Important Things to Remember. Mail Order Form. Total:

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1 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_MPINFO4891FH (09/15) Detach Here Mail Order Form Member Name: Member ID: Date of Birth: Ship To: Addr ess: Apt./Room #: City: State: Zip: Phone: ( ) Alternate Contact: Phone: ( ) Item # Description Qty Price Total Total:

2 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 ) Monday thr If you need assistance or October 1 February 14, we r ough Friday fr e available seven days a week fr om 8 am to 8 pm and Satur om 8 am to 8 pm. day from 8 am to noon. Fr dering, please call Customer Service at (TTY/TDD r elay: om Option #2: Or der 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. e 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, af fix postage, and dr op it in the mail. Option #1: Mail Or Select your items and list them on the other side of this or der Form der form. Be sur 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

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

4 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 am to 8 pm or Saturday from 8 am to noon. From October 1 February 14, we re available seven days a week from 8 am to 8 pm. We value your membership and look forward to serving you in the years ahead. Sincerely, Florida Hospital Care Advantage

5 Table of Contents Allergy & Flu Cough Drops Dental Care Diagnostic Equipment Thermometer...7 Ear Care...7 Eye Care Fiber Supplements...8 First Aid Bandages First Aid Gauze, Dressings...9 First Aid Tape...10 Foot Care Hot & Cold Therapy Incontinence Supplies Lactose...13 Medication Motion Sickness...13 Ointments & Topicals Ointments & Topicals Analgesics Ointments & Topicals Cleaners...15 Hemorrhoid...15 Pain Relief Skin Care...18 Skin Care Sunscreen...18 Stomach & Laxatives Support Ankle & Back Support Elbow & Knee...21 Support Wrist...21 Feminine & UTI Products...21 First Aid Kits...22 Vitamins & Minerals Vitamins & Minerals Special Supplements...24 iv Mail in the order form for fast and easy delivery of your OTC items

6 Allergy & Flu Careall Medicated Chest Rub 3.53 Oz $1.50 Complete Allergy Medicine 100/Tb N $1.50 Nasal Decongestant Spray (Afrin) 1 Oz $1.75 Generic Nasal Spray Extra Moisture 1 Oz $2.25 Generic Allergy 24/Bx $2.25 Generic Cough/Cold High Blood Pressure 16/Tb $2.75 Generic Tussin DM 4 Oz $3.00 Mucus Relief Tabs 30/Tb $3.25 Generic Saline Nasal Spray 1.5 Oz $3.00 Mentholatum Ointment 1 Oz Jar $3.25 Banophen Elixir (Unboxed) 4 Oz Benadryl $3.00 Generic Allergy/Sinus Headache 20/Ct $3.25 Generic Night Time Cold-Flu Relief 16/Tb $3.75 Generic Effervescent Cold Relief 20/Tb Generic Allergy 10 Mg Loratidine 30/Ct Generic Tussin DM Sugar Free 4 Oz Campho-Phenique Cold Sore Treatment $5.50 Severe Sinus Congestion Allergy & Cold Liquid Gels 20/Ct $5.75 Visit us online at Fieldtex-FHCA.com 1

7 Allergy & Flu Benadryl Allergy 24/Bx $6.00 Alka Seltzer Plus Cold Cherry 20/Tb $6.75 Generic Mucus Relief DM 30/Ct $7.00 Alka Seltzer Original Foil 36/Tb $7.00 Vick s Dayquil Cold & Flu Caps 8/Ct $7.75 Child/Adult Cough DM 12 hour Est Release Suspension 3 Oz (Delsym DM) $7.75 Coricidin HBP 20/Bx $8.00 Robitussin Cough & Chest Sugar Free 4 Oz $8.50 Airborne Original Orange 10/Tb $8.25 Alka Seltzer Plus Severe Cough Mucus & Congestion Day/Night 20/Ct $8.50 Alka Seltzer Plus Severe Sinus Congestion Allergy & Cough Liquid Gels 20/Ct $8.25 Tylenol Sinus Severe 24/Caps $8.75 Tylenol Cold & Flu 8 Oz $9.25 Allegra 24 Hr 180 Mg 30/Ct $25.00 Vick s Vaporub 3.53 Oz $10.00 Generic All day Allergy Cetirizene 30/Ct $11.00 Vick s DayQuil Cold & Flu Caps 20/Bx $12.00 Delsym Cough Suppressant 3 Fl Oz $ Mail in the order form for fast and easy delivery of your OTC items

8 Allergy & Flu Alka Seltzer Plus Cold & Cough Liquid Gels 40/Ct $13.50 Sambucol Night Cold & Flu syrup 4 Oz $13.50 Zicam Allergy Relief.5 Oz Nasal Gel $13.50 Allegra 12 Hr 60 Mg 12/Ct $14.00 Breathe Right Nasal Strips Large 30/Bx $15.00 Breathe Right Strips Sm/Med 30/Bx $15.00 Claritin Reditabs 10/Bx $15.00 Zyrtec 10 Mg 14/Ct $17.50 Mucinex Fast-Max Cold, Flu & Sore Throat 9 Oz $15.00 Flonase OTC 60 Nasal Spray for Allergies $19.50 Mucinex DM 20/Bx $15.75 Abreva.07 Oz $23.25 Abreva Oral Care Pump 2.0 gram $24.00 Cough Drops Generic Vitamin C Drops 60 Mg 30/Bg $1.50 Generic Sugar Free Menthol Cough Drops 25/Bg Generic Sugar Free Black Cherry Cough Drops 25/Bg Visit us online at Fieldtex-FHCA.com 3

9 Cough Drops Luden s Cough Drop SF Wild Cherry 25/Ea $2.25 Halls Honey Lemon Cough Drops 30/Bg $2.50 Halls Menthol-Lyptus Cough Drops 30/Bg $2.50 Luden s Throat Drops Wild Cherry 30/Bg $2.50 Halls Defense Asst Sugar Free Citrus Vitamin C 60 Mg 25/Bg $2.75 Halls Defense Citrus 100 % Daily Vitamin C 30/Bg $2.75 Ricola Cough Drop Cherry Honey 24/Ea $2.75 Sucrets Sore Throat Lozenges Cherry 18/Bx Ricola Cough Drops 21/Bg $2.75 Chloraseptic Lozenges - Citrus 18/Bx $4.75 Ricola Sugar Free Cough Drops Lemon 19/Bg $2.75 Cough Drops Honey Lemon 30/Ct $1.50 Dental Care Generic Nylon Toothbrush $1.00 Generic Premium Toothbrush $1.00 Generic Premium Anticavity Toothpaste 4.6 Oz $1.25 Generic Dental Floss Wax Mint 100 Yds N $1.25 Generic Elite Angle Full Head Soft Toothbrush $1.75 Colgate Plus Soft Toothbrush A 4 Mail in the order form for fast and easy delivery of your OTC items

10 Dental Care Denture Cleaner Tablets 40/Ct Oral B Interdental Starter Kit Brush A J&J Reach Floss Waxed Mint 55 Yds Colgate Extra Clean, Med. Adult 558 Toothbrush Generic Floss Waxed Unflavored 100 Yds Generic Mint Flosser W/Pick 50/Bg Denture Bath Sea Bond (1 Container) $2.25 Pepsodent Complete Care 6 Oz $2.50 Generic Tongue Cleaner 1/Ct $2.25 AquaFresh Cavity Protection Tube 5.6 Oz $3.00 Generic Denture Adhesive 2.04 Oz $2.50 Oral B Ortho Soft Toothbrush $3.00 Generic Elite Angle Full Head Med Toothbrush $3.00 Colgate Zig/Zag Wave Med Toothbrush A $3.25 Colgate Wave Soft Toothbrush $3.25 Oral B Denture Brush Twin Head $3.25 Crest Regular Toothpaste 4.6 Oz $3.50 Colgate Total Clean Mint 4.2 Oz $4.25 Visit us online at Fieldtex-FHCA.com 5

11 Fixodent Original 1.4 Oz $4.50 Crest Pro Health Clean Mint 4.2 Oz $4.50 Polident Overnight 40/Ct $4.75 Polident 3-Minute 40/Ct $4.75 Poligrip SPG Free 1.4 Oz $4.75 Generic Denture Cleaning 90/Tb N $4.75 Polident Tablets Smokers 40/Ct $5.00 Poligrip Extra Care 2.2 Oz $7.00 Orajel Dry Mouth Gel 1.5 Oz $6.50 Fixodent ADH Neutral Zinc Free 2.4 Oz $7.00 Orajel Medicated Mouth Sore Swabs 12/Ea $7.00 Fixodent Complete Cream 2.2 Oz Soothing Mint $7.00 Polgrip SPG Free 2.4 Oz $7.50 Biotene Toothpaste Gentle Mint 4.3 Oz $8.00 Polident Overnight 84/Ct $8.25 Polgrip Twin Pack Original 2.4 Oz $14.25 Denture Brush $ Mail in the order form for fast and easy delivery of your OTC items

12 Ear Care Generic Ear Wax Removal Kit $3.75 Swim-Ear Ear Drops 1 Oz $4.75 Debrox Earwax Removal Drops.5 Oz $7.50 Murine Ear Wax Removal System $8.00 Diagnostic Equipment Thermometer Digital Thermometer Waterproof $5.00 Eye Care Artificial Tears Sterile.5 Fl Oz N Prestige Ear Digital Thermometer $25.00 Visine Advanced Relief Lubricant/Redness Reliever Eye Drops.28 Oz $2.75 Generic Sterile Lubricating Eye Drops.5 Oz $3.50 Clear Eyes Itchy Eye Relief.50 Oz $4.75 Clear Eyes Triple Action Relief.5 Oz $5.50 Visine Advanced Relief.5 Fl Oz $6.00 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 7

13 Eye Care Visine A.C. Seasonal Itching.5 Oz $6.50 Visine-A Eye Allergy Relief Eye Drops.5 Oz $7.00 Stye Eye Ointment Oz $8.50 Blink Contacts Lubricant Eye Drops.338 Oz $8.75 Eye Drops Original.5 Oz N $1.50 Lubricating Relief Eye Drops.5 Oz N Fiber Supplements Fiber-Tabs 90/Ct $8.00 Flaxseed Soft Gel 1000 Mg 60/Ct $6.50 Generic Sugar Free Best Fiber Powder 62 Servings $8.50 Fiber-Con Caplets 36/Bx $7.75 Metamucil Smooth Orange Singles 30/Ct $16.25 First Aid Bandages Antibacterial Sheer Band Aid Assorted 20/Ct Sheer 7/8 Spot Bandage 100/Bx BX100 $2.25 All-In-1 Finger Dressing $3.75 Elastic Bandage 2 X 5 Yds $0.50 Elastic Bandage 3 X 5 Yds $0.75 Elastic Bandage 4 X 5 Yds $ Mail in the order form for fast and easy delivery of your OTC items

14 First Aid Bandages Krinkle Bandage Roll 4.5 X 4.1 Yds $1.25 Cohesive Elastic Bandage 3 X 5 Yds $1.50 J&J Plastic Bandages 3/4 X 3 60/Bx $2.75 J & J Knuckle & Fingertip Bandage 20/Bx $3.50 J & J Flexible 3/4 X 3 Bandage 30/Bx $3.75 J & J Flex. Fabric Asst. Bandages 30/Bx J & J Flexible XL 1 3/4 X 4 Bandage 10/Bx First Aid Gauze, Dressings Cotton Swabs 300/Ct $1.75 New Skin Liquid Bandage 50 Apps $4.50 Combine Pads 5 X 9 20/Bx BX20 $3.50 Roll Gauze 2 X 4 Yds 12/Pk PK12 Gauze Pads 2 X 2 Sterile 100/Bx BX100 Roll Gauze 4 X 4 Yds Pk/ PK12 $5.00 Nexcare Non-Stick Pads 3 X 4 12/Bx $5.25 Gauze Pads 4 X 4 Sterile 100/Bx BX100 $7.25 Generic Cotton Balls 300/Ea $1.50 Visit us online at Fieldtex-FHCA.com 9

15 First Aid Tape Tape 1/2 X 5 Yds Covered $1.75 Lucid Clear Surg Tape 2 X 10 Yds Micropure Surgical Tape 1/2 X 10 Yds $0.75 Clear Surgical Tape 1 X 10 Yds $1.00 Foot Care Generic Moleskin Plus 4/Ct $2.50 Generic Clortimazole Cream Usp 1%.5 Oz $3.50 Tolnaftate 1% Antifungal Cream.5 Oz $3.00 Generic Medicated Foot Powder 4 Oz $3.50 Generic Toe Separator Triple Layer 6 Pc $3.25 Generic Corn & Callus Remover.5 Oz Generic Liquid Wart Remover.5 Oz $4.25 Liquid Callus & Corn Remover.31 Oz $4.50 Dr. Scholl s Corn Cushion Strips 6/Ct $6.00 Generic Corn Cushions 9/Ct Lotrimin Spray 4.6 Oz $9.25 Tridema Diabetic Foot Healing Cream 4.2 Oz $ Mail in the order form for fast and easy delivery of your OTC items

16 Foot Care Compound W Plantar Pads 20/Ct $10.00 Dr. Scholl s Dream Walk Ball of Foot Cushions 2/Ct $11.00 Freeze Off Original Spray 8/Applications $16.50 Medicated Corn Remover Pads 9/Ct Hot & Cold Therapy Heat Pack 5 X $0.75 Therma-Kool 6 X 9 Reusable Cold/Hot Pack $2.75 Cold Pack Pocket Wrap $1.50 Thermacare Muscle & Joint Heat 1/Bx $3.75 Cool-It Eye Pack 2.5 X 5 Reusable Cold $1.50 Generic Cool & Heat Balm 3.5 Oz $4.75 Generic Extra Strength Cold & Hot Therapy Patch 5/Pk $4.75 Reusable Ice Bag Medium $5.25 Salonpas Hot-Gel Patch 6/Ea $9.00 Salonpas Deep Relieving Gel 2.75 Oz $9.00 Thermacare Lower Back & Hip 2/Ea $9.00 Thermacare Neck To Arm 3/Ea $9.00 Visit us online at Fieldtex-FHCA.com 11

17 Hot & Cold Therapy Thermacare Knee & Elbow Heat 2/Bx $9.50 Salonpas Arthritis Pain Patch 5/Ea $9.50 Advocate Heating Pad Classic 12 X $17.00 Incontinence Vitamin A&D Ointment 4 Oz $1.75 A&D Ointment White 1.5 Oz $3.75 Balmex Adult Care Cream 3 Oz $5.50 Maxi Care 30 X 30 Absorbent Pad 10/Bg $6.50 Poise Liners Very Light 48/Ct N $7.50 Surecare Shield Light-Moderate 25/Ct $7.00 Poise Very Light Extra Coverage Lg 44/Ct $8.00 Desitin Max Strength 3 Oz $7.25 Poise Pads Moderate 20/Ct $8.25 Reusable Bed Pad 34 X $14.75 Surecare Underwear XL /Bg $16.25 Surecare Underwear Lg /Bg $17.00 Surecare Underwear Md /Bg $17.00 Depend Brief Max. Protection Large 16/Ct $18.75 Depend Shields For Men 58/Ct $ Mail in the order form for fast and easy delivery of your OTC items

18 Incontinence Depend Adj. Underwear L/XL 16/Ct $21.00 Depend Adj. Underwear Sm/Med 18/Ct $21.00 Poise Pads Maximum 48/Bg $21.00 Poise Pads Ultimate Coverage 33/Ct $21.00 Lactose GoodSense Dairy Digestive Fast Acting Caplets 60/Ct $10.75 Dairy Aid Original Strength Caplets 60/Btl $6.50 Medication Motion Sickness Dramamine Tablets 12/Tb $5.50 Generic Motion Sickness 12/Ct $1.75 Lactaid Fast Acting Caps 32/Ct $10.50 Acu-Strap Morning & Motion Sickness Band $3.75 Ointments & Topicals Dynarex Zinc Oxide Cream 2 Oz Hydrocortisone Cream 1% 1 Oz Bacitracin 1 Oz $2.25 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 13

19 Triple Antibiotic Ointment 1 Oz $2.50 Cool Blaze Burn Gel 6/Bx $3.00 Generic Hydrocortisone 1% Anti-Itch Max Strength 1 Oz $3.50 Generic Itch Relief Cream Extra Strength 1 Oz $3.00 Antifungal Cream 1 Oz $3.25 Calamine Lotion Generic Brand 3.99 Oz $3.25 Generic Burn Gel 4 Oz $4.25 Balmex Zinc Oxide Cream 2 Oz $4.50 Triple Antibiotic (Neosporin) Plus 1 Oz $4.75 Benadryl Extra Itch Cooling Spray 2 Oz $6.75 Triple Antibiotic (Neosporin) Plus 1 Oz $7.50 Gold Bond Anti-Itch Max Relief 2 Oz $7.50 Ointments & Topicals Analgesics IcyHot 1.25 Oz $4.50 Tiger Balm Ultra Strength Sports Rub 1.7 Oz $15.25 Muscle Rub 3 Oz Vanishing Scent Gel Mineral Ice Rub Freeze 4 Oz $2.25 Muscle Rub Ultra Strength 3 Oz $3.00 Aspercreme 1.25 Oz Mail in the order form for fast and easy delivery of your OTC items

20 Ointments & Topicals Analgesics Analgesic Cream W/Aloe 3 Oz $4.50 BenGay Greaseless Balm 2 Oz $5.75 Flexall Plus 2 Oz $6.00 Cortizone-10 Ointment 2 Oz $9.50 Ointments & Topicals Cleaners Alcohol Wipes 200/Bx BX200 $2.25 Bactine First Aid Liquid 4 Oz $5.50 Decolorized Iodine 2 Oz J & J Hurt Free Antiseptic Wash 6 Oz $5.00 Hemorrhoid Generic Medicated Pads 100/Ct $4.50 Generic Hemorrhoid Relief Ointment 2 Oz $4.50 Prep Hemorrhoid Suppositories 24/Ct $5.75 Tucks Medicated Pads 40/Ct $6.00 Visit us online at Fieldtex-FHCA.com 15

21 Pain Relief Acetaminophen Regular Strength 325 Mg 100/Ct $1.25 Generic Orange Boxed Aspirin 81 Mg 36/Ct $1.50 Low Dose Aspirin 81 Mg 120/Tb N $1.50 Generic Naproxen 220 Mg 100/Ct N $5.75 Advil Gel Caplets 200 Mg 24/Ct $5.75 Advil Migraine Liqui-Gel 20/Ct $6.00 Tylenol Extra Strength 500mg 24/Ct $6.00 Motrin PM Caplets 20/Ct $6.25 Advil Film Coated Caps 20/Ct $6.25 Advil Liquid Gels 200 Mg 20/Ea $6.25 Motrin IB Liquid Gels 20/Ea $6.25 Tylenol PM 24/Ct $6.50 Aleve PM Caps 20/Ct $7.00 St. Joseph E.C. Aspirin 81 Mg 120/Tb $7.55 Extra Strength Bayer Aspirin 500mg 50/Caps $7.75 Motrin Ib 200 Mg 50/Ct $8.00 Advil PM Liqui-Gels 20/Ct $8.75 Advil 200 Mg 50/Ct $ Mail in the order form for fast and easy delivery of your OTC items

22 Pain Relief Advil Gel Cap 50/Ct $9.00 Aleve Easy Open Cap 200 Mg 40/Gelcaps $9.50 Aspirin Regimen Bayer Low Strength Tabs 81mg 120/Ct $9.50 Bayer Aspirin Tabs 325mg 100/Ct $10.00 Bayer Women s Caplets Aspirin 81mg Plus Calcium 300mg 60/Ct $10.00 Advil PM Caplets 200 Mg 40/Ct $11.00 Tylenol Reg Strength 100/Tbs $11.25 Tylenol Extra Strength 500mg 100/Ct $14.00 Motrin IB 200 Mg 100/Ct $13.00 Advil Liqui-Gel 80/Ct $15.00 Advil 200 Mg 100/Ct $14.00 Aleve Arthritis Cap 100/Ct $15.50 Excedrin Extra Strength Caplets 100/Ct $15.75 Aleve Liquid Gels 80/Ct $18.00 Non-Aspirin PM Acetaminophen 500 Mg 50/Ct $1.50 Chewable Aspirin 81 Mg Orange 36/Ct $1.75 Acetaminophen Extra Strength APAP 500 Mg 100/Ct N $2.25 St. Joseph Chewable Aspirin 81 Mg 36/Tb $2.50 Visit us online at Fieldtex-FHCA.com 17

23 Pain Relief Norwich Aspirin 325 Mg 100/Btl $2.75 Generic Sleep Aid (Generic Sominex) 50/Ct $3.00 Generic Children s Pain Relief 80 Mg Chew 30/Ct $3.00 Bayer Chewable Aspirin 81 Mg Cherry 36/Ct $3.50 QC Headache Relief Extra Strength (Generic of Excedrin) 50/Tbs $3.50 Ibuprofen 200 Mg Caplets 100/Ct N $3.50 Generic Arthritis Pain Relief APAP 650 Mg 24/Ct Skin Care Generic Aloe Vera 16 Oz Generic Sleep Aid 25 Mg 16/Ct Generic Aloe With Lidocaine Gel 8 Oz $4.25 Excedrin Migraine Caplets 24/Ct $5.75 Medicated Body Powder 10 Oz $4.75 Generic Scar Gel 1.75 Oz $8.25 Aveeno Anti-Itch Lotion 4 Oz $8.00 Skin Care Sunscreen Generic Sunblock SPF 50 8 Oz $6.50 Coppertone Sunblock SPF 30 8 Oz $12.00 Aveeno Natural Protection Lotion Sunscreen With Broad Spectrum SPF 50 3 Oz $ Mail in the order form for fast and easy delivery of your OTC items

24 Stomach & Laxatives Tums Chewy Delight Cherry Ultra Strength 6/Ct $1.75 Tums Chewy Delight Peppermint Ultra Strength 6/Ct $1.75 Generic Laxative Bisacodyl 25/Ct Enema Adult 4.5 Oz Generic Anti-Nausea Liq Cherry 4 Oz $2.50 Generic Gentle Stool Softener 25/Ct $2.75 Glycerin Suppository 25/Ct $3.00 Gas-X Softgels Extra Strength 10/Ct $3.50 Generic Senna Laxative 100/Ct $3.25 Generic Antacid & Pain Reliever 36/Ct Anti-Diarrheal 2 Mg 24/Ct $3.50 Generic Gas Relief Prevention 20/Ct $5.00 Pepto Bismol 4 Oz $5.00 Ranitidine 75 Mg 30/Ct $5.00 Phillips Stool Softner 30/Ct $5.75 Generic Famotidine Acid Reducer 10 Mg 30/Ct $6.00 Beano Tablets 30/Btl $6.25 Ex-Lax Chocolate 24/Ct $6.25 Visit us online at Fieldtex-FHCA.com 19

25 Stomach & Laxatives Tums Tropical Flavor 96/Ct Flavor may vary due to availablity $6.50 Alka-Seltzer Relief Chews Heartburn Assorted Flavor 36/Ct $6.75 Zantac 75 Acid Reducer 10/Ct $7.00 Tums Extra Str Orange 80/Ct $7.00 Imodium Liquid 4 Oz $7.50 Miralax OTC 7 Dose 4.1 Oz $8.75 Lansoprazole (Prevacid) 15 Mg 14/Tb $10.00 Zantac 75 Acid Reducer 30/Bx $13.75 Alka-Seltzer Relief Chews Heartburn + Gas Tropical Punch 54/Ct $10.00 Pepcid AC Original Strength 30/Tb $14.00 Omeprazole 20 Mg 14/Ct $13.00 Prevacid 24 Hr 15 Mg OTC 14/Tb $16.50 Prilosec OTC 14/Ct $17.00 Omeprazole 20 Mg 28/Ct $22.00 Phillips Colon Health Probiotic Supplement 30/Ct $23.50 Support Ankle and Back Mueller Ankle Support Elastic Small Medium Large $6.25 Adjustable Ankle Support $8.25 Scott Specialties Ankle Support X-Large Open Toe and Heel $ Mail in the order form for fast and easy delivery of your OTC items

26 Support Ankle and Back Procare Elastic Ankle Support Small Medium Large XL $5.00 Mueller Back Brace Adjustable $22.25 Support Elbow and Knee Neoprene Elbow Support - One Size Fits All $14.75 Procare Elbow Support Small Large XL $5.25 Elbow Cap X-Large (Elbow Support) $11.75 Procare Knee Support Sleeve Small Medium Large XL 5.00 Support Wrist Adjustable Wrist Support $14.25 Tera-Prene Tennis Elbow Sleeve X-Large $23.00 Wrist Sleeve Left Right $21.25 Wristlet $3.00 Feminine & UTI Products Monistat Soothing Care Powder Gel 1.5 Oz $8.50 Uristat Pain Relief 36/Tb $8.75 Monistat 7 Day $14.50 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 21

27 First Aid Kits Kitchen First Aid Kit $5.00 Compact First Aid Kit $6.50 J&J First Aid Kit 125 Pc $12.50 Companion 2 First Aid Kit $5.00 Generic Mini First Aid Kit $2.50 Vitamins & Minerals Generic Folic Acid 400 Mcg Tablets 100/Btl $1.75 Generic Calcium 600Mg +D 200 IU 60/Btl Generic FeroSul 5 Gr Green Tablets 100/Btl Generic Vitamin D 400 IU Tablets 100/Btl $2.25 Generic Vitamin D 1000 IU Tablets 100/Btl $2.75 Generic Calcium 500 Mg Chewables 60/Btl $3.25 Dual- Vitamins & Minerals Generic Tab-A-Vite W/Iron 100/Btl Magnesium 200 mg 100/Tbs $4.75 Windmill Vitamin C /Btl $4.25 K 100 MCG 100/Tbs $5.00 Windmill Vitamin B Mcg 100/Btl $4.25 Potassium Gluconate 595 Mg 100/Tbs $ Mail in the order form for fast and easy delivery of your OTC items

28 Vitamins & Minerals Zinc Chewable (Natural Citrus Flavor) 60/Tbs $5.25 Generic Chocolate Calcium Chews 60/Ct $5.50 Generic Chocolate Calcium Sugar Free Chews 60/Ct $5.50 Generic High Potency Vita & Mineral 100/Btl $5.50 Generic Oyster Shell 500 Mg+D 150/Btl $5.50 Generic Vitamin B Mcg 130/Btl $6.00 One A Day Proactive 65+ for Men and Women 150/Tbs $12.00 Generic Vitamin B-6 50 Mg (Pyridoxine) 100/Btl $3.50 Glucoflex Glucosamine & Chondroitin 60/Btl $13.75 Generic Magnesium 500 Mg Tablets 100/Btl $3.75 Mason D5000 IU 100 Softgels $19.50 Certa-Vite Senior (Centrum Silver) 60/Ct Dual- Fish Oil Cholesterol Free 1000 Mg 100/Ct $6.00 Windmill Vitamin E /Tb $6.75 Mason D400 IU Chewable (Vanilla Flavor) 100 Chews $6.75 B-2 100mg 100/Tbs $7.00 Windmill Sustain Release B-Complex 60/Btl $7.00 Prosight With Lutein Caps 36/Ct $7.50 Visit us online at Fieldtex-FHCA.com 23

29 Vitamins & Minerals Generic Vitamin C 1000 Mg Tablets 100/Btl $7.50 Generic Century Mature Men s Mult-Vit 100/Ct $7.75 Generic Century Ult Women s Multi-Vit 100/Ct $7.75 Mason B Mg 100/Tbs $7.75 One A Day Women s 50+ Advantage 65/Ct $11.25 One A Day Men s 50+ Advantage 65/Ct $11.25 Dual- Vitamin E 100 IU Dl-Alpha Softgels 100/Btl $3.25 Generic B-Complex B-12 Caplets 100/Btl $3.50 Vitamins & Minerals Special Supplements Red Yeast Rice 1200 Mg 60/Btl $7.50 Coconut Oil 1000 Mg 60/Btl $8.75 Generic Vitamin B Mcg 130/Btl $3.50 Glucosamines Chondroitin Extra Strength 60/Btl $9.50 Mason Natural Prostate 30/Softgels $12.25 Mason Natural Prostate Therapy Complex 60/Softgels $15.75 Major Chromium Picolinate 200 Mcg 100/Ct $ Mail in the order form for fast and easy delivery of your OTC items

30 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 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 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 - 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. If an item is out-of-stock 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 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-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 (HMO-POS) Plan, your Over-the-Counter (OTC) benefit will automatically terminate. Products covered by this benefit 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 2016 benefit year** Visit us online at Fieldtex-FHCA.com 25

31 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 26 Mail in the order form for fast and easy delivery of your OTC items

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33 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. 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_MPINFO4887FH (09/15)