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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

3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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Page 1: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

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

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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

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

Page 2: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 3: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 4: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 5: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 6: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 7: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 8: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 9: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 10: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 11: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 12: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 13: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 14: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 15: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 16: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 17: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 18: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 19: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 20: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 21: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 22: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 23: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 24: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 25: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 26: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 27: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 28: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 29: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 30: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 31: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 32: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 33: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 34: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 35: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 36: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 37: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 38: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 39: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 40: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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

Page 41: 3 MY OVER-THE-COUNTER ALLOWANCE...OVER-THE-COUNTER (OTC) MEDICATIONS AND HEALTH PRODUCTS Your 2020 catalog 3 MY OVER-THE-COUNTER ALLOWANCE $30 quarterly allowance …

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