Over-The-Counter (OTC) Benefit Catalog (TTY ) Fieldtex-FHCA.com

Transcription

1 Over-The-Counter (OTC) Benefit Catalog (TTY ) Fieldtex-FHCA.com

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3 Dear Member: Thank you for choosing the Florida Hospital Care Advantage Explorer (HMO-POS) Plan. Your plan includes an over-the-counter benefit that allows you to order up to $25 of products and supplies every month from this Over-The-Counter (OTC) Benefit Catalog. The $25 monthly allowance willl not roll over to the next month if not used. There are two ways to place your monthly order: Option #1: Mail Order Form 1. Select your items and list them on the enclosed order form. It is important that you do not order more than the $25 limit. 2. Be sure to include your member ID number and birth day on the form. 3. Mail the order form to: Fieldtex Products, Inc. FHCA Order Department 3055 Brighton-Henrietta TL Road Rochester, New York Your order form must be received by Fieldtex by the end of the month in order to obtain the benefit for that particular month. 5. Then just wait 7 10 days for the delivery of your products by mail. 6. You will receive your next month s order form with your products when they are shipped to you. Option #2: Place Your Order Online 1. Go to Fieldtex-FHCA.com and login using your member ID number as the User Name and your birth date as your Password. You can find your member ID number on your Florida Hospital Care Advantage member ID card. 2. As you add items to your cart, you will see the balance on the screen so you can be careful not to order beyond your benefit allowance. 3. If you choose to order beyond your allowance, you will have the option to enter your credit card information at check out, but be sure to redeem your points first so that only the amount over the allowance is billed to your card. 4. Your order is received and shipped within 24 hours. 5. You can also login to check your account balance, look at your order history, track shipments or place orders. Need Assistance? If you need help using the order form or placing your order online through Fieldtex, we can help. Call Customer Service toll-free at (TTY/TDD relay: ) Monday through Friday from 8 a.m. to 8 p.m. or Saturday from 8 a.m. to noon. From October 1 February 14, we re available seven days a week from 8 a.m. to 8 p.m. We value your membership and look forward to serving you in the years ahead. Sincerely, Florida Hospital Care Advantage

4 Table of Contents Allergy & Flu Cough Drops Dental Care...4 Dental Care Denture Dental Care Toothbrusth...6 Dental Care Toothpaste Diagnostic Equipment Thermometers...7 Ear Care...7 Eye Care...8 Feminine and UTI Products...8 Fiber Supplements...9 First Aid Bandages First Aid Dressings & Gauze...10 First Aid Tape...10 First Aid Kits...11 Foot Care Hemorrhoid...12 Hot & Cold Therapy Incontinence Supplies Lactose...14 Medication Motion Sickness...15 Ointments & Topicals...15 Ointments & Topicals Analgesics...16 Ointments & Topicals Cleaners...16 Pain Relief Skin Care...19 Sleep Aid...19 Stomach & Laxatives Sunscreen...22 Support Ankle/Back...22 Support Elbow/Knee...23 Support Wrist...23 Vitamins & Minerals Vitamins & Minerals Special Supplements...26 iv Mail in the order form for fast and easy delivery of your OTC items

5 Allergy & Flu Airborne Original Orange 10/Tabs $9.00 Alka Seltzer Original Foil 36/Tabs $7.00 Alka Seltzer Plus Cold & Cough 40 Liq/Gel $14.00 Alka Seltzer Plus Severe Cough Mucus & Congestion 12 Day/8 Night Liq/Gels $8.75 Alka Seltzer Plus Severe Sinus Congestion 20 Liq/Gels $8.25 Alka-Seltzer Plus Cold 20/Tabs $6.75 Allegra 12 Hr 12/Tabs $14.00 Allegra 24Hr 180Mg 30/Ct $25.00 Banophen Elixir (Unboxed) 4 Oz (Benadryl) $3.00 Benadryl Allergy 24/Bx $6.00 Breathe Right Nasal Strips Large 30/Bx $16.00 Breathe Right Strips Sm/Med 30/Ct $16.00 Careall Medicated Chest Rub 3.53 Oz $1.50 Child/Adult Cough DM 12 Hour Extended Release 3 fl oz $8.00 Claritin Reditabs 10/Bx $16.00 Complete Allergy Medicine 100/Tabs N $1.50 Coricidin HPB 20/Bx $8.25 Delsym Cough Suppressant 3 Fl Oz $13.50 Visit us online at Fieldtex-FHCA.com 1

6 Allergy & Flu Flonase OTC 60 Nasal Spray For Allergies $20.00 Goodsense All Day Allergy 30Ct (Cetirizene) $12.00 Goodsense Allergy 10Mg Loratidine 30/Ct $4.00 Goodsense Allergy 24/Caps $2.25 Goodsense Allergy/Sinus Headache 20/Ct $3.25 Goodsense Effervescent Cold Relief 20/Tabs $4.25 Goodsense Mucus Relief DM 30/Ct $7.75 Goodsense Saline Nasal Spray 1.5 Oz $3.00 Goodsense Nasal Spray Extra Moisture 1 Oz $3.00 Goodsense Tussin DM 4 Oz $3.00 Goodsense Nitetime Cold-Flu Relief 16/SG $3.75 Goodsense Tussin Dm Sugar Free 4 Oz $4.00 Major Cough/Cold High Blood Pressure 16/Tabs $2.75 Mentholatum Ointment 1 Oz Jar $3.25 Mucinex DM 20/Bx $17.00 Mucinex Fast-Max Cold, Flu & Sore Throat $16.00 Mucus Relief Tabs 30/Tabs $3.50 Nasal Decongestant Spray (Afrin) 1 Oz $ Mail in the order form for fast and easy delivery of your OTC items

7 Allergy & Flu Robitussin Cough & Chest Sugar Free 4 Oz $9.00 Severe Sinus Congestion Allergy & Cold Liquid Gels 20/Ct $5.75 Tylenol Cold & Flu 8 Oz $9.25 Tylenol Cold/Flu Severe Caplets 24/Ct $9.00 Tylenol Sinus Severe 24/Caps $9.25 Vicks Dayquil 8/Ct $8.00 Vick s Dayquil Cold & Flu Caps 24/Ct $13.00 Zyrtec 10Mg 14/Tabs $18.00 Cough Drops Chloraseptic Lozenges Citrus 18/Bx $4.75 Cough Drops Honey Lemon 30/Bag $1.50 Goodsense Black Cherry Cough Sugar Free Drops 25/Bag $2.00 Halls Cough Drops Honey Lemon 30/Bag $2.75 Halls Defense Asst Sugar Free Citrus 25/Bag $2.75 Halls Defense Citrus 30/Ea $2.75 Halls Menthol-Lyptus Cough Drops 30/Bag $2.50 Luden s Cough Drop Sugar Free Wild Cherry 25/Bag $2.50 Luden s Throat Drops Wild Cherry 30/Bag $2.50 Visit us online at Fieldtex-FHCA.com 3

8 Cough Drops QC Sugar Free Cough Drops Menthol 25/Bag $2.00 QC Vitamin C Drops 30/Bag $1.50 Ricola Cough Drop Cherry Honey 24/Bag $2.75 Ricola Cough Drops 21/Bag $2.75 Ricola Sugar Free Cough Drops Lemon 19/Bag $2.75 Sucrets Sore Throat Lozenges Cherry 18/Bx $4.00 Dental Care Freshmint Dental Floss Wax Mint 100 Yds N $1.25 Goodsense Tongue Cleaner 1/Ct $2.50 Goodsense Floss Waxed Unflavored 100/Yds $2.00 J&J Reach Floss Waxed Mint 55 Yds $2.00 Goodsense Mint Flosser W/Pick 50/Bag $2.00 Orajel Dry Mouth Gel 1.5 Oz $7.00 Orajel Medicated Mouth Sore Swabs 12/Ea $7.25 Dental Care Denture Denture Bath Sea Bond (1 Container) $2.25 Denture Brush $0.75 Denture Cleaner Tablets 40/Ct $ Mail in the order form for fast and easy delivery of your OTC items

9 Dental Care Denture Fixodent Adhesive Neutral Zinc Free 2.4 Oz $7.75 Fixodent Complete Cream Mint 2.2 Oz $7.50 Fixodent Free Cream 2.4 Oz $7.50 Fixodent Original 1.4 Oz $4.75 Fixodent Plus Scope Adhesive 2 Oz $7.50 Freshmint Denture Adhesive 2.4 Oz $2.50 Freshmint Denture Cleaning 90/Tabs N $4.75 Polident Overnight 40/Ct Oral B Denture Brush Twin Head $3.25 Polident Overnight 84/Ct $8.50 Polident 3-Minute 40/Ct Polident Tablets for Smokers 40/Ct Poligrip Extra Care 2.2 Oz $7.50 Poligrip SPG Free 1.4 Oz Poligrip SPG Free 2.4 Oz $7.75 Poligrip Super Original 2.4 Oz $7.75 Poligrip Twin Pack Original Oz $14.25 Visit us online at Fieldtex-FHCA.com 5

10 Dental Care Toothbrush Colgate Plus Soft Toothbrush A $2.00 Colgate White Adult Soft Toothbrush $1.00 Freshmint Generic Toothbrush $1.00 Freshmint Nylon Toothbrush $0.50 Goodsense Elite Angle Full Head Medium Toothbrush $2.75 Goodsense Elite Angle Full Head Soft Toothbrush $2.75 Oral B Adult Medium Toothbrush $4.00 Oral B Precision Clean Refill $14.00 Oral B Ortho Soft Toothbrush $4.00 Oral B Precision Clean Power Toothbrush $19.00 Dental Care Toothpaste Act Dry Mouth Toothpaste 4.6 Oz $9.50 Aquafresh Cavity Protection Tube 5.6 Oz $3.50 Biotene Toothpaste Gentle Mint 4.3 Oz $8.00 Colgate Total Clean Mint 4.2 Oz $4.50 Crest Prohealth Clean Mint Toothpaste 3.7 Oz $4.75 Crest Regular Toothpaste 4.6 Oz $ Mail in the order form for fast and easy delivery of your OTC items

11 Dental Care Toothpaste Crest Toothpaste Baking Soda + Peroxide 6.4 Oz $4.00 Freshmint Anticavity Toothpaste 4.6 Oz $1.25 Listerine Toothpaste Essential Care Original Gel 4.2 Oz $7.50 Pepsodent Complete Care 5.5 Oz $2.50 Sensodyne Original Toothpaste 4 Oz $8.00 Diagnostic Equipment Thermometers Digital Temporal Thermometer Temple Touch Infrared Probe Hand Held $24.00 Ear Care Debrox Earwax Removal Drops 1/2 Oz $7.50 Digital Thermometer Waterproof Goodsense Ear Wax Removal Kit 0.5 fl Oz $3.75 Prestige Temp/Ear Digital Thermometer $25.00 Murine Ear Wax Removal System 0.5 fl Oz $8.00 Swim-Ear Ear Drops 1 Oz $4.75 You no longer have to wait until the first of the month to mail in your orders! Send it in when you make your selection and it will be processed as soon as your next benefit becomes available Visit us online at Fieldtex-FHCA.com 7

12 Eye Care Artificial Tears Sterile 1/2 FL Oz N $2.00 Blink Contacts Lubricant Eye Drop 10 ML $8.75 Clear Eyes Itchy Eye Relief.5 Oz Clear Eyes Triple Action Relief.5 Oz $5.50 Eye Drops Original.5 Oz N $1.50 Goodsense Sterile Irritation Relief Eye Drops.5 Oz $3.50 Lubricating Relief Eye Drops.5 Oz N $2.00 Visine Advanced Lubricant/Redness.28 Oz $2.75 Stye Eye Ointment Oz $8.75 Visine-A Eye Allergy Relief Eye Drops.5 Oz $7.75 Visine A.C. Seasonal Itching.5 Oz $6.00 Feminine and UTI Products Monistat 7 Day 1.59 oz $14.50 Monistat Soothing Care Powder Gel 1.5 Oz $8.50 Uristat Pain Relief 36/Tabs $ Mail in the order form for fast and easy delivery of your OTC items

13 Fiber Supplements Fiber Choice Sugar Free Chewable Assorted $15.00 Fiber-Con Caplets 36/Ct $7.75 Fiber-Tabs 90/Ct $8.00 Flaxseed Soft Gel 1000Mg 60/Ct $7.25 Goodsense Best Fiber Powder Sugar Free 62 Servings $9.00 Metamucil Smooth Orange Singles 30/Ea $17.25 First Aid Bandages All-In-One Finger Dressing (3 sterile dressings) $3.75 Elastic Bandage 3 X 5 Yds $1.25 Antibacterial Sheer Band Aid Assorted 20/Ct $2.00 Elastic Bandage 4 X 5 Yds $1.50 Elastic Bandage 2 X 5 Yds $1.00 J & J Flex. Fabric Assorted Bandages 30/Bx $4.00 J & J Flexible 3/4 X 3 Bandage 30/Bx $4.00 J & J Flexible XL 1 3/4 X 4 Bandage 10/Bx $4.00 J & J Knuckle & Fingertip Bandage 20/Bx $4.00 J&J Plastic Bandages 3/4 X 3 60/Bx $3.00 Krimptex Bandage Roll 4.5 X 4.1 Yds $1.25 New Skin Liquid Bandage 50 Applications.3 fl Oz Visit us online at Fieldtex-FHCA.com 9

14 First Aid Bandages Nexcare Non-Stick Pads 3 X 4 12/Bx $5.25 Sheer Spot 7/8 Bandage 100/Bx BX100 $2.25 First Aid Dressings and Gauze Cohesive Elastic Bandage 3 X 5 Yds $1.50 Cotton Swabs 300/Ct $1.75 J&J Gauze Pads 4 X 4 10/Bx $4.25 QC Cotton Balls 100% Cotton 300/Bag $1.50 First Aid Tape Clear Surgical Tape 1 X 10 Yds $1.25 Clear Surgical Tape 2 X 10 Yds $2.50 Covered Tape 1/2 X 5 Yds $1.75 Micropure Surgical Tape 1/2 X 10 Yds $1.00 You no longer have to wait until the first of the month to mail in your orders! Send it in when you make your selection and it will be processed as soon as your next benefit becomes available 10 Mail in the order form for fast and easy delivery of your OTC items

15 First Aid Kits Goodsense Mini First Aid Kit $2.50 J&J First Aid Kit 125 Piece $13.00 Personal Soft First Aid Kit $6.50 Foot Care Foot Care Kit $7.50 Arm & Hammer Easy Spray Foot Powder 7.5 Oz $9.75 Arm & Hammer Odor Control Foot Powder 7.0 Oz $8.50 Compound W Plantar Pads 20/Ct $10.00 Goodsense Corn & Callus Remover.3 fl Oz $4.00 Freeze Off Original Spray 8/Applications $17.00 Goodsense Corn Cushions 9/Ct $2.0 Goodsense Clotrimazole Cream Usp 1% 1 Oz $3.50 Goodsense Liquid Wart Remover.3 fl Oz $4.25 Goodsense Medicated Foot Powder 4 Oz $3.50 Goodsense Moleskin Plus 4/Ct (4.125 x ) $2.50 Goodsense Toe Separator Triple Layer 6 Pc $3.25 Liquid Callus & Corn Remover.31 fl Oz $4.50 Lotrimin Spray 4.6 Oz $9.75 Medicated Corn Remover Pads 9/Ct $2.00 Visit us online at Fieldtex-FHCA.com 11

16 Foot Care Tolnaftate Antifungal Cream.5 Oz $3.00 Triderma Diabetic Foot Healing Cream 4.2 Oz $10.00 Hemorrhoid Goodsense Hemorrhoid Relief Ointment 2 Oz $4.50 Goodsense Medicated Pads 100/Ct $5.50 Prep Hemorrhoid Suppositories 24/Ct $6.00 Preparation H Cooling Gel 0.9 Oz $10.00 Hot & Cold Therapy Advocate Heating Pad Classic 12 X $17.50 Preparation H Suppositories 24/Ct $20.00 Cold Pack Pocket Wrap $1.50 Tucks Medicated Pads 40/Ct $7.00 Cool-It Eye Pack Reusable Cold 2.5 X $1.50 Goodsense Cool & Heat Balm 3.5 Oz $4.75 Heat Pack 5 x $0.75 QC Extra Str Cold & Hot Therapy Patch 5/Pk $4.75 Reusable Ice Bag Medium $6.00 Salonpas Arthritis Pain Patch 5/Ea $9.50 Salonpas Deep Relieving Gel 2.75 Oz $ Mail in the order form for fast and easy delivery of your OTC items

17 Hot & Cold Therapy Salonpas Hot-Gel Patch 6/Ea $10.00 Thermacare Knee/Elbow Heat 2/Ea $10.00 Thermacare Lower Back & Hip 2/Ea $10.00 Thermacare Muscle & Joint Heat 1/Ea $3.75 Thermacare Neck To Arm 3/Ea $10.00 Therma-Kool 6X9 Reusable Cold/Hot Pack $2.75 Incontinence A & D Original Ointment 1.5 Oz $3.75 Maxi Care 30 X 30 Absorbent Pad 10/Bag $7.00 Balmex Adult Cream 3 Oz $5.50 Prevail Bladder Control Pad Maximum 48/Bag $15.00 Balmex Zinc Oxide Cream 2 Oz $4.50 Prevail Bladder Control Pads Moderate 20/Bag Prevail Bladder Control Pads Ultra Thin 30/Bag $7.00 Prevail Boxers For Men - Large/ XLarge 10/Bag $17.00 Prevail Boxers For Men - Medium 12/Bag $17.00 Prevail Breezers Ultimate Absorbency Unisex Large Blue Waist /Bag $21.00 Prevail Breezers Ultimate Absorbency Unisex Medium White Waist /Bag $21.00 Prevail Breezers Ultimate Absorbency Unisex Regular Lavender Waist /Bag $21.00 Visit us online at Fieldtex-FHCA.com 13

18 Incontinence Prevail Breezers Ultimate Absorbency Unisex X-Large Beige Waist /Bag $21.00 Prevail Male Guard 14/Bag $5.50 Prevail Per-Fit Protective Underwear Women XLarge 14/Bag $13.50 Prevail Per-Fit Protective Underwear Women/Medium 20/Bag $12.00 Prevail Per-Fit Underwear Women/Large 18/Bag $12.00 Reusable Bed Pad 34 X $15.00 Surecare Shield Light-Moderate 25/Pk $8.00 Surecare Underwear XL /Bag $17.25 Surecare Underwear Lg /Bag $18.00 Vitamin A&D Ointment 4 Oz $2.00 Surecare Underwear Md /Bag $18.00 Lactose Dairy Aid Original Strength Caplet 60/Ct $6.75 Goodsense Dairy Digestive Fast Acting Caps 60/Ct $10.75 Lactaid Fast Acting Caps 32/Caps $11.00 Schiff Digestive Advantage Defense 32/Caps $ Mail in the order form for fast and easy delivery of your OTC items

19 Medication Motion Sickness Acu-Strap Morning & Motion Sickness Band $3.75 Dramamine Tablets 12/Tabs $5.50 Dramamine Tablets 12/Tabs $5.50 Ointments & Topicals Antifungal Cream 1 Oz $3.75 Aveeno Anti-Itch Lotion 4 Oz $8.00 Bacitracin 1 Oz $2.25 Benadryl Extra Itch Cooling Spray 2 Oz $7.00 Gold Bond Anti-Itch Max Relief Cream 2 Oz $8.00 Calamine Lotion Major Brand 177 ML $3.25 Goodsense Burn Gel 4 Oz $4.25 Cool Blaze Burn Gel 6/Bx.125 Oz/Ea $3.00 Goodsense Hydrocortisone 1% Anti-Itch Max Strength 1 Oz $3.50 Goodsense Itch Relief Cream Extra Soothing 1 Oz $3.00 Hydrocortisone Ointment 1% 1 Oz Tube $2.00 QC Triple Antibiotic Ointment 1 Oz $4.75 Triple Antibiotic Ointment Tube 1 Oz $2.50 Triple Antibiotic (Neosporin) Plus 1 Oz $7.75 Visit us online at Fieldtex-FHCA.com 15

20 Ointments & Topicals Analgesics Analgesic Cream W/Aloe 3 Oz $4.50 Aspercreme 1.25 Oz $4.25 Ben Gay Greaseless Balm 2 Oz $6.00 Cortizone-10 Ointment 2 Oz $9.75 Flex-All Ultra Plus 2 Oz $6.75 Icy Hot Cream 1.25 Oz $4.50 Muscle Rub Ultra Strong 3 Oz $3.00 Muscle Rub Vanishing Scent Gel 3 Oz $2.00 Ointments & Topicals Cleaners Alcohol Wipes 200/Bx BX200 $2.25 Bactine First Aid Liquid 4 Oz $5.50 Tiger Balm Ultra Strength Sports Rub 1.7 Oz $16.00 Decolorized Iodine 2 Oz $4.00 J & J Hurt Free Antiseptic Wash 6 Oz Pain Relief Acetaminophen Extra Strength 500 Mg Apap 100/Ct N $2.25 Acetaminophen Regular Strength 325mg 100/Ct $1.25 Advil 100 Ct $ Mail in the order form for fast and easy delivery of your OTC items

21 Pain Relief Advil 50/Ct $9.00 Advil Film Coated Caps 20/Ct $6.25 Advil Gel Cap 50/Ct $9.00 Advil Gel Caplets 24/Ct $5.75 Advil Liqui-Gel 80/Ct $16.00 Advil Liqui-Gels 20/Caps $6.00 Advil Migraine Liqui-Gel 20/Ct $6.50 Advil PM 40/Coated Caplets $11.25 Advil PM Liqui-Gels 20/Ct $8.75 Aleve Arthritis Cap 100/Ct $15.50 Aleve Easy Open Cap 220Mg 40/Gelcaps $9.75 Aleve Liquid Gels 80/Ct $18.50 Aleve PM Caps 20/Ct $7.00 Aspirin Regimen Bayer Low Strength Tabs 120/Tabs $10.00 Bayer Aspirin Tabs 325Mg 100/Ct $10.00 Bayer Chewable Aspirin 81Mg Cherry 36/Ct $3.75 Bayer Women s Caplets Aspirin 81Mg Plus 777Mg Calcium 60/Tabs $10.00 Chewable Aspirin 81Mg Orange 36/Ct $1.75 Visit us online at Fieldtex-FHCA.com 17

22 Pain Relief Excedrin Extra Strength Caplets 100/Ct $16.00 Excedrin Migraine Caplets 24/Ct $5.75 Extra Strength Bayer Aspirin 500Mg 50/Caps $7.75 Goodsense Arthritis Pain Relief APAP 650Mg 24/Caps $4.00 Goodsense Boxed Aspirin 81Mg Orange 36/Ct $1.50 Ibuprofen IB Caplets 200Mg 100/Ct N $3.50 Low Dose Aspirin 81 Mg 120/Tabs N $1.50 Motrin IB Liquid Gels 20/Ct $6.25 Motrin IB 100/Ct $13.50 Motrin PM Caplets 20/Ct $6.25 Motrin IB 50/Caps $8.50 Naproxen (Generic Aleve) 220Mg 100/Ct N $5.75 Non Aspirin Acetaminophen PM 500Mg 50/Ct $1.50 Norwich Aspirin 100/Ct $3.00 QC Children s 80 Mg Chew Fruit 30/Ct $3.00 QC Headache Relief Extra Strength 50/Tabs $3.50 St. Joseph Aspirin 81Mg 120/Micro Tabs $7.50 St. Joseph Low Dose Aspirin 81Mg 36/Chewable $ Mail in the order form for fast and easy delivery of your OTC items

23 Pain Relief Tylenol Extra Strength 500Mg 100/Ct $14.50 Tylenol Extra Strength 500Mg 24/Ct $6.00 Tylenol PM Caplets 24/Ct $6.50 Tylenol Reg Strength 100/Tabs $11.25 Skin Care Abreva Oral Care Pump 2.0 Gram $25.00 Goodsense Aloe With Lidocaine Gel 8 Oz $4.25 Campho-Phenique Cold Sore Treatment.23 Oz $5.75 Goodsense Scar Gel 1.75 Oz $8.25 Goodsense Aloe Vera 16 Oz $4.00 Medicated Body Powder 10 Oz $4.75 Sleep Aid Sleep Aid (Generic Unisom) 16/Ct $4.00 Sleep Tabs (Generic Of Sominex) 50/Ct $3.00 You no longer have to wait until the first of the month to mail in your orders! Send it in when you make your selection and it will be processed as soon as your next benefit becomes available Visit us online at Fieldtex-FHCA.com 19

24 Stomach & Laxatives Alka-Seltzer Heartburn + Gas Relief Chews 54/Ct $10.75 Alka-Seltzer Heartburn Relief Chews Assorted 36/Ct $6.75 Anti-Diarrheal 2 Mg 24/Caps $3.75 Beano Tablets 30/Btl $6.50 Enema Adult 4.5 Oz $2.00 Ex-Lax Chocolate 24/Pieces $6.25 Gas-X Extra Strength 10/Softgels $3.50 Goodsense Antacid & Pain Reliever 36/Ct $4.00 Generic Tums 96/Ct $4.25 Goodsense Anti-Nausea Liquid Cherry 4 Oz $2.50 Glycerin Suppository 25/Ct $3.00 Goodsense Famotidine Acid Reducer 10Mg 30/Ct $6.00 Goodsense Gentle Stool Softener 25/Ct $2.75 Goodsense Laxative Bisocodyl 25/Ct $2.00 Goodsense Senna Laxative 100/Ct $3.25 Imodium Liquid 4 Oz $7.75 Lansoprazole (Prevacid) 15Mg 14/Tabs $11.00 Miralax OTC 7 Dose 4.1 Oz $ Mail in the order form for fast and easy delivery of your OTC items

25 Stomach & Laxatives Omeprazole 20 Mg 14/Tabs $13.00 Omeprazole 20Mg (Prilosec OTC) 28/Ct $23.00 Pepcid AC Original Strength 30/Tabs $14.00 Pepto Bismol 4 Oz Phillips Colon Health Probiotic Supplement 30/Tabs $24.00 Phillips Stool Softner 30/Ct $5.75 Prevacid 24 Hr 15Mg OTC 14/Tabs $17.50 Prilosec OTC 14/Tabs $18.00 QC Gas Relief And Prevention 20/Caps QC Ultra Strength Antacid Calcium Supplement Flavors Vary 72/Tabs $5.25 Ranitidine 75Mg 30/Ct Rolaids Advanced Antacid Plus Anti-Gas 60/Tabs $8.00 Rolaids Softchews Antacid Flavors Vary 12/Bx $3.50 Rolaids Ultra Antacid Tabs Fruit 72/Tabs $7.50 Tums 96/Ct Flavors Vary $7.25 Zantac 75 10/Tabs $7.00 Zantac 75 Acid Reducer 30 Tabs $14.00 Visit us online at Fieldtex-FHCA.com 21

26 Sunscreen Aveeno Natural Sunscreen SPF 50 3 Oz $13.25 Coppertone Sunscreen SPF 30 8 Oz $13.00 Nature s Glo Sunscreen SPF 50 8 Oz $7.25 Support Ankle Adjustable Ankle Support $9.25 Mueller Ankle Support Elastic Large $6.25 Mueller Ankle Support Elastic Medium $6.25 Mueller Ankle Support Elastic Small $6.25 Procare Elastic Ankle Support Small Procare Elastic Ankle Support Large Procare Elastic Ankle Support XL Procare Elastic Ankle Support Med Scott Specialties Ankle Support XL $12.00 Support Back Mueller Back Brace Adjustable $ Mail in the order form for fast and easy delivery of your OTC items

27 Support Elbow Neoprene Elbow Support - One Size Fits All $14.75 Procare Elbow Support Lg $5.25 Procare Elbow Support XL $5.25 Procare Elastic Elbow Support Sm $5.25 Tera-Prene Tennis Elbow Sleeve XL $23.00 Support Knee Procare Knee Support Sleeve Large Procare Knee Support Sleeve XL Procare Knee Support Sleeve Med Procare Knee Support Sleeve Small Support Wrist Adjustable Wrist Support $14.25 Quick-Fit Wrist Support Left Unisize $22.00 Quick-Fit Wrist Support Right Unisize $22.00 Wrist Brace $12.00 Wristlet $3.00 Visit us online at Fieldtex-FHCA.com 23

28 Vitamins & Minerals Certa-Vite Senior (Centrum Silver) 60/Ct $4.00 Goodsense Century Mature Men s 50+ Multi-Vitamin 100/Ct $8.75 Goodsense Century Ultimate Women s Multi-Vit 100/Ct $8.75 Goodsense Chocolate Calcium Chews 60/Ct $5.50 K 100 Mcg 100/Tabs Major B-Complex B-12 Caplets 100/Btl $3.50 Major Calcium 600Mg +D 200 IU 60/Btl $2.00 Major Magnesium 500 Mg Tablets 100/Btl $3.75 Major Folic Acid 400 Mcg Tablets 100/Btl $1.75 Major Oyster Shell 500 Mg+D 150/Btl $5.50 Major High Potency Vitamins & Minerals 100/Ct $5.50 Major Tab-A-Vite W/Iron 100/Btl $4.00 Major Vitamin B Mcg 130/Btl $6.00 Major Vitamin B Mcg 130/Btl $3.50 Major Vitamin B-6 50Mg (Pyridoxine) 100/Ct $3.50 Major Vitamin C 1000 Mg Tablets 100/Btl $7.50 Major Vitamin D 1000 IU Tablets 100/Btl $2.75 Major Vitamin D 400 IU Tablets 100/Btl $ Mail in the order form for fast and easy delivery of your OTC items

29 Vitamins & Minerals Mason D5000 IU 100 Softgels $19.75 One A Day Men s 50+ Advantage 65/Ct $12.00 One A Day Proactive 65+ For Men And Women 150/Tabs $12.75 One A Day Women s 50+ Advantage 65/Ct $12.00 Vitamin E 100 IU Dl-Alpha Softgels 100/Ct $3.25 Windmill Sustain Release B-Complex 60/Tabs $7.00 Windmill Vitamin B Mcg 100/Tabs Windmill Vitamin C /Tabs $4.25 Windmill Vitamin E /Tabs $7.75 Fish Oil Cholesterol Free 1000/Mg 120/Softgels $6.00 Glucoflex Glucosamine & Chondroitin 60/Bx $15.00 Major Coenzyme Q Mg 30/Tabs $15.00 Major Ferosul 5 Gr Green Tablets 100/Btl $2.00 Mason Magnesium 200 Mg 100/Tabs $4.75 Potassium Gluconate 595 Mg 100/Tabs $5.25 Goodsense Chocolate Calcium Sugar Free Chews 60/Ct $5.50 Visit us online at Fieldtex-FHCA.com 25

30 Vitamins & Minerals Special Supplements Coconut Oil 1000 Mg 60/Softgels $8.75 Glocosamine Chondroitin 2X Strength 60/Btl $10.25 Major Chromium Picolinate 200Mcg 100/Btl $7.75 Mason Natural Prostate 30/Softgels $12.25 Mason Natural Prostate Therapy Complex 60/SoftGels $15.75 Red Yeast Rice 1200Mg 60/Caps $7.50 Zinc Chewable (Natural Citrus Flavor) 60/Tabs $ Mail in the order form for fast and easy delivery of your OTC items

31 Important Things to Remember Please note that certain items in this catalog may be covered under Medicare Part B or Part D. When the item is covered under Part B or Part D, you may not be able to use this OTC benefit. You cannot use future allowance amounts when placing your order. However if you wish to use personal funds for purchases that exceed your allowance, please call Fieldtex Products with your credit card information. Please note that neither Medicare or Health First Health Plans will reimburse you for purchases above your monthly allowance. Any unused portion of your monthly allowance cannot be carried over to the following month. Please allow 7-10 days for delivery of in-stock items. You will be notified if an item is out of stock and may take longer for delivery. If mailing your order, please allow 1 week for mail delivery to Fieldtex. Mail orders will be processed the month in which they are received, unless that monthly allowance has been used, then they will be processed when a new allowance becomes available. If you receive a damaged item, call Fieldtex Products immediately at (TTY Hearing Impaired: 711) Monday through Friday 8 a.m. to 5 p.m. The item will be exchanged for an identical item at no cost to you. Please note that only damaged products can be exchanged within 30 days of purchase, no other returns are allowed. If an out of stock item is to occur or a product is discontinued, only generic products will be replaced for a generic product, a generic will never be replaced for a name brand name item. Fieldtex Products is the supplier of all the products in this catalog and can only answer questions pertaining to your order. Medical information regarding the use of these products is not available. Please consult your physician. The health information provided in this catalog is general in nature and is not medical advice or a substitute for professional health care. It is provided for your information and convenience only. Fieldtex Products does not guarantee the accuracy or completeness of the information, and does not recommend or endorse the products which are referenced in the catalog. Products in this catalog should only be ordered for the enrolled member. All items listed on pages are Dual Purpose items. In order to purchase these items under your plan, your personal physician must recommend them to you for a specific diagnosed condition. Please speak to your physician before ordering these items. If you disenroll from Health First Health Plans Platinum (HMO) Plan your Over-the-Counter (OTC) benefit will automatically terminate. Products may not be purchased at a local retail pharmacy or through any other source other than the Fieldtex Products, Inc. Over-the-Counter (OTC) Benefit Catalog. Your monthly allowance will not roll over to the next month if not used. **Please keep this catalog for your entire 2017 benefit year** Visit us online at Fieldtex-FHCA.com 27

32 Non-Eligible OTC Categories Alternative Medicines Baby Items Contraceptives Convenience Items Cosmetics Food Supplements Replacement Items, Attachments, Peripherals Homeopathic and Alternative Medicines including Botanicals, Herbals, Probiotics and Neutraceuticals Diapers, Formula Birth Control Pills, Spermacide, Prophylactics Scales, Fans, Magnifying Glasses, Ear Plugs, Insoles, Arch Supports and Gloves Mouthwashes, Bad Breath Remedies, Deodorants, Lip Soothers, Grooming Devices, Skin Moisturizers, Teeth Whiteners Sugar/Salt Supplements, Energy Bars, Liquid Energizers, Protein Bars, Power Drinks Hearing Aid Batteries, Contact Lens Containers, etc. when not factory packaged with the original item 28 Mail in the order form for fast and easy delivery of your OTC items

33 English: ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call (TTY: ). Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: ). French Creole: ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele (TTY: ). Vietnamese: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số (TTY: ). Portuguese: ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para (TTY: ). Chinese: 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 (TTY: ) French: ATTENTION : Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le (ATS : ). Tagalog: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa (TTY: ). Russian: ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (телетайп: ). Arabic: ملحوظة: إذا كنت تتحدث اذكر اللغة فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم )رقم هاتف الصم والبكم: (. Italian: ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero (TTY: ). German: ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: (TTY: ). Korean: 주의 : 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다 (TTY: ) 번으로전화해주십시오. Polish: UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer (TTY: ). Gujarati: સ ચન : જ તમ ગ જર ત બ લત હ, ત નન:શ લ ક ભ ષ સહ ય સ વ ઓ તમ ર મ ટ ઉપલબ ધ છ. ફ ન કર (TTY: ). Thai: เร ยน: ถ าค ณพ ดภาษาไทยค ณสามารถใช บร การช วยเหล อทางภาษาได ฟร โทร (TTY: ). Y0089_EL6074FH Accepted

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36 Ordering is Easy! You can fill out and mail the enclosed order form or place your order online at Fieldtex-FHCA.com. Please see complete step-by-step instructions inside. Visit us online at Fieldtex-FHCA.com. Florida Hospital Care Advantage is administered by Health First Health Plans. Health First Health Plans is an HMO plan with a Medicare contract. Enrollment in Health First Health Plans depends on contract renewal. Florida Hospital Care Advantage does not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations. This information is not a complete description of benefits. Contact the plan for more information. The Formulary, pharmacy network, may change at any time. You will receive notice when necessary. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. Y0089_MPINFO6217 (09/16)

37 Important Things to Remember The health information provided in the catalog is general in nature and is not medical advice or a substitute for professional health care. It is provided for your information and convenience only. Fieldtex Products does not guarantee the accuracy or completeness of the information, and does not recommend or endorse the products which are referenced in the catalog. Products in the catalog should only be ordered for the enrolled member. All items listed on pages of the catalog are Dual-Eligible items. In order to purchase these items under your plan, your personal physician must recommend them to you for a specific diagnosed condition. Please speak to your physician before ordering these items. If you disenroll from the Florida Hospital Care Advantage Explorer Plan (HMO-POS), your Over-The-Counter (OTC) benefit will automatically terminate. Products may not be purchased at a local retail pharmacy or through any other source other than the Fieldtex Products, Inc Over-The- Counter Benefit Catalog. Benefits may change on January 1 of each year. Florida Hospital Care Advantage is administered by Health First Health Plans. Health First Health Plans is an HMO plan with a Medicare contract. Enrollment in Health First Health Plans depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. The Formulary, pharmacy network, may change at any time. You will receive notice when necessary. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. Y0089_MPINFO6216 (09/16) Detach Here Mail Order Form Member Name: Member ID: Date of Birth: Ship To: Address: Apt./Room #: City: State: Zip: Phone: ( ) Alternate Contact: Phone: ( ) Item # Description Qty Price Total Total: Florida Hospital Care Advantage complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: ). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele (TTY: ).

38 Important Things to Remember Place Stamp Here Please note that certain items in the catalog may be covered under Medicare Part B or Part D. When the item is covered under Part B or Part D, you may not be able to use this OTC benefit. You cannot use future allowance amounts when placing your order. However if you wish to use personal funds for purchases that exceed your allowance, please call Fieldtex Products with your credit card information. Please note that neither Medicare or Florida Hospital Care Advantage will reimburse you for purchases above your monthly allowance. Any unused portion of your monthly allowance cannot be carried over to the following month. Please allow 7-10 days for delivery of in-stock items. You will be notified if an item is out of stock and may take longer for delivery. If mailing your order, please allow one week for mail delivery to Fieldtex. Mail orders will be processed the month in which they are received. If you receive a damaged item, call Fieldtex Products immediately at (TTY Hearing Impaired: 711) Monday - Friday, 8 am to 5 pm. The item will be exchanged for an identical item at no cost to you. Please note that only damaged products can be exchanged within 30 days of purchase. No other returns are allowed. Substitutions will not be made except in the case of generic products. Fieldtex Products is the supplier of all the products in the catalog and can only answer questions pertaining to your order. Medical information regarding the use of these products is not available. Please consult your physician. FROM: Fieldtex Products, Inc. FHCA Order Department 3055 Brighton-Henrietta TL Road Rochester, New York If you need assistance ordering, please call Customer Service at (TTY/TDD relay: ) Monday through Friday from 8 am to 8 pm and Saturday from 8 am to noon. From October 1 February 14, we re available seven days a week from 8 am to 8 pm. Option #2: Order Online Place your order online at Fieldtex-FHCA.com. Log in using your member ID number as the user name, and your birth date as the password. As you add items to your cart, you will see the balance on the screen so you can be careful not to order beyond your benefit allowance. Option #1: Mail Order Form Select your items and list them on the other side of this order form. Be sure to stay within your $25 allowance. Include your member ID number and birth date on the form. Fold and tape the form closed with the address showing on the outside, affix postage, and drop it in the mail. Simply fill out and mail this order form or place your order online. Ordering is Easy! Over-The-Counter (OTC) Benefit Order Form Fieldtex-FHCA.com