Fluoride Item No 1914 $550
- 64 oz
Toothpaste Pepsodentreg
Item No 1414 $500
- 55 oz
Toothbrush Tek Proreg Angled Soft Item No 1412 $300
- 1 ct
Toothpaste Colgatereg
Item No 1831 $600
- 4 oz
Toothbrush Rechargeable Item No 1450 $4000
- 1 ct
Toothbrush Soft 2-pack Item No 1948 $600
- 2 ct
Dental amp Denture Care continued
Toothpaste Ultrabritereg
Advanced Whitening Item No 1716 $700
- 6 oz
Toothpaste Sensitive Teeth Item No 1903 $600
- Compare to Sensodynereg
- 43 oz
Water Jet Item No 1744 $4200
- 1 ct
Water Jet Replacement Tips Item No 1743 $1700
- 5 ct
Diabetic Skin Relief Foot Cream Item No 1839 $1200
- Compare to Gold Bondreg
Skin Protectant Foot Cream - 34 oz
Diabetic Socks Black bull Medium Item No 1956 bull Large Item No 1957 bull X-Large Item No 1958 $900
- 3 pair
Diabetic Foot Care
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
15
Diabetic Foot Care continued
Diabetic Socks Ultra Soft Padded Black bull Medium Item No 1959 bull Large Item No 1960 bull X-Large Item No 1961 $1100
- 2 pair
Diabetic Socks Ultra Soft Padded White bull Medium Item No 1962 bull Large Item No 1963 bull X-Large Item No 1964 $1100
- 2 pair
Diabetic Socks White bull Medium Item No 1953 bull Large Item No 1954 bull X-Large Item No 1955 $900
- 3 pair
Bathroom Scale Talking Daggersect
Item No 1981 $5700
- 1 ct
Blood Pressure Monitor Desktop Replacement Cuff Dagger
Item No 1504 $1500
- 1 ct
Blood Pressure Monitor Desktop Talking Dagger
Item No 1503 $5500
- 1 ct
Bathroom Scale Daggersect
Item No 1935 $3500
- 1 ct
Activity Tracker Item No 1982 $5200
- 1 ct
Blood Pressure Monitor Desktop Automatic Dagger
Item No 1253 $5000
- 1 ct
Blood Pressure Monitor Wrist Dagger
Item No 1501 $3500
- 1 ct
Diagnostic Equipment
Blood Pressure Monitor Wrist Talking Dagger
Item No 1502 $4500
- 1 ct
Finger Pulse Oximeter Dagger
Item No 1505 $4200
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
16
Diagnostic Equipment continued
Peak Flow Meter Dagger
Item No 1789 $1700
- 1 ct
Thermometer Digital 60 seconds Item No 1063 $650
- 1 ct
Thermometer Digital Ear Item No 1285 $2700
- 1 ct
Thermometer Flexible Tip Digital 10 seconds Item No 1697 $1000
- 1 ct
Heart Rate Monitor Watch Dagger
Item No 1771 $4000
- 1 ct
Diagnostic Tests Ear Care
Eye Care
Thermometer Talking Ear and Forehead Item No 1925 $4500
- 1 ct
Home Access Cholesterol Test Dagger
Item No 1251 $3000
- 1 kit
Cotton Tipped Swabs Item No 1742 $600
- Compare to Johnson amp Johnsonreg
- 300 ct
EZ Detectreg Colon Cancer Test Kit Dagger
Item No 1416 $1300
- 1 ct
Ear Wax Removal Drops Item No 1190 $500
- Compare to Debroxreg
- 15 ml65
Ear Wax Removal System with Rubber Bulb Item No 1363 $700
- Compare toDebroxreg
- 15 ml65
Ear Pain Relief Ear Drops Item No 1841 $1300
- Compare to Hylands Ear Reliefreg
- 10 ml
Artificial Tears Drops Item No 1192 $600
- Compare toVisine Tearsreg
- 5 oz
Artificial Tears Ointment Item No 1194 $600
- Compare to Refresh PMreg
- 35 gm
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Artificial Tears OintmentItem No 1194$600
- Compare to Refresh PMreg
- 35 gm
17
Eye Care continued
First Aid
Contact Lens Solution Multi-Purpose Item No 1468 $800
- Compare to Renureg
Multipurpose Solution - 12 oz
Eye Drops Clear Eyesreg
Item No 1199 $600
- 2 oz
Eye Drops Irritation Relief Item No 1806 $950
- Compare toVisine ACreg
- 15 ml
Eye Drops Redness Relief Item No 1061 $500
- Compare to Visinereg
Original Redness Relief - 15 ml005
Eye Wash Solution Bausch + Lombreg
Item No 1196 $800
- 4 oz
Antiseptic Skin Cleanser Item No 1808 $1100
- Compare to Hibiclensreg
- 8 oz
Bactinereg Solution Item No 1142 $1000
- 4 oz
Adhesive Bandages Item No 1344 $500
- Compare to Band-Aidreg Plastic Strips
- 60 ct
Alcohol Pads Item No 1200 $550
- 100 ct70
After Bitereg
Relief Item No 1803 $900
- 5 oz
Antiseptic Towelettes Item No 1201 $700
- 100 ct
Bacitracin Ointment Item No 1020 $600
- 1 oz500 U gm
Bandage Elastic - 2 x 45 yd Item No 1207 $400
- Compare to Acereg
- 1 ct
Bandage Elastic - 3 x 5 yd Item No 1209 $400
- Compare to Acereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
12
Abrevareg
Item No 1152 $2600
- 2 gm10
Carmexreg
Item No 1255 $400
- 75 gm
Herpecin-Lreg Lip Balm Item No 1153 $800
- 1 oz1
Releevreg Cold Sore Treatment Item No 1359 $2400
- 6 ml13
Blistexreg Lip Ointment Item No 1256 $500
- 6 gm
Cushion Foam Ring Item No 1732 $2100
- 1 ct
Cushion Lumbar Item No 1731 $2700
- 1 ct
Humidifier Ultra-Sonic Cool Mist Item No 1795 $5800
- Compare to Vicksreg Ultrasonic Humidifier - 1 ct
Cushion Gel Foam Seat Item No 1466 $4000
- 1 ct
Cold Sore amp Medicated Lip Products
Daily Living Aids
Pill Case Weekly AMPM Item No 1934 $1100
- 1 ct
Pill Cutter with Safety Shield Item No 1932 $1000
- 1 ct
Pillow CPAP Fiber Filled Item No 1836 $6000
- 1 ct
Pillow CPAP Memory Foam Item No 1837 $9500
- 1 ct
Pillow Hypoallergenic Item No 1936 $5300
- 1 ct
Pill Crusher with Storage Item No 1933 $1000
- 1 ct
Medical ID Bracelet bull Blank Item No 1875 1 ct
$1650
bull Diabetic Item No 1877 1 ct bull Heart Item No 1876 1 ct
$1500
Medicine Bottle Opener with Magnifier Item No 2017 $1000
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
13
Dental amp Denture Care
Denture Cleaning Tablets Item No 1032 $600
- Compare to Polidentreg
- 40 ct
Efferdentreg Plus Mint Tablets Item No 1653 $800
- 36 ct
Effergripreg Denture Cream Adhesive Item No 1843 $900
- 25 oz
Biotenereg Dry Mouth Oral Rinse Item No 1817 $1400
- 16 oz
Denture Brush Item No 1747 $650
- Compare to G-U-Mreg
- 1 ct
Interdental Flossups Item No 1751 $500
- Compare to G-U-Mreg
- 90 ct
Orajelreg Pain Relief Item No 1454 $1100
- 25 oz20
Oral Pain Relief Item No 1286 $600
- Compareto Orajelreg
- 5 oz20
Polidentreg Overnight Item No 1892 $1250
- 84 ct
Fixodentreg
Item No 1187 $700
- 75 oz
Tongue Cleaner Item No 1746 $600
- 1 ct
Toothbrush Battery Powered Item No 2015 $2000
- 1 ct
Toothbrush Colgatereg Adult Soft Item No 1413 $300
- 1 ct
Reachreg Waxed Dental Floss - Mint Item No 1455 $500
- 55 yd
Polidentreg Denture Cream Item No 1324 $650
- 39 oz
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Toothpaste Crestreg Sensi-Relief Item No 1838 $950
- 41 oz
Toothpaste Fluoride Item No 1914 $550
- 64 oz
Toothpaste Pepsodentreg
Item No 1414 $500
- 55 oz
Toothbrush Tek Proreg Angled Soft Item No 1412 $300
- 1 ct
Toothpaste Colgatereg
Item No 1831 $600
- 4 oz
Toothbrush Rechargeable Item No 1450 $4000
- 1 ct
Toothbrush Soft 2-pack Item No 1948 $600
- 2 ct
Dental amp Denture Care continued
Toothpaste Ultrabritereg
Advanced Whitening Item No 1716 $700
- 6 oz
Toothpaste Sensitive Teeth Item No 1903 $600
- Compare to Sensodynereg
- 43 oz
Water Jet Item No 1744 $4200
- 1 ct
Water Jet Replacement Tips Item No 1743 $1700
- 5 ct
Diabetic Skin Relief Foot Cream Item No 1839 $1200
- Compare to Gold Bondreg
Skin Protectant Foot Cream - 34 oz
Diabetic Socks Black bull Medium Item No 1956 bull Large Item No 1957 bull X-Large Item No 1958 $900
- 3 pair
Diabetic Foot Care
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
15
Diabetic Foot Care continued
Diabetic Socks Ultra Soft Padded Black bull Medium Item No 1959 bull Large Item No 1960 bull X-Large Item No 1961 $1100
- 2 pair
Diabetic Socks Ultra Soft Padded White bull Medium Item No 1962 bull Large Item No 1963 bull X-Large Item No 1964 $1100
- 2 pair
Diabetic Socks White bull Medium Item No 1953 bull Large Item No 1954 bull X-Large Item No 1955 $900
- 3 pair
Bathroom Scale Talking Daggersect
Item No 1981 $5700
- 1 ct
Blood Pressure Monitor Desktop Replacement Cuff Dagger
Item No 1504 $1500
- 1 ct
Blood Pressure Monitor Desktop Talking Dagger
Item No 1503 $5500
- 1 ct
Bathroom Scale Daggersect
Item No 1935 $3500
- 1 ct
Activity Tracker Item No 1982 $5200
- 1 ct
Blood Pressure Monitor Desktop Automatic Dagger
Item No 1253 $5000
- 1 ct
Blood Pressure Monitor Wrist Dagger
Item No 1501 $3500
- 1 ct
Diagnostic Equipment
Blood Pressure Monitor Wrist Talking Dagger
Item No 1502 $4500
- 1 ct
Finger Pulse Oximeter Dagger
Item No 1505 $4200
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
16
Diagnostic Equipment continued
Peak Flow Meter Dagger
Item No 1789 $1700
- 1 ct
Thermometer Digital 60 seconds Item No 1063 $650
- 1 ct
Thermometer Digital Ear Item No 1285 $2700
- 1 ct
Thermometer Flexible Tip Digital 10 seconds Item No 1697 $1000
- 1 ct
Heart Rate Monitor Watch Dagger
Item No 1771 $4000
- 1 ct
Diagnostic Tests Ear Care
Eye Care
Thermometer Talking Ear and Forehead Item No 1925 $4500
- 1 ct
Home Access Cholesterol Test Dagger
Item No 1251 $3000
- 1 kit
Cotton Tipped Swabs Item No 1742 $600
- Compare to Johnson amp Johnsonreg
- 300 ct
EZ Detectreg Colon Cancer Test Kit Dagger
Item No 1416 $1300
- 1 ct
Ear Wax Removal Drops Item No 1190 $500
- Compare to Debroxreg
- 15 ml65
Ear Wax Removal System with Rubber Bulb Item No 1363 $700
- Compare toDebroxreg
- 15 ml65
Ear Pain Relief Ear Drops Item No 1841 $1300
- Compare to Hylands Ear Reliefreg
- 10 ml
Artificial Tears Drops Item No 1192 $600
- Compare toVisine Tearsreg
- 5 oz
Artificial Tears Ointment Item No 1194 $600
- Compare to Refresh PMreg
- 35 gm
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Artificial Tears OintmentItem No 1194$600
- Compare to Refresh PMreg
- 35 gm
17
Eye Care continued
First Aid
Contact Lens Solution Multi-Purpose Item No 1468 $800
- Compare to Renureg
Multipurpose Solution - 12 oz
Eye Drops Clear Eyesreg
Item No 1199 $600
- 2 oz
Eye Drops Irritation Relief Item No 1806 $950
- Compare toVisine ACreg
- 15 ml
Eye Drops Redness Relief Item No 1061 $500
- Compare to Visinereg
Original Redness Relief - 15 ml005
Eye Wash Solution Bausch + Lombreg
Item No 1196 $800
- 4 oz
Antiseptic Skin Cleanser Item No 1808 $1100
- Compare to Hibiclensreg
- 8 oz
Bactinereg Solution Item No 1142 $1000
- 4 oz
Adhesive Bandages Item No 1344 $500
- Compare to Band-Aidreg Plastic Strips
- 60 ct
Alcohol Pads Item No 1200 $550
- 100 ct70
After Bitereg
Relief Item No 1803 $900
- 5 oz
Antiseptic Towelettes Item No 1201 $700
- 100 ct
Bacitracin Ointment Item No 1020 $600
- 1 oz500 U gm
Bandage Elastic - 2 x 45 yd Item No 1207 $400
- Compare to Acereg
- 1 ct
Bandage Elastic - 3 x 5 yd Item No 1209 $400
- Compare to Acereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
13
Dental amp Denture Care
Denture Cleaning Tablets Item No 1032 $600
- Compare to Polidentreg
- 40 ct
Efferdentreg Plus Mint Tablets Item No 1653 $800
- 36 ct
Effergripreg Denture Cream Adhesive Item No 1843 $900
- 25 oz
Biotenereg Dry Mouth Oral Rinse Item No 1817 $1400
- 16 oz
Denture Brush Item No 1747 $650
- Compare to G-U-Mreg
- 1 ct
Interdental Flossups Item No 1751 $500
- Compare to G-U-Mreg
- 90 ct
Orajelreg Pain Relief Item No 1454 $1100
- 25 oz20
Oral Pain Relief Item No 1286 $600
- Compareto Orajelreg
- 5 oz20
Polidentreg Overnight Item No 1892 $1250
- 84 ct
Fixodentreg
Item No 1187 $700
- 75 oz
Tongue Cleaner Item No 1746 $600
- 1 ct
Toothbrush Battery Powered Item No 2015 $2000
- 1 ct
Toothbrush Colgatereg Adult Soft Item No 1413 $300
- 1 ct
Reachreg Waxed Dental Floss - Mint Item No 1455 $500
- 55 yd
Polidentreg Denture Cream Item No 1324 $650
- 39 oz
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Toothpaste Crestreg Sensi-Relief Item No 1838 $950
- 41 oz
Toothpaste Fluoride Item No 1914 $550
- 64 oz
Toothpaste Pepsodentreg
Item No 1414 $500
- 55 oz
Toothbrush Tek Proreg Angled Soft Item No 1412 $300
- 1 ct
Toothpaste Colgatereg
Item No 1831 $600
- 4 oz
Toothbrush Rechargeable Item No 1450 $4000
- 1 ct
Toothbrush Soft 2-pack Item No 1948 $600
- 2 ct
Dental amp Denture Care continued
Toothpaste Ultrabritereg
Advanced Whitening Item No 1716 $700
- 6 oz
Toothpaste Sensitive Teeth Item No 1903 $600
- Compare to Sensodynereg
- 43 oz
Water Jet Item No 1744 $4200
- 1 ct
Water Jet Replacement Tips Item No 1743 $1700
- 5 ct
Diabetic Skin Relief Foot Cream Item No 1839 $1200
- Compare to Gold Bondreg
Skin Protectant Foot Cream - 34 oz
Diabetic Socks Black bull Medium Item No 1956 bull Large Item No 1957 bull X-Large Item No 1958 $900
- 3 pair
Diabetic Foot Care
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
15
Diabetic Foot Care continued
Diabetic Socks Ultra Soft Padded Black bull Medium Item No 1959 bull Large Item No 1960 bull X-Large Item No 1961 $1100
- 2 pair
Diabetic Socks Ultra Soft Padded White bull Medium Item No 1962 bull Large Item No 1963 bull X-Large Item No 1964 $1100
- 2 pair
Diabetic Socks White bull Medium Item No 1953 bull Large Item No 1954 bull X-Large Item No 1955 $900
- 3 pair
Bathroom Scale Talking Daggersect
Item No 1981 $5700
- 1 ct
Blood Pressure Monitor Desktop Replacement Cuff Dagger
Item No 1504 $1500
- 1 ct
Blood Pressure Monitor Desktop Talking Dagger
Item No 1503 $5500
- 1 ct
Bathroom Scale Daggersect
Item No 1935 $3500
- 1 ct
Activity Tracker Item No 1982 $5200
- 1 ct
Blood Pressure Monitor Desktop Automatic Dagger
Item No 1253 $5000
- 1 ct
Blood Pressure Monitor Wrist Dagger
Item No 1501 $3500
- 1 ct
Diagnostic Equipment
Blood Pressure Monitor Wrist Talking Dagger
Item No 1502 $4500
- 1 ct
Finger Pulse Oximeter Dagger
Item No 1505 $4200
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
16
Diagnostic Equipment continued
Peak Flow Meter Dagger
Item No 1789 $1700
- 1 ct
Thermometer Digital 60 seconds Item No 1063 $650
- 1 ct
Thermometer Digital Ear Item No 1285 $2700
- 1 ct
Thermometer Flexible Tip Digital 10 seconds Item No 1697 $1000
- 1 ct
Heart Rate Monitor Watch Dagger
Item No 1771 $4000
- 1 ct
Diagnostic Tests Ear Care
Eye Care
Thermometer Talking Ear and Forehead Item No 1925 $4500
- 1 ct
Home Access Cholesterol Test Dagger
Item No 1251 $3000
- 1 kit
Cotton Tipped Swabs Item No 1742 $600
- Compare to Johnson amp Johnsonreg
- 300 ct
EZ Detectreg Colon Cancer Test Kit Dagger
Item No 1416 $1300
- 1 ct
Ear Wax Removal Drops Item No 1190 $500
- Compare to Debroxreg
- 15 ml65
Ear Wax Removal System with Rubber Bulb Item No 1363 $700
- Compare toDebroxreg
- 15 ml65
Ear Pain Relief Ear Drops Item No 1841 $1300
- Compare to Hylands Ear Reliefreg
- 10 ml
Artificial Tears Drops Item No 1192 $600
- Compare toVisine Tearsreg
- 5 oz
Artificial Tears Ointment Item No 1194 $600
- Compare to Refresh PMreg
- 35 gm
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Artificial Tears OintmentItem No 1194$600
- Compare to Refresh PMreg
- 35 gm
17
Eye Care continued
First Aid
Contact Lens Solution Multi-Purpose Item No 1468 $800
- Compare to Renureg
Multipurpose Solution - 12 oz
Eye Drops Clear Eyesreg
Item No 1199 $600
- 2 oz
Eye Drops Irritation Relief Item No 1806 $950
- Compare toVisine ACreg
- 15 ml
Eye Drops Redness Relief Item No 1061 $500
- Compare to Visinereg
Original Redness Relief - 15 ml005
Eye Wash Solution Bausch + Lombreg
Item No 1196 $800
- 4 oz
Antiseptic Skin Cleanser Item No 1808 $1100
- Compare to Hibiclensreg
- 8 oz
Bactinereg Solution Item No 1142 $1000
- 4 oz
Adhesive Bandages Item No 1344 $500
- Compare to Band-Aidreg Plastic Strips
- 60 ct
Alcohol Pads Item No 1200 $550
- 100 ct70
After Bitereg
Relief Item No 1803 $900
- 5 oz
Antiseptic Towelettes Item No 1201 $700
- 100 ct
Bacitracin Ointment Item No 1020 $600
- 1 oz500 U gm
Bandage Elastic - 2 x 45 yd Item No 1207 $400
- Compare to Acereg
- 1 ct
Bandage Elastic - 3 x 5 yd Item No 1209 $400
- Compare to Acereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
14
Toothpaste Crestreg Sensi-Relief Item No 1838 $950
- 41 oz
Toothpaste Fluoride Item No 1914 $550
- 64 oz
Toothpaste Pepsodentreg
Item No 1414 $500
- 55 oz
Toothbrush Tek Proreg Angled Soft Item No 1412 $300
- 1 ct
Toothpaste Colgatereg
Item No 1831 $600
- 4 oz
Toothbrush Rechargeable Item No 1450 $4000
- 1 ct
Toothbrush Soft 2-pack Item No 1948 $600
- 2 ct
Dental amp Denture Care continued
Toothpaste Ultrabritereg
Advanced Whitening Item No 1716 $700
- 6 oz
Toothpaste Sensitive Teeth Item No 1903 $600
- Compare to Sensodynereg
- 43 oz
Water Jet Item No 1744 $4200
- 1 ct
Water Jet Replacement Tips Item No 1743 $1700
- 5 ct
Diabetic Skin Relief Foot Cream Item No 1839 $1200
- Compare to Gold Bondreg
Skin Protectant Foot Cream - 34 oz
Diabetic Socks Black bull Medium Item No 1956 bull Large Item No 1957 bull X-Large Item No 1958 $900
- 3 pair
Diabetic Foot Care
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
15
Diabetic Foot Care continued
Diabetic Socks Ultra Soft Padded Black bull Medium Item No 1959 bull Large Item No 1960 bull X-Large Item No 1961 $1100
- 2 pair
Diabetic Socks Ultra Soft Padded White bull Medium Item No 1962 bull Large Item No 1963 bull X-Large Item No 1964 $1100
- 2 pair
Diabetic Socks White bull Medium Item No 1953 bull Large Item No 1954 bull X-Large Item No 1955 $900
- 3 pair
Bathroom Scale Talking Daggersect
Item No 1981 $5700
- 1 ct
Blood Pressure Monitor Desktop Replacement Cuff Dagger
Item No 1504 $1500
- 1 ct
Blood Pressure Monitor Desktop Talking Dagger
Item No 1503 $5500
- 1 ct
Bathroom Scale Daggersect
Item No 1935 $3500
- 1 ct
Activity Tracker Item No 1982 $5200
- 1 ct
Blood Pressure Monitor Desktop Automatic Dagger
Item No 1253 $5000
- 1 ct
Blood Pressure Monitor Wrist Dagger
Item No 1501 $3500
- 1 ct
Diagnostic Equipment
Blood Pressure Monitor Wrist Talking Dagger
Item No 1502 $4500
- 1 ct
Finger Pulse Oximeter Dagger
Item No 1505 $4200
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
16
Diagnostic Equipment continued
Peak Flow Meter Dagger
Item No 1789 $1700
- 1 ct
Thermometer Digital 60 seconds Item No 1063 $650
- 1 ct
Thermometer Digital Ear Item No 1285 $2700
- 1 ct
Thermometer Flexible Tip Digital 10 seconds Item No 1697 $1000
- 1 ct
Heart Rate Monitor Watch Dagger
Item No 1771 $4000
- 1 ct
Diagnostic Tests Ear Care
Eye Care
Thermometer Talking Ear and Forehead Item No 1925 $4500
- 1 ct
Home Access Cholesterol Test Dagger
Item No 1251 $3000
- 1 kit
Cotton Tipped Swabs Item No 1742 $600
- Compare to Johnson amp Johnsonreg
- 300 ct
EZ Detectreg Colon Cancer Test Kit Dagger
Item No 1416 $1300
- 1 ct
Ear Wax Removal Drops Item No 1190 $500
- Compare to Debroxreg
- 15 ml65
Ear Wax Removal System with Rubber Bulb Item No 1363 $700
- Compare toDebroxreg
- 15 ml65
Ear Pain Relief Ear Drops Item No 1841 $1300
- Compare to Hylands Ear Reliefreg
- 10 ml
Artificial Tears Drops Item No 1192 $600
- Compare toVisine Tearsreg
- 5 oz
Artificial Tears Ointment Item No 1194 $600
- Compare to Refresh PMreg
- 35 gm
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Artificial Tears OintmentItem No 1194$600
- Compare to Refresh PMreg
- 35 gm
17
Eye Care continued
First Aid
Contact Lens Solution Multi-Purpose Item No 1468 $800
- Compare to Renureg
Multipurpose Solution - 12 oz
Eye Drops Clear Eyesreg
Item No 1199 $600
- 2 oz
Eye Drops Irritation Relief Item No 1806 $950
- Compare toVisine ACreg
- 15 ml
Eye Drops Redness Relief Item No 1061 $500
- Compare to Visinereg
Original Redness Relief - 15 ml005
Eye Wash Solution Bausch + Lombreg
Item No 1196 $800
- 4 oz
Antiseptic Skin Cleanser Item No 1808 $1100
- Compare to Hibiclensreg
- 8 oz
Bactinereg Solution Item No 1142 $1000
- 4 oz
Adhesive Bandages Item No 1344 $500
- Compare to Band-Aidreg Plastic Strips
- 60 ct
Alcohol Pads Item No 1200 $550
- 100 ct70
After Bitereg
Relief Item No 1803 $900
- 5 oz
Antiseptic Towelettes Item No 1201 $700
- 100 ct
Bacitracin Ointment Item No 1020 $600
- 1 oz500 U gm
Bandage Elastic - 2 x 45 yd Item No 1207 $400
- Compare to Acereg
- 1 ct
Bandage Elastic - 3 x 5 yd Item No 1209 $400
- Compare to Acereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
15
Diabetic Foot Care continued
Diabetic Socks Ultra Soft Padded Black bull Medium Item No 1959 bull Large Item No 1960 bull X-Large Item No 1961 $1100
- 2 pair
Diabetic Socks Ultra Soft Padded White bull Medium Item No 1962 bull Large Item No 1963 bull X-Large Item No 1964 $1100
- 2 pair
Diabetic Socks White bull Medium Item No 1953 bull Large Item No 1954 bull X-Large Item No 1955 $900
- 3 pair
Bathroom Scale Talking Daggersect
Item No 1981 $5700
- 1 ct
Blood Pressure Monitor Desktop Replacement Cuff Dagger
Item No 1504 $1500
- 1 ct
Blood Pressure Monitor Desktop Talking Dagger
Item No 1503 $5500
- 1 ct
Bathroom Scale Daggersect
Item No 1935 $3500
- 1 ct
Activity Tracker Item No 1982 $5200
- 1 ct
Blood Pressure Monitor Desktop Automatic Dagger
Item No 1253 $5000
- 1 ct
Blood Pressure Monitor Wrist Dagger
Item No 1501 $3500
- 1 ct
Diagnostic Equipment
Blood Pressure Monitor Wrist Talking Dagger
Item No 1502 $4500
- 1 ct
Finger Pulse Oximeter Dagger
Item No 1505 $4200
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
16
Diagnostic Equipment continued
Peak Flow Meter Dagger
Item No 1789 $1700
- 1 ct
Thermometer Digital 60 seconds Item No 1063 $650
- 1 ct
Thermometer Digital Ear Item No 1285 $2700
- 1 ct
Thermometer Flexible Tip Digital 10 seconds Item No 1697 $1000
- 1 ct
Heart Rate Monitor Watch Dagger
Item No 1771 $4000
- 1 ct
Diagnostic Tests Ear Care
Eye Care
Thermometer Talking Ear and Forehead Item No 1925 $4500
- 1 ct
Home Access Cholesterol Test Dagger
Item No 1251 $3000
- 1 kit
Cotton Tipped Swabs Item No 1742 $600
- Compare to Johnson amp Johnsonreg
- 300 ct
EZ Detectreg Colon Cancer Test Kit Dagger
Item No 1416 $1300
- 1 ct
Ear Wax Removal Drops Item No 1190 $500
- Compare to Debroxreg
- 15 ml65
Ear Wax Removal System with Rubber Bulb Item No 1363 $700
- Compare toDebroxreg
- 15 ml65
Ear Pain Relief Ear Drops Item No 1841 $1300
- Compare to Hylands Ear Reliefreg
- 10 ml
Artificial Tears Drops Item No 1192 $600
- Compare toVisine Tearsreg
- 5 oz
Artificial Tears Ointment Item No 1194 $600
- Compare to Refresh PMreg
- 35 gm
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Artificial Tears OintmentItem No 1194$600
- Compare to Refresh PMreg
- 35 gm
17
Eye Care continued
First Aid
Contact Lens Solution Multi-Purpose Item No 1468 $800
- Compare to Renureg
Multipurpose Solution - 12 oz
Eye Drops Clear Eyesreg
Item No 1199 $600
- 2 oz
Eye Drops Irritation Relief Item No 1806 $950
- Compare toVisine ACreg
- 15 ml
Eye Drops Redness Relief Item No 1061 $500
- Compare to Visinereg
Original Redness Relief - 15 ml005
Eye Wash Solution Bausch + Lombreg
Item No 1196 $800
- 4 oz
Antiseptic Skin Cleanser Item No 1808 $1100
- Compare to Hibiclensreg
- 8 oz
Bactinereg Solution Item No 1142 $1000
- 4 oz
Adhesive Bandages Item No 1344 $500
- Compare to Band-Aidreg Plastic Strips
- 60 ct
Alcohol Pads Item No 1200 $550
- 100 ct70
After Bitereg
Relief Item No 1803 $900
- 5 oz
Antiseptic Towelettes Item No 1201 $700
- 100 ct
Bacitracin Ointment Item No 1020 $600
- 1 oz500 U gm
Bandage Elastic - 2 x 45 yd Item No 1207 $400
- Compare to Acereg
- 1 ct
Bandage Elastic - 3 x 5 yd Item No 1209 $400
- Compare to Acereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
16
Diagnostic Equipment continued
Peak Flow Meter Dagger
Item No 1789 $1700
- 1 ct
Thermometer Digital 60 seconds Item No 1063 $650
- 1 ct
Thermometer Digital Ear Item No 1285 $2700
- 1 ct
Thermometer Flexible Tip Digital 10 seconds Item No 1697 $1000
- 1 ct
Heart Rate Monitor Watch Dagger
Item No 1771 $4000
- 1 ct
Diagnostic Tests Ear Care
Eye Care
Thermometer Talking Ear and Forehead Item No 1925 $4500
- 1 ct
Home Access Cholesterol Test Dagger
Item No 1251 $3000
- 1 kit
Cotton Tipped Swabs Item No 1742 $600
- Compare to Johnson amp Johnsonreg
- 300 ct
EZ Detectreg Colon Cancer Test Kit Dagger
Item No 1416 $1300
- 1 ct
Ear Wax Removal Drops Item No 1190 $500
- Compare to Debroxreg
- 15 ml65
Ear Wax Removal System with Rubber Bulb Item No 1363 $700
- Compare toDebroxreg
- 15 ml65
Ear Pain Relief Ear Drops Item No 1841 $1300
- Compare to Hylands Ear Reliefreg
- 10 ml
Artificial Tears Drops Item No 1192 $600
- Compare toVisine Tearsreg
- 5 oz
Artificial Tears Ointment Item No 1194 $600
- Compare to Refresh PMreg
- 35 gm
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Artificial Tears OintmentItem No 1194$600
- Compare to Refresh PMreg
- 35 gm
17
Eye Care continued
First Aid
Contact Lens Solution Multi-Purpose Item No 1468 $800
- Compare to Renureg
Multipurpose Solution - 12 oz
Eye Drops Clear Eyesreg
Item No 1199 $600
- 2 oz
Eye Drops Irritation Relief Item No 1806 $950
- Compare toVisine ACreg
- 15 ml
Eye Drops Redness Relief Item No 1061 $500
- Compare to Visinereg
Original Redness Relief - 15 ml005
Eye Wash Solution Bausch + Lombreg
Item No 1196 $800
- 4 oz
Antiseptic Skin Cleanser Item No 1808 $1100
- Compare to Hibiclensreg
- 8 oz
Bactinereg Solution Item No 1142 $1000
- 4 oz
Adhesive Bandages Item No 1344 $500
- Compare to Band-Aidreg Plastic Strips
- 60 ct
Alcohol Pads Item No 1200 $550
- 100 ct70
After Bitereg
Relief Item No 1803 $900
- 5 oz
Antiseptic Towelettes Item No 1201 $700
- 100 ct
Bacitracin Ointment Item No 1020 $600
- 1 oz500 U gm
Bandage Elastic - 2 x 45 yd Item No 1207 $400
- Compare to Acereg
- 1 ct
Bandage Elastic - 3 x 5 yd Item No 1209 $400
- Compare to Acereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
Artificial Tears OintmentItem No 1194$600
- Compare to Refresh PMreg
- 35 gm
17
Eye Care continued
First Aid
Contact Lens Solution Multi-Purpose Item No 1468 $800
- Compare to Renureg
Multipurpose Solution - 12 oz
Eye Drops Clear Eyesreg
Item No 1199 $600
- 2 oz
Eye Drops Irritation Relief Item No 1806 $950
- Compare toVisine ACreg
- 15 ml
Eye Drops Redness Relief Item No 1061 $500
- Compare to Visinereg
Original Redness Relief - 15 ml005
Eye Wash Solution Bausch + Lombreg
Item No 1196 $800
- 4 oz
Antiseptic Skin Cleanser Item No 1808 $1100
- Compare to Hibiclensreg
- 8 oz
Bactinereg Solution Item No 1142 $1000
- 4 oz
Adhesive Bandages Item No 1344 $500
- Compare to Band-Aidreg Plastic Strips
- 60 ct
Alcohol Pads Item No 1200 $550
- 100 ct70
After Bitereg
Relief Item No 1803 $900
- 5 oz
Antiseptic Towelettes Item No 1201 $700
- 100 ct
Bacitracin Ointment Item No 1020 $600
- 1 oz500 U gm
Bandage Elastic - 2 x 45 yd Item No 1207 $400
- Compare to Acereg
- 1 ct
Bandage Elastic - 3 x 5 yd Item No 1209 $400
- Compare to Acereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
18
First Aid continued
Bandages Gauze Sterile Conforming Stretch - 3 x 41 yd Item No 1223 $750
- 12 ct
Cotton Tipped Applicator - 6 Item No 1669 $1200
- 1000 ct
Diphenhydramine HCL ZincAcetate (Anti-Itch Cream) Item No 1140 $500
- Compare to Benadryl Creamreg
- 1 oz
Burn Relief Spray Item No 1926 $1000
- Compare to Solarcainereg
- 45 oz05
First Aid Kit 20 Pieces Item No 1947 $700
- 1 ct
First Aid Kit 75 Pieces Item No 1215 $1000
- 1 ct
First Aid Kit 175 Pieces Item No 1738 $1700
- 1 ct
Face Masks Procedural with Earloops Item No 1896 $1400
- 50 ct
Bandage Elastic - 4 x 5 yd Item No 1211 $500
- Compare to Acereg
- 1 ct
Bandage Elastic - 6 x 5 yd Item No 1213 $500
- Compare to Acereg
- 1 ct
Caldyphen Clear (Anti-Itch Lotion) Item No 1144 $900
- Compare to Caladrylreg
- 6 oz1
Cotton Balls Item No 1763 $600
- 300 ct
HotCold Pack 1 small amp 1 large Item No 1062 $900
- 1 ct
Hydrocortisone1 Cream Item No 1074 $600
- Compare to Cortaidreg
- 1 oz1
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
19
First Aid continued
Hydrogen Peroxide Item No 1228 $500
- 16 oz3
Isopropyl Alcohol Item No 1713 $600
- 16 oz70
Liquid Bandage Item No 1872 $850
- 45 oz
Petroleum Jelly Item No 2018 $700
- Compare toVaselinereg
- 4 oz
Nitrile Exam Gloves Item No 1840 $1200
- 100 ct
Insect Repellent Spray - Deet Item No 1796 $1200
- 4 oz30
Iodine Solution Antiseptic Item No 1203 $800
- 4 oz
Isopropyl Alcohol Wintergreen Item No 1229 $600
- 16 oz70
Neosporinreg Plus Item No 1326 $1100
- 5 oz
Tape Paper Surgical - 1 x 10 yd Item No 1217 $600
- Compare to 3M Tapereg
- 1 ct
Tape Paper Surgical - 2 x 10 yd Item No 1218 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 1 x 10 yd Item No 1219 $600
- Compare to 3M Tapereg
- 1 ct
Tape Silk Surgical - 2 x 10 yd Item No 1220 $600
- Compare to 3M Tapereg
- 1 ct
Tape Transparent Surgical - 2 x 10 yd Item No 1222 $600
- Compare to 3M Tapereg
- 1 ct
Triple Antibiotic Ointment Item No 1014 $700
- Compare to Neosporinreg
- 1 oz
Tape Transparent Surgical - 1 x 10 yd Item No 1221 $600
- Compare to 3M Tapereg
- 1 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
20
Foot Care
Callus Remover Pads Item No 1238 $700
- Compare toDr Schollsreg
- 6 ct
Corn Remover Pads Item No 1236 $700
- Compare toDr Schollsreg
- 9 ct
Pre-moist Hemorrhoid Pads Item No 1364 $800
- Compare toTucksreg
- 100 ct
Preparation Hreg
Medicated Wipes Item No 1895 $1300
- 48 ct
Bunion Guard Item No 1784 $900
- 1 ct
Preparation Hreg
Cream Item No 1248 $1200
- 26 gm
Foot Power Medicated Item No 1240 $700
- 5 oz
Hemorrhoidal Ointment Item No 1066 $700
- Compare toPreparation Hreg
- 2 oz
Hemorrhoidal Suppository Item No 1247 $700
- 12 ct
Hemorrhoid Relief
Incontinence Supplies
Adult Briefs Medium - 32 to 44 Item No 2026 $1700
- Compare to Dependreg
- 24 ct
Adult Briefs Large- 44 to 58 Item No 2027 $1800
- Compare to Dependreg
- 24 ct
Adult Briefs X-Large- 58 to 63 Item No 2028 $1800
- Compare to Dependreg
- 20 ct
A amp D Ointmentreg
Item No 1300 $750
- 2 oz
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
21
Incontinence Supplies continued
Bathing Wipes Item No 2010 $800
- 1 ct
Attendsreg Discreet Mens Guard Item No 1811 $1600
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Mens Shield Item No 1810 $1500
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Panty Liner Item No 1815 $1400
- Compare to Dependreg
- 28 ct
Attendsreg Discreet Womens Moderate Bladder Control Pad Item No 1813 $1800
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Maximum Bladder Control Pad Item No 1812 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultimate Bladder Control Pad Item No 1814 $2000
- Compare to Dependreg
- 20 ct
Attendsreg Discreet Womens Ultrathin Pad Item No 1816 $1400
- Compare to Dependreg
- 20 ct
Barrier Cream Item No 1302 $1000
- Compare toLantisepticreg
Barrier Cream - 4 oz
Bladder Control Shaped Pad ModerateAbsorbency Item No 1478 $1700
- Compare to Dependreg
- 24 ct
Disposable Underwear Large - 44rdquo to 58rdquo Item No 1026 $1600
- Compare to Dependreg
- 18 ct
Bladder Control Shaped Pad HeavyAbsorbency Item No 1479 $1900
- Compare to Dependreg
- 24 ct
Bladder Control Shaped Pad MaximumAbsorbency Item No 1480 $1600
- Compare to Dependreg
- 18 ct
Disposable Underwear Medium - 34rdquo to 44rdquo Item No 1021 $1600
- Compare to Dependreg
- 20 ct
Disposable Underwear X-Large - 58rdquo to 68rdquo Item No 1027 $1600
- Compare to Dependreg
- 14 ct
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
22
Incontinence Supplies continued
Flushable Wipes Item No 1928 $750
- 24 ct
Flushable Wipes Item No 2000 $1200
- 60 ct
Lantisepticreg Skin Protectant Ointment Item No 1202 $1200
- 4 oz50
Perineal Wash Rinse-Free Item No 2022 $700
- 8 oz
No-Rinse Body Wash Item No 1884 $1200
- 8 oz
Premierreg Adult Briefs Medium - 32 to 44 Item No 1993 $3400
- Compare to Dependreg
- 14 ct
Premierreg Adult Briefs Large - 44 to 58 Item No 1994 $3400
- Compare to Dependreg
- 12 ct
Premierreg Adult Briefs X-Large - 58 to 63 Item No 1995 $3400
- Compare to Dependreg
- 10 ct
Premierreg Disposable Underwear Medium - 36 to 44 Item No 1990 $3400
- Compare to Dependreg
- 18 ct
Premierreg Disposable Underwear Large - 44 to 58 Item No 1991 $3400
- Compare to Dependreg
- 16 ct
Premierreg Disposable Underwear X-Large - 56 to 68 Item No 1992 $3400
- Compare to Dependreg
- 14 ct
Underpad Disposable - 23 x 36 Item No 2029 $1100
- Compare to Dependreg
- 15 ct
Underpad Disposable - 23 x 24 Item No 1476 $1500
- Compare to Dependreg
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
23
Incontinence Supplies continued
Underpad Disposable - 30 x 30 Item No 1477 $800
- Compare to Dependreg
- 10 ct
Underpad Extra AbsorbantAir Permeable 30 x 36 Item No 1996 $1500
- Compare to Dependreg
- 5 ct
Washcloth with Lanolin Item No 1348 $900
- 64 ct
Lice Elimination Kit Item No 1929 $2700
- Compare to RIDreg
- 1 kit
Lice Treatment Rinse (Permethrin) Item No 1269 $1400
- Compare to Nixreg
- 59 ml1
Lice Treatment Shampoo Item No 1271 $900
- Compare to RIDreg
- 4 oz
Dimenhydrinate (Motion Sickness Tablets) Item No 1263 $500
- Compare to Dramaminereg
- 12 ct50 mg
Lice Treatment (Pediculicide) Motion Sickness
Dramaminereg Chewables Orange Item No 1264 $700
- 8 ct50 mg
Meclizine HCL (Motion Sickness Caplets) Item No 1366 $800
- 100 ct125 mg
Pain Relief Aids
Aspercremereg
Item No 1924 $750
- 125 oz
ColdHot Menthol Medicated Patch Item No 1944 $800
- Compare to IcyHotreg
- 5 ct5
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
24
Pain Relief Aids continued
Heating PadDigital 12 x 15 Item No 2024 $4500
- 1 ct
Heating Pad Wrap For Shoulder Neck and Back 25 x 26 Item No 1943 $5500
- 1 ct
Heating PadX-Large 12 x 24 Item No 1942 $3500
- 1 ct
Fast Freezereg Pain Relief Spray Item No 1846 $1400
- Compare to Biofreezereg
Pain Relief Spray - 4 oz
Heating Pad12 x 15 Item No 1861 $2600
- 1 ct
HeatWraps - Back amp Hip Item No 1859 $1300
- Compare to ThermaCarereg
- 2 ct
HeatWraps - Neck Shoulder amp Wrist Item No 1860 $1300
- Compare to ThermaCarereg
- 3 ct
Ice Bag - 9 Item No 1761 $900
- 1 ct
Lidocaine Patch Item No 1871 $1500
- Compare toAspercremereg
Lidocaine Patch - 5 ct 4
Menthol Gel Item No 1923 $850
- Compare toMineral Icereg
- 8 oz2
Pain Relieving Muscle Rub Item No 1475 $600
- Compare to Bengayreg
- 2 oz25
Salonpasreg Pain Relief Patches Item No 1739 $1400
- 5 ct
Pain Relief Mask Item No 1762 $900
- 1 ct
Thermacarereg
Lower Back amp Hip Item No 1912 $1500
- 2 ct
Thermacarereg
Menstrual Relief Item No 1913 $1500
- 3 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
25
Pain Relievers amp Fever Reducers
Warm or Cold Water Bottle Rubber Latex Item No 1781 $1000
- 1 ct
Wellpatchreg Migraine Item No 1261 $1000
- 4 ct
Pain Relief Aids continued
Acetaminophen (PainReliever Extra Strength) Item No 2030 $400
- Compare to Tylenol Extra Strengthreg
- 24 ct500 mg
Acetaminophen (PainReliever Extra Strength) Item No 2002 $1500
- Compare to Tylenol Extra Strengthreg
- 500 ct500 mg
Alevereg
Item No 1104 $1600
- 100 ct220 mg
Acetaminophen (PainReliever Regular Strength) Item No 1001 $600
- Compare to Tylenolreg
- 100 ct325 mg
Acetaminophen (PainReliever Extra Strength) Item No 1600 $900
- Compare to Tylenol Extra Strengthreg
- 100 ct500 mg
Arthritis Pain Reliever Item No 1311 $1200
- Compare toTylenol Arthritisreg
- 100 ct650 mg
Aspirin Enteric Coated Item No 1096 $500
- Compareto Bayer reg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1002 $600
- Compare toBayer Low Dosereg
- 120 ct81 mg
Aspirin Item No 1095 $500
- Compare to Bayerreg
- 100 ct325 mg
Aspirin Enteric Coated Low Dose Item No 1998 $1200
- Compare to BayerLow Dosereg
- 500 ct81 mg
Aspirin Low DoseChewables Item No 1802 $500
- Compare to Bayerreg
Aspirin Chewable Low Dosereg
- 36 ct81 mg
Capsaicin (Pain Relief Cream) Item No 1367 $1000
- Compare to Capzasinreg
- 2 oz0025
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
26
Pain Relievers amp Fever Reducers continued
Ibuprofen (PainReliever Fever Reducer) Item No 2031 $400
- Compareto Advilreg
- 24 ct200 mg
Ibuprofen (PainReliever Fever Reducer) Item No 1004 $600
- Compare to Advilreg
- 100 ct200 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 2032 $500
- Compare to Alevereg
- 24 ct220 mg
Naproxen Sodium (Pain Reliever Fever Reducer) Item No 1097 $1100
- Compare to Alevereg
- 100 ct220 mg
Pain Reliever Plus (Acetaminophen Aspirin) Item No 1365 $700
- Compare toExcedrinreg
- 100 ct250 mg 250 mg 65 mg
Pain Reliever PM (AcetaminophenExtra Strength) Item No 1332 $1000
- Compare toTylenol PMreg
- 100 ct500 mg 25 mg
Skin amp Sun Care
Aloe Vera Cream Item No 1070 $600
- 8 oz
Calamine Skin Protectant Lotion Item No 1821 $600
- 6 oz
Scar Gel Item No 1852 $1000
- 1 oz
Sunscreen Lotion SPF 30 Item No 1284 $600
- 35 oz
Acne Gel 10 Benzoyl Peroxide Item No 1076 $700
- Compare toPersa-Gelreg
- 15 oz10
Ammonium Lactate Moisturizing Lotion Item No 1368 $800
- Compare toAmLactinreg
- 8 oz12
Hand Sanitizer Item No 1065 $500
- Compare toPurellreg
- 8 oz
Moisturizing Body Lotion with Aloe Item No 1893 $800
- 8 oz
Sleep Aids
Nasal Strips Medium Item No 1724 $1200
- Compare toBreathe Rightreg
- 30 ct
Nasal Strips Large Item No 1725 $1200
- Compare toBreathe Rightreg
- 30 ct
Sleep Tablets Item No 1276 $600
- Compare toSominexreg
- 50 ct25 mg
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
27
Smoking Cessation
Nicotine Gum Dagger
Item No 1372 $2500
- Compare toNicorettereg
- 50 ct4 mg
Nicotine Lozenges Dagger
Item No 1281 $4200
- Compare toNicorettereg
- 72 ct4 mg
Nicotine Patch Step 1Dagger
Item No 1369 $4500
- Compare toNicoDerm CQ Step 1reg
- 14 ct21 mg 24 hr
Nicotine Patch Step 2Dagger
Item No 1370 $4500
- Compare toNicoDerm CQ Step 2reg
- 14 ct14 mg 24 hr
Nicotine Patch Step 3Dagger
Item No 1371 $4500
- Compare toNicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
Supports amp Braces
Ankle Support Item No 1225 $800
- Compare toAcereg
- 1 ct
Arthritis Knee Sleeve bull Small Item No 2011 bull Medium Item No 2012 bull Large Item No 2013 bull X-Large Item No 2014 $2500
- 1 ct
Back Support bull Deluxe Criss Cross Small - 28 to 32 Item No 1760 bull Deluxe Criss Cross Medium - 33 to 37 Item No 1759 bull Deluxe Criss Cross Large - 38 to 42 Item No 1758 $2400
- 1 ct
Arthritis Gloves bull Small Item No 1767 bull Medium Item No 1766 bull Large Item No 1765 $2500
- 1 pair
Back Support Elastic - 24 to 46 Item No 1487 $2500
- Compare to Acereg
- 1 ct
Back Support Elastic with Lumbar Item No 1488 $3000
- Compare to Acereg
- 1 ct
Carpal Tunnel Brace bull Small Item No 1770 bull Medium Item No 1769 bull Large Item No 1768 $2500
- 1 pair
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
28
Hip Protector bull Small Item No 1862 bull Medium Item No 1863 bull Large Item No 1864 bull X-Large Item No 1865 $4300
- 1 ct
Elbow Support Item No 1224 $1500
- 1 ct
Supports amp Braces continued
Compression Knee High Socks Mens Black Dagger
bull Medium (Shoe Size 8 - 10) Item No 1398 bull Large (Shoe Size 105 - 12) Item No 1399 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Mens White Dagger
bull Medium (Shoe Size 8 - 10) Item No 1400 bull Large (Shoe Size 105 - 12) Item No 1401 $1700
- 1 pair15 - 20 mmHg
Compression Knee High Socks Womens Beige Dagger
bull Small (Shoe Size 4 - 5) Item No 1406 bull Medium (Shoe Size 55 - 75) Item No 1407 bull Large (Shoe Size 8 - 105) Item No 1408 $1500
- 1 pair8 - 15 mmHg
Compression Knee High Socks Womens Black Dagger
bull Small (Shoe Size 4 - 5) Item No 1409 bull Medium (Shoe Size 55 - 75) Item No 1410 bull Large (Shoe Size 8 - 105) Item No 1411 $1500
- 1 pair8 - 15 mmHg
Knee Stabilizer Item No 1465 $2300
- 1 ct
Knee Support Elastic bull Small Item No 1481 bull Medium Item No 1482 bull Large Item No 1483 $1000
- Compare to Acereg
- 1 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
29
Wrist Support Item No 1227 $1200
- 1 ct
Wrist Support Night Item No 1463 $2800
- Compare to Futuroreg
Night Wrist Support - 1 ct
Supports amp Braces continued
Knee Support Elastic with Stays bull Small Item No 1484 bull Medium Item No 1485 bull Large Item No 1486 $1600
- Compare to Acereg
- 1 ct
Rib Belt - Female (one size fits most) Item No 1457 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Rib Belt - Male (one size fits most) Item No 1456 $2100
- Compare toCuradreg Rib Belt
- 1 ct
Wrist Splint Item No 1230 $1900
- Compare to Futuroreg
Wrist Splint - 1 ct
Vitamins amp Minerals
Airbornereg
Immune SupportChewables Dagger
Item No 1805 $1600
- 32 ct
Biotin Gummy Dagger
Item No 1820 $1200
- Compare toVitafusionreg
- 60 ct5000 mcg
Calcium Dagger
Item No 1291 $500
- Compare toCaltratereg
- 60 ct600 mg
Calcium Chew Chocolate Dagger
Item No 1945 $1100
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
Calcium + Vitamin D3 Dagger
Item No 1373 $700
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 IU
Calcium + Vitamin D3 Gummy Dagger
Item No 1823 $1400
- Compare to Caltrate-Dreg
- 60 ct500 mg 1000 IU
Coenzyme Q-10 Dagger
Item No 1829 $1200
- 30 ct50 mg
Coenzyme Q-10 Dagger
Item No 1828 $1400
- 30 ct100 mg
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
30
Vitamins amp Minerals continued
Folic Acid Dagger
Item No 1850 $800
- 100 ct800 mcg
DHEA Hormonal Supplement Dagger
Item No 1737 $1200
- 50 ct50 mg
Ferrous Gluconate (Iron Supplement) Dagger
Item No 1417 $700
- Compare toFergonreg
- 110 ct27 mg
Ferrous Sulfate (Iron Supplement) Dagger
Item No 1376 $500
- Compare toFergonreg
- 100 ct325 mg
Leg Cramps Pain Relief Caplets Dagger
Item No 1869 $1400
- 50 ct
Magnesium Dagger
Item No 1418 $800
- 110 ct250 mg
Melatonin Dagger
Item No 1879 $1200
- 100 ct5 mg
Fish Oil Soft Gels Dagger
Item No 1741 $1100
- 60 ct1000 mg
Flaxseed Dagger
Item No 1849 $1200
- 100 ct1000 mg
Glucosamine Chondroitin(Joint Health Support) Dagger
Item No 1003 $1100
- 60 ct250 mg 200 mg
Healthy Eyesreg
with Lutein Dagger
Item No 1975 $850
- Compare toOcuvitereg
- 60 ct
Immune SupportChewables Dagger
Item No 1866 $1200
- Compare to Airbornereg
- 50 ct
Melatonin Gummy Dagger
Item No 1971 $1500
- Compare toVitafusionreg
- 120 ct5 mg
Multivitamin Centrum Silverreg Chewables Dagger
Item No 1420 $1700
- 60 ct
Glucose Tablets Item No 1997 $800
- 50 ct
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
31
Vitamins amp Minerals continued
Multivitamin Dailywith Minerals Dagger
Item No 1385 $700
- Compare toCentrumreg reg
- 100 ct
Multivitamin One Daily Menrsquos Dagger
Item No 1886 $1000
- Compare to One-A-Day Mensreg
- 100 ct
Multivitamin Daily Dagger
Item No 1393 $800
- Compare toOne-A-DayEssentialreg
- 100 ct
Multivitamin Daily Gummy Dagger
Item No 1972 $1250
- Compare toVitafusionreg
- 120 ct
Multivitamin One Daily Womenrsquos Dagger
Item No 1887 $1000
- Compare to One-A-Day Womensreg
- 100 ct
Multivitamin Senior Dagger
Item No 1392 $1000
- Compare toCentrum Silverreg
- 90 ct
Niacin Dagger
Item No 1378 $500
- 100 ct100 mg
Niacin Dagger
Item No 1394 $1000
- 100 ct500 mg
Niacin No Flush Dagger
Item No 1930 $1500
- 60 ct500 mg
Omega amp DHA Gummy Dagger
Item No 1976 $1400
- Compare toVitafusionreg
- 120 ct275 mg 50 mg
Potassium Gluconate Dagger
Item No 1977 $600
- 100 ct595 mg
Rena-Vite Dagger
Item No 1395 $1350
- 100 ct
Stress Formula Tablets with Zinc Dagger
Item No 1734 $1400
- 60 ct
Vitafusionreg
Fiber WeightManagement Dagger
Item No 1735 $1800
- 90 ct
Vitamin A Dagger
Item No 1379 $600
- 100 ct10000 IU
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
32
Vitamins amp Minerals continued
Vitamin B-Complex Dagger
Item No 1382 $600
- 100 ct
Vitamin B-1 Dagger
Item No 1016 $600
- 100 ct100 mg
Vitamin B-6 Dagger
Item No 1380 $600
- 100 ct50 mg
Vitamin B-Complex Gummy Dagger
Item No 1915 $1200
- Compare toVitafusionreg
- 70 ct
Vitamin C Dagger
Item No 1017 $600
- 100 ct500 mg
Vitamin B-6 Dagger
Item No 1388 $800
- 100 ct100 mg
Vitamin B-12 Dagger
Item No 1381 $800
- 100 ct1000 mcg
Vitamin B-12 Sublingual Dagger
Item No 1974 $1000
- 30 ct5000 mcg
Vitamin C Dagger
Item No 1706 $1100
- 100 ct1000 mg
Vitamin C Gummy Dagger
Item No 1916 $1100
- Compare toVitafusionreg
- 60 ct250 mg
Vitamin D3 Dagger
Item No 1383 $600
- 100 ct400 IU
Vitamin D3 Dagger
Item No 1390 $800
- 100 ct1000 IU
Vitamin D3 Dagger
Item No 1973 $1000
- 100 ct5000 IU
Vitamin D3 Gummy Dagger
Item No 1978 $1300
- 120 ct2000 IU
Zinc Chelated Dagger
Item No 1419 $800
- 100 ct50 mg
Vitamin E Soft Gels Dagger
Item No 1384 $900
- 100 ct400 IU
Talk with your doctor before starting a new product regimen
OTC MEDICATIONS AND HEALTH PRODUCTS
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
Zinc Chelated Dagger
Item No 1419$800
- 100 ct50 mg
33
Wart Remover
Wart Removal System Dr Schollsreg
Item No 1288 $1400
- 20 ct
Wart Removal System Wartnersreg
Item No 1289 $1900
- 1 ct
Wart Remover Liquid Item No 1075 $900
- Compare toCompound Wreg
- 9 ml17
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before orderingDagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Productordering policies may vary by facility
PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent versionof chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or sprayor a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation)anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasiticantipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores cornscough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinalhay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lipproducts menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinussleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart worms wounds etc The following arenot eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring CarePlan Baby medicines contraceptivesdehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine)and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Pleasecontact Member Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products groomingdevices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soapsare also not eligible
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna IntellectualProperty Inc This is not a complete list The benefit information is a brief summary not a complete description of benefits For moreinformation contact the plan or read the Member Handbook Cigna-HealthSpring CarePlan is a health plan that contracts with bothMedicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
34
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
35
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
36
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
KEEP TRACK OF YOUR ORDERS BELOW
Date Item
37
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
H8423_19_71428 APPROVED 01302019
Multi-language Interpreter Services
English ndash ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711) This call is free
Spanish ndash ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) Esta llamada es gratuita
Chinese ndash 注意如果您使用繁體中文您可以免費獲得語言援助服務請致電1-877-653-0327 (TTY 711)
此電話免費
Vietnamese ndash CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711) Cuộc gọi nagravey miễn phiacute
French Creole ndash ATANSYON Si w pale Kreyogravel Ayisyen gen segravevis egraved pou lang ki disponib gratis pou ou Rele 1-877-653-0327 (TTY 711) Apegravel sa a gratis
Korean ndash 주의 한국어를 사용하시는 경우 언어 지원 서비스를 무료로 이용하실 수 있습니다 1-877-653-0327 (TTY 711) 번으로 전화해 주십시오 이 전화는 무료입니다
Polish ndash UWAGA Jeżeli moacutewisz po polsku możesz skorzystać z bezpłatnej pomocy językowej Zadzwoń pod numer 1-877-653-0327 (TTY 711) To połączenie jest bezpłatne
French ndash ATTENTION Si vous parlez franccedilais des services drsquoaide linguistique vous sont proposeacutes gratuitement Appelez le 1-877-653-0327 (ATS 711) Cet appel est gratuit
Arabic ndash عربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان اتصل برقم ملحوظة إذا كنت تتحدث اللغة ال1-877-653-0327TTY 711) (هذه المكالمة بالمجان
Russian ndash ВНИМАНИЕ Если вы говорите на русском языке то вам доступны бесплатные услуги перевода Звоните 1-877-653-0327 (TTY 711) Звонок бесплатный
Tagalog ndash PAUNAWA Kung nagsasalita ka ng Tagalog maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad Tumawag sa 1-877-653-0327 (TTY 711) Libre ang tawag na ito
FarsiPersian ndash گان برای شما فراهم می باشديالت زبانی به صورت رايد تسهيتوجه اگر به زبان فارسی صحبت می کن
گان است ين تماس رايد ايريتماس بگ ) (0327TTY 711-653-877-1با شماره
German ndash ACHTUNG Wenn Sie Deutsch sprechen stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfuumlgung Rufnummer 1-877-653-0327 (TTY 711) Dieser Anruf ist kostenlos
Portuguese ndash ATENCcedilAtildeO Se fala portuguecircs encontram-se disponiacuteveis serviccedilos linguiacutesticos graacutetis Ligue para 1-877-653-0327 (TTY 711) Esta ligaccedilatildeo eacute gratuita
Italian ndash ATTENZIONE nel caso in cui la lingua parlata sia lrsquoitaliano sono disponibili servizi di assistenza linguistica gratuiti Chiamare il numero 1-877-653-0327 (TTY 711) La chiamata egrave gratuita
Japanese ndash 注意事項日本語を話される場合無料の言語支援をご利用いただけます1-877-653-0327 (TTY 711)までお電話にてご連絡くださいこの通話は無料です
Navajo ndash D77 baa ak0 n7n7zin D77 saad bee y1n7[tirsquogo Dineacute Bizaad saad bee 1k1rsquo1n7darsquo1worsquod66rsquo trsquo11 jiikrsquoeh 47 n1 h0l= koj8rsquo h0d77lnih 1-877-653-0327 (TTY 711) Diacuteiacute beacuteeacutesh bee hanersquoiacutegiacuteiacute trsquoaacuteaacute jiacuteiacutekrsquoeh
જરયાતી બોલતયા હો તો નનશલક ભયાષયા સહયા સવયાઓ તમયારયા મયાટGujarati ndash ધયાન આપો જો તમ ગ ઉપલબધ છ ફોન કરો 1-877-653-0327 (TTY 711) આ કૉલ મફત છ
Urdu ndash ے ہيں تو آپ کےلئے زبان معاون خدمات مفت ميں دستياب ہيں کال کريںتوجہ ديں اگرآپ اردو زبان بولت (TTY 711) 1-877-653-0327 ہ کال مفت ہے ي
ທບບ
Greek ndash ΠΡΟΣΟΧΗ Υπάρχουν διαθέσιμες δωρεάν υπηρεσίες υποστήριξης για εσάς εάν μιλάτε ελληνικά Καλέστε στο 1-877-653-0327 ( για χρήστες TTY καλέστε 711) Η κλήση αυτή είναι δωρεάν
Lao ndash ເອາໃຈໃສ ຖາທານເວາພາສາລາວ ຈະມ ລການຊວຍເຫ ອດານພາສາ ໂດຍບເສຍຄາ ພອມໃຫ ລການແກ ານ ໂທໄປທ 1-877-653-0327 (TTY 711) ສາລບການໂທນແມນບເສຍຄາ
38
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
Notice of Nondiscrimination Discrimination is Against the Law
Cigna complies with applicable Federal civil rights laws and does not discriminate on the basis of race colo r national origin age disability or sex Cigna does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna Provides free aids and services to people with disabilities to communicate effectively with us such as
o Qualified sign language interpreters o Written information in other formats (large print audio accessible electronic formats other formats)
Provides free language services to people whose primary language is not English such as o Qualified interpreters o Information written in other languages
If you need these services contact Member Services
If you believe that Cigna has failed to provide these services or discriminated in another way on the basis of race colo r national origin age disability or sex you can file a grievance with
CignaAttn Appeals Complaints and Grievances DepartmentPO Box 211088 Bedford Texas 76095 Phone 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 am to 8 pmFax 1-877-809-0783
You can file a grievance in writing by mail or fax If you need help filing a grievance Member Services is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobb yjsf or by mail or phone at
US Department of Health and Human Services 200Independence Avenue SWRoom 509F HHH Building Washington DC 202011-800-368-1019 800-537-7697 (TDD)
Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation includingHealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by CignaIntellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaidto provide benefits of both programs to enrollees ATTENTION If you speak languages other than English languageassistance services free of charge are available to you Call 1-877-653-0327 (TTY 7-1-1) 7 days a week 8 amto 8 pmCentral Time ATENCIOacuteN si usted habla un idioma que no sea ingleacutes tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 7-1-1) los 7 diacuteas de la semana de 8 am a 8 pm hora del Centro copy 2019 CignaH8423_17_49039 Approved 929159
39
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 1 102219 258 PM
OVERndashTHEndashCOUNTER (OTC) BENEFIT
ORDER FORM
STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name AptSuite
City State Zip Code
Please check box if this is a new address Daytime Phone Email (Optional)
STEP 2 - PRODUCT SELECTION
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
1 $ $
2 $ $
3 $ $
4 $ $
5 $ $
Use the other side to order more products Subtotal from Other Side $
Total Order $
Please mail this completed form in the postage-paid envelope to OTC Servicing Center PO Box 526266 Miami FL 33152-9819 Your order total will be applied to the month in which we receive your form For example you mail your order form on June 29th However we receive it on July 1st Your order total will be applied to your July benefit It will not apply to your June benefit
H8423_20_80835 Approved
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019
H8423_20_80835_MMP_OTC_Order_Form_930226_v5 PRINTindd 2 102219 258 PM
STEP 2 - PRODUCT SELECTION (Continued)
Cash checks credit cards or money orders are not accepted under this Over-the-Counter (OTC) benefit
Item Product Description Quantity Unit Price TOTAL
6 $ $
7 $ $
8 $ $
9 $ $
10 $ $
11 $ $
12 $ $
13 $ $
14 $ $
15 $ $
16 $ $
17 $ $
18 $ $
19 $ $
20 $ $
Please add Subtotal to the other side Subtotal $
ATTENTION If you speak English language assistance services free of charge are available to you Call 1-877-653-0327 (TTY 711)ATENCIOacuteN si habla espantildeol tiene a su disposicioacuten servicios gratuitos de asistencia linguumliacutestica Llame al 1-877-653-0327 (TTY 711) CHUacute Yacute Nếu bạn noacutei Tiếng Việt coacute caacutec dịch vụ hỗ trợ ngocircn ngữ miễn phiacute dagravenh cho bạn Gọi số 1-877-653-0327 (TTY 711)Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza color nacionalidad edad discapacidad o sexo All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including HealthSpring Life amp Health Insurance Company Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc Cigna-HealthSpring CarePlan is a health plan that contracts with both Medicare and Texas Medicaid to provide benefits of both programs to enrollees copy 2019 Cigna930226 01019