Over-The-Counter (OTC) Benefit Catalog (TTY )

Transcription

1 Over-The-Counter (OTC) Benefit Catalog (TTY )

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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 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 you 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 have free language interpreter services available for members who do not speak English. 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...3 Dental Care Diagnostic Thermometer...6 Ear Care...6 Eye Care Fiber Supplements...7 First Aid Bandages...8 First Aid Gauze & Dressings...9 First Aid Tape...10 First Aid Kits...10 Cholesterol...10 Foot Care...11 Hot & Cold Therapy...12 Incontinence...13 Medication Motion Sickness...14 Ointments & Topicals Ointments & Topicals Analgesics...15 Ointments & Topicals Hemorrhoid...16 Ointments & Topicals Cleaners...16 Pain Relief Skin Care...18 Skin Care Sunscreen...18 Stomach & Laxatives Lactose...20 Supports Ankle...21 Supports Back...21 Supports Elbow and Knee...21 Vitamins & Minerals Vitamins & Minerals Special Supplements...24 iv Mail in the postage paid order form for fast and easy delivery of your OTC items

5 Allergy & Flu Abreva Invisable Patch 6/Ct $13.25 Acetaminophen Regular Strength 325 Mg 100/Ct $1.25 Airborne Original Orange 10/Tb $8.25 Alka Seltzer Plus Cold Cherry 20/Tb $6.75 Allegra 24 Hr 180 Mg 12/Ct $14.00 Generic Aller Ease 30/Ct $15.50 Banophen Elixir (Unboxed) 4 Oz $3.00 Breathe Right Nasal Strips Large 30/Bx $14.50 Benadryl Allergy 24/Bx $6.00 Campho-Phenique Cold Sore Treatment $5.50 Breathe Right Strips Sm/Med 30/Bx $14.50 Chewable Aspirin 81 Mg Orange 36/Ct $1.75 Claritin Reditabs 10/Bx $14.00 Complete Allergy Medicine 100/Tb N $1.50 Coricidin HBP 20/Bx $7.25 Delsym Cough Suppressant 3 Oz $12.00 Generic All day Allergy Cetirizene 30/Ct $11.00 Generic Allergy 10 Mg Loratidine 30/Ct $4.00 Visit us online at 1

6 Allergy & Flu Generic Allergy 24/Bx $2.25 Generic Allergy/Sinus Headache 20/Ct $3.25 Generic Cough/Cold High Blood Pressure 16/Tb $2.75 Generic Effervescent Health Formula Orange 10/Tb $5.25 Generic Effervescent Cold Relief 20/Tb $3.75 Generic Mucus Relief 30/Ct $7.00 Generic Mucus Relief DM 30/Ct $7.00 Generic Nasal Spray Extra Moisture 1 Oz $2.25 Mucus Relief Tabs 30/Tb $3.25 Generic Night Time Cold-Flu Relief 16/Tb $3.75 Nasal Decongestant Spray (Afrin) 1 Oz $1.75 Generic Saline Nasal Spray 1.5 Oz $3.00 Generic Tussin DM 4 Oz $3.00 Generic Tussin DM 4 Oz $4.00 Generic Tussin Form CF Cold & Cough 4 Oz $3.50 Generic Vapor Rub 3.53 Oz Jar Mentholatum Ointment 1 Oz Jar $3.25 Mucinex DM 20/Bx $ Mail in the postage paid order form for fast and easy delivery of your OTC items

7 Allergy & Flu Zyrtec 10 Mg 14/Ct $17.00 Robitussin Cough & Chest Sugar Free 4 Oz $8.50 Vick s DayQuil Cold & Flu Caps 8/Ct $7.75 Vick s NyQuil Sinex 20/Bx $10.00 Vick s Vaporub 3.53 Oz $10.00 Cough Drops Halls Defense Citrus 100% Daily Vitamin C 30/Bg $2.75 Generic Sugar Free Menthol Cough Drops 25/Bg Halls Defense Asst Sugar Free Citrus Vitamin C 60 Mg 25/Bg $2.50 Generic Vitamin C Drops 60 Mg 30/Bg $1.50 Halls Honey Lemon Cough Drops 30/Bg $2.50 Halls Menthol-Lyptus Cough Drops 30/Bg $2.50 Generic Sugar Free Black Cherry Cough Drops 25/Bg Chloraseptic Lozenges Citrus 18/Bx $4.75 Sucrets Sore Throat Lozenges Cherry 18/Bx $4.00 Ricola Sugar Free Cough Drops Lemon 19/Bg $2.75 Ricola Cough Drops 21/Bg $2.75 Luden s Throat Drops Wild Cherry 30/Bg $2.50 Visit us online at 3

8 Dental Care Colgate Extra Clean, Med. Adult 558 Toothbrush Colgate Plus Soft Toothbrush A Colgate Wave Soft Toothbrush $3.25 Poligrip Super Original 1.4 Oz $4.75 Sensodyne Original Toothpaste 4 Oz $7.25 Aqua Fresh With Tartar + Whitening 6 Oz $3.25 Colgate Zig/Zag Wave Med Toothbrush A $3.25 Denture Bath Sea Bond (1 Container) $2.25 Crest Pro Health Clean Mint 4.2 Oz $4.50 Denture Brush $0.75 Crest Regular Toothpaste 4.6 Oz $3.50 Denture Cleaner Tablets 40/Ct Fixodent Original 1.4 Oz $4.25 Generic Dental Floss Wax Mint 100 Yds N $1.25 Colgate Total Clean Mint 4.2 Oz $4.25 Generic Denture Adhesive 2.04 Oz $2.50 Generic Nylon Toothbrush $1.00 Generic Premium Toothbrush $ Mail in the postage paid order form for fast and easy delivery of your OTC items

9 Dental Care Generic Premium Anticavity Toothpaste 4.6 Oz $1.25 Generic Denture Cleaning 90/Tb N $4.75 Generic Elite Angle Full Head Med Toothbrush $3.00 Generic Floss Waxed Unflavored 100 Yds Generic Mint Flosser W/Pick 50/Bg Generic Super Slide Floss 54.7 Yds $2.25 Generic Tongue Cleaner 1/Ct $2.25 Orajel Medicated Mouth Sore Swabs 12/Ea $7.00 J&J Reach Floss Waxed Mint 55 Yds Oral B Denture Brush Twin Head $3.25 Orajel Dry Mouth Gel 1.5 Oz $6.50 Oral B Interdental Starter Kit Brush A Oral B Ortho Soft Toothbrush $3.00 Pepsodent Complete Care 6 Oz $2.50 Polident Overnight 40/Ct $4.75 Poligrip Extra Care 1.2 Oz $4.75 Generic Elite Angle Full Head Soft Toothbrush $1.75 Visit us online at 5

10 Diagnostic Thermometer Digital Thermometer Waterproof $5.00 Prestige Ear Digital Thermometer $25.00 Ear Thermometer One Second Read $23.00 Ear Care Generic Instant Ear Dry 1 Oz $3.50 Debrox Earwax Removal Drops 5 Oz $7.50 Generic Ear Wax Removal Kit $3.75 Swim-Ear Ear Drops 1 Oz $4.75 Eye Care Opti-Clear.5 Oz Eyedrop $2.50 Eye Drops Original.5 Oz N $1.50 Clear Eyes All Season Outdoor.5 Oz $6.75 Clear Eyes Redness Relief.5 Oz $7.50 Visine A.C. Seasonal Itching.5 Oz $6.50 Blink Contacts Lubricant Eye Drops.338 Oz $ Mail in the postage paid order form for fast and easy delivery of your OTC items

11 Eye Care Clear Eyes Triple Action Relief.5 Oz $5.50 Lubricating Relief Eye Drops.5 Oz N Artificial Tears Sterile.5 Oz N Stye Eye Ointment Oz $8.50 Generic Sterile Lubricating Eye Drops.5 Oz $3.50 Visine Advanced Relief.5 Oz $6.00 Clear Eyes Itchy Eye Relief.5 Oz $4.75 Fiber Supplements Metamucil Wafers Apple Crisp 12/Ea $8.25 Fiber-Con Caplets 36/Bx $7.75 Generic Sugar Free Best Fiber Powder 62 Servings $8.50 Fiber-Tabs 90/Ct $8.00 Generic Fiberlax Caps 90/Bx $6.50 Flaxseed Soft Gel 1000 Mg 60/Ct $6.50 Metamucil Smooth Orange Singles 30/Ct $15.75 Visit us online at 7

12 First Aid Bandages All-In-1 Finger Dressing $3.25 J&J Gauze Pads 4 X 4 10/Bx $4.00 Sheer 7/8 Spot Bandage 100/Bx BX100 $2.25 Plastic Bandage 2 X /Bx $5.00 Cohesive Elastic Bandage 3 X 5 Yds $1.50 J&J Plastic Bandages 3/4 X 3 60/Bx $2.75 Elastic Bandage 6 X 5 Yds $1.50 Elastic Bandage 4 X 5 Yds $1.00 Elastic Bandage 2 X 5 Yds $0.50 Krinkle Bandage Roll 4.5 X 4.1 Yds $1.25 Elastic Bandage 3 X 5 Yds $0.75 J & J Knuckle & Fingertip Bandage 20/Bx $3.50 J & J Advance Healing Blister 6/Bx $5.25 J & J Flexible 3/4 X 3 Bandage 30/Bx $3.75 New Skin Liquid Bandage 50 Apps $4.50 Antibacterial Sheer Band Aid Asst. 20/Ct J & J Flex. Fabric Asst. Bandages 30/Bx $4.00 J & J Flexible XL 1 3/4 X 4 Bandage 10/Bx $ Mail in the postage paid order form for fast and easy delivery of your OTC items

13 First Aid Gauze & Dressings Gauze Pads 4 X 4 Sterile 100/Bx BX100 $7.25 Gauze Pads 3 X 3 Sterile 100/Bx BX100 $4.75 Gauze Pads 2 X 2 Sterile 100/Bx BX100 $4.00 Generic Cotton Balls 300/Ea $1.50 Roll Gauze 3 X 4 Yds 12/Pk PK12 $6.00 Roll Gauze 4 X 4 Yds 12/Pk PK12 $5.00 Nexcare Non-Stick Pads 3 X 4 12/Bx $5.25 Roll Gauze 2 X 4 Yds 12/Pk PK12 $4.00 J&J Hurt Free Wrap 2 x 2.3 Yds $5.50 Cotton Swabs 300/Ct $1.75 Combine Pads 5 X 9 20/Bx BX20 $3.50 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 9

14 First Aid Tape Tape 1 X 10 Yds Covered Spool $2.75 Tape 1/2 X 5 Yds Covered $1.75 Micropure Surgical Tape 1/2 X 10 Yds $0.75 Clear Surgical Tape 1 X 10 Yds $1.00 Lucid Clear Surgical Tape 2 X 10 Yds First Aid Kits J&J First Aid Kit 140 Pc $12.50 Compact First Aid Kit $6.50 Kitchen First Aid Kit $5.00 Personal First Aid Kit $6.00 Generic Mini First Aid Kit $2.50 Cholesterol Coconut Oil 1000 Mg 60/Btl $8.75 Red Yeast Rice 1200 Mg 60/Btl $ Mail in the postage paid order form for fast and easy delivery of your OTC items

15 Foot Care Lotrimin Spray 4.6 Oz $9.25 Compound W Liquid.31 Oz $10.00 Miconazole Nitrate Cream 2% 1 Oz $5.00 Generic Lamb s Wool Padding 3/8 Oz $2.50 Generic Moleskin Plus 4/Ct $2.50 Generic Liquid Wart Remover.5 Oz $4.25 Generic Clortimazole Cream Usp 1%.5 Oz $3.50 Tolnaftate 1 % Antifungal Cream.5 Oz $3.00 Generic Corn & Callus Remover.5 Oz $4.00 Compound W Gel.25 Oz $10.50 Medicated Corn Remover Pads 9/Ct Generic Corn Cushions 9/Ct Tolnaftate-Powder 1% 1.5 Oz $4.25 Generic Toe Separator Triple Layer 6 Pc $3.25 Liquid Callus & Corn Remover.31 Oz $4.50 Generic Medicated Foot Powder 4 Oz $3.50 Visit us online at 11

16 Hot & Cold Therapy Advocate Heating Pad Classic 12 X $17.00 Cold Pack Pocket Wrap $1.50 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 Insulated Instant Hot Pack 6 X $0.75 Reusable Ice Bag Medium $5.25 Salonpas Hot-Gel Patch 6/Ea $9.00 Salonpas Arthritis Pain Patch 5/Ea $9.50 Thermacare Joint Therapy Cold Wrap 1/Ea $11.50 Salonpas Deep Relieving Gel 2.75 Oz $9.00 Thermacare Knee & Elbow Heat 2/Bx $9.50 Thermacare Lower Back & Hip 2/Ea $9.00 Thermacare Muscle & Joint Heat 1/Bx $3.75 Thermacare Muscle Cold Wraps 1/Ea $11.50 Thermacare Neck To Arm 3/Ea $9.00 Therma-Kool 6 X 9 Reusable Cold/Hot Pack $ Mail in the postage paid order form for fast and easy delivery of your OTC items

17 Incontinence Balmex Adult Care Cream 3 Oz $5.50 Depend Adj. Underwear Sm/ Med 18/Ct $21.00 Depend Adj. Underwear L/XL 16/Ct $21.00 Depend Brief Max. Protection Large 16/Ct $18.50 Depend Shields For Men 58/Ct $20.00 Desitin Max Strength 3 Oz $7.25 Maxi Care 30 X 30 Absorbent Pad 10/Ct $6.50 Poise Pads Moderate 20/Ct $8.25 Poise Liners Very Light 48/Ct N $7.50 Poise Pads Ultimate Coverage 33/Ct $21.00 Poise Pads Maximum 48/Ct $21.00 Poise Pads Ultra Long 27/Ct $21.00 Poise Very Light Extra Coverage Lg 44/Ct $8.00 Surecare Shield Light-Moderate 25/Ct $7.00 Surecare Underwear Lg /Ct $17.00 Surecare Underwear Md /Ct $17.00 Surecare Underwear XL /Ct $16.25 A&D Ointment White 1.5 Oz $3.75 Visit us online at 13

18 Medication Motion Sickness Generic Motion Sickness 12/Ct $1.75 Motion Eaze.084 Oz $8.25 Dramamine Tablets 12/Tb $5.50 Acu-Strap Morning & Motion Sickness Band $3.75 Ointments & Topicals Gold Bond Anti-Itch Max Relief 2 Oz $7.50 Providine Iodine USP 10% Ointment 1 Oz $3.75 Polysporin Antibiotic Ointment 1 Oz $10.25 Generic Burn Gel 4 Oz $4.25 Antifungal Cream 1 Oz $3.25 Bacitracin 1 Oz $2.25 Generic Itch Relief Cream Extra Strength 1 Oz $3.00 Calamine Lotion Generic Brand 3.99 Oz $3.25 Hydrocortisone Cream 1% 1 Oz Mail in the postage paid order form for fast and easy delivery of your OTC items

19 Ointments & Topicals Generic Hydrocortisone 1% Anti-Itch Max Strength 1 Oz $3.50 Triple Antibiotic (Neosporin) Plus 1 Oz $4.75 Callergy Clear Lotion 6 Oz $4.75 Triple Antibiotic Ointment 1 Oz $2.50 Triple Antibiotic (Neosporin) Plus 1 Oz $7.50 Ointments & Topicals Analgesics IcyHot 1.25 Oz $4.50 Muscle Rub Ultra Strength 3 Oz $3.00 Analgesic Cream W/Aloe 3 Oz $4.50 Flexall Plus 2 Oz $6.00 Tiger Balm Ultra Strength Sports Rub 1.7 Oz $14.75 Mineral Ice Rub Freeze 4 Oz $2.25 Muscle Rub 3 Oz Vanishing Scent Gel BenGay Greaseless Balm 2 Oz $5.75 Aspercreme 1.25 Oz $4.00 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 15

20 Ointments & Topicals Hemorrhoid Generic Medicated Pads 100/Ct $4.50 Generic Hemorrhoidal Cream Max Strength 1.8 Oz $4.25 Generic Hemorrhoid Relief Ointment 2 Oz $4.50 Prep Hemorrhoid Suppositories 24/Ct $5.75 Tucks Medicated Pads 40/Ct $6.00 Americaine Hemorrhoidal Ointment 1 Oz $6.75 Ointments & Topicals Cleaners Alcohol Wipes 200/Bx BX200 $2.25 Pain Relief Non-Aspirin PM Acetaminophen 500 Mg 50/Ct $1.50 Bactine First Aid Liquid 4 Oz $5.50 Aleve Easy Open Cap 200 Mg 40/Ct $9.50 J & J Hurt Free Antiseptic Wash 6 Oz $5.00 Norwich Aspirin 325 Mg 100/Btl $2.50 Bayer Chewable Aspirin 81 Mg Cherry 36/Ct $3.50 Generic Naproxen 220 Mg 100/Ct N $5.75 Generic Arthritis Pain Relief APAP 650 Mg 24/Ct $ Mail in the postage paid order form for fast and easy delivery of your OTC items

21 Pain Relief Ibuprofen 200 Mg Caplets 100/Ct N $3.50 Motrin Ib 200 Mg 50/Ct $7.75 Advil 200 Mg 50/Ct $8.75 Advil PM Caplets 200 Mg 40/Ct $11.00 Generic Orange Boxed Aspirin 81 Mg 36/Ct $1.50 Generic Cherry Headache Powders 4/Ct $8.00 Anacin Caffeine 30/Tb $5.25 St. Joseph Chewable Aspirin 81 Mg 36/Tb $2.50 Advil Gel Caplets 200 Mg 24/Ct $5.75 St. Joseph E.C. Aspirin 81 Mg 120/Tb $7.55 Advil Liquid Gels 200 Mg 20/Ct $6.25 Low Dose Aspirin 81 Mg 120/Tb N $1.50 Generic Sleep Aid 25 Mg 16/Ct $4.00 Goody s Cool Orange Ex Str 4/Ct $1.75 Generic Children s Pain Relief 80 Mg Chew 30/Ct $3.00 Acetaminophen Extra Strength APAP 500 Mg 100/Ct N $2.25 Generic Sleep Aid (Generic Sominex) 50/Ct $3.00 Visit us online at 17

22 Skin Care Generic Aloe With Lidocaine Gel 8 Oz $4.25 Generic Scar Gel 1.75 Oz $8.25 Generic Aloe Vera 16 Oz $4.00 Medicated Body Powder 10 Oz $4.75 Skin Care Sunscreen Generic Sunblock SPF 15 8 Oz $5.00 Stomach & Laxatives Generic Famotidine Acid Reducer 10 Mg 30/Ct $6.00 Coppertone Sunblock SPF 30 8 Oz $12.00 Generic Antacid & Pain Reliever 36/Ct $4.00 Generic Sunblock SPF 50 8 Oz $5.50 Generic Laxative Bisacodyl 25/Ct Glycerin Suppository 25/Ct $2.50 Generic Tums 96/Ct $4.25 Generic Gentle Stool Softener 25/Ct $ Mail in the postage paid order form for fast and easy delivery of your OTC items

23 Stomach & Laxatives Ranitidine 75 Mg 30/Ct $5.00 Pepto Bismol 4 Oz $5.00 Enema Adult 4.5 Oz Zantac 75 Acid Reducer 10/Ct $6.25 Pepcid AC Max Strength 8/Ct $6.25 Omeprazole 20 Mg 14/Ct $13.00 Prilosec OTC 14/Ct $17.00 Imodium Liquid 4 Oz $7.50 Alka Seltzer Original Foil 36/Tb $7.00 Dulcolax Suppositories 4/Bx $6.50 Generic Senna Laxative 100/Ct $3.25 Tums Extra Str Orange 80/Ct $7.00 Miralax OTC 7 Dose 4.1 Oz $8.75 Tums Tropical Flavor 96/Ct $6.50 Generic Rolaids Ultra Strength Cherry 18/Ct $2.25 Generic Senna Laxative 60/Ct $1.75 Prevacid 24 Hr 15 Mg OTC 14/Tb $16.00 Beano Tablets 30/Btl $6.25 Visit us online at 19

24 Stomach & Laxatives Anti-Diarrheal 2 Mg 24/Ct $3.50 Tums Chewy Delight Peppermint Ultra Strength 6/Ct $1.75 Tums Chewy Delight Cherry Ultra Strength 6/Ct $1.75 Beano + Dairy Defense 12/Ct $6.00 Generic Gas Relief Prevention 20/Ct $5.00 Gas-X Softgels Extra Strength 10/Ct $3.50 Pepto Bismol Chew Tabs Original 48/Tb $9.75 Ex-Lax Chocolate 24/Ct $6.25 Pepto Bismol Tabs Cherry 48/Tb $9.75 Generic Anti-Nausea Liq Cherry 4 Oz $2.50 Lansoprazole (Prevacid) 15 Mg 14/Tb $8.75 Pink Bismuth Chew Tab 30/Bx $4.00 Lactose Lactaid Fast Acting Caps 32/Ct $10.50 Dairy Aid Original Strength Caplets 60/Btl $6.50 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 20 Mail in the postage paid order form for fast and easy delivery of your OTC items

25 Supports Ankle Adjustable Ankle Support $8.25 Procare Elastic Ankle Support Small Medium Large XL $5.00 Mueller Ankle Support Elastic Small Medium Large $6.25 Supports Back Mueller Back Brace Lumbar Unversial $26.75 Mueller Back Brace Adjustable $22.25 Supports Elbow and Knee Neoprene Elbow One Size Fits All $14.75 Vitamins & Minerals Certa-Vite Senior (Centrum Silver) 60/Ct $4.00 Procare Elbow Support Small Large XL $5.25 One A Day Women s 50+ Advantage 65/Ct $11.25 Procare Knee Support Sleeve Small Medium Large XL $5.00 One A Day Men s 50+ Advantage 65/Ct $11.25 Generic Century Mature Men s Mult-Vit 100/Ct $7.75 Generic Century Ult Women s Multi-Vit 100/Ct $7.75 Generic Tab-A-Vite W/Iron 100/Btl $4.00 Visit us online at 21

26 Vitamins & Minerals Fish Oil High Potency 100/Ct $15.00 Generic B-Complex B-12 Caplets 100/Btl $3.50 Garlic 500 Mg Soft Gel 100/Btl $7.25 Prosight With Lutein Caps 36/Ct $7.50 Ginseng Soft Gel 50/Ct $7.25 Fish Oil Cholesterol Free 1000 Mg 100/Ct $6.00 Dual- Generic Calcium 600Mg +D 200 IU 60/Btl Generic Chocolate Calcium Chews 60/Ct $5.50 Windmill Vitamin C /Btl $4.25 Generic Chocolate Calcium SF Chews 60/Ct $5.50 Windmill Vitamin B Mcg 100/Btl $4.25 Windmill Super B-50 Vitamins 100/Btl $9.00 Windmill Calcium Citrate + D 120/Btl $8.50 Generic Vitamin C 1000 Mg Tablets 100/Btl $7.50 Generic Selenium 200 Mcg 60/Btl $6.25 Generic Folic Acid 400 Mcg Tablets 100/Btl $1.75 Generic Magnesium 500 Mg Tablets 100/Btl $3.75 Generic Vitamin B Mcg 130/Btl $ Mail in the postage paid order form for fast and easy delivery of your OTC items

27 Vitamins & Minerals Windmill Vitamin E /Tb $6.75 Windmill Sustain Release B-Complex 60/Btl $7.00 Generic Coenzyme Q Mg 30/Tb $15.75 Tab-A Vit Women s Formula 60/Ct $4.50 Generic Calcium 500 Mg Chewables 60/Btl $3.25 Generic Vitamin A-10,000 Soluble 100/Ct $3.00 Generic FeroSul 5 Gr Green Tablets 100/Btl Generic Vitamin D 1000 IU Tablets 100/Btl $2.75 Generic High Potency Vita & Mineral 100/Btl $5.50 Certa-Vite (Centrum) 30/Ct $2.75 Generic Oyster Shell 500 Mg+D 150/Btl $5.50 Generic Vitamin D 400 IU Tablets 100/Btl $2.25 Dual- Vitamin E 100 IU Dl-Alpha 100/Btl $3.25 Generic Vitamin B Mcg 130/Btl $3.50 Generic Vitamin B Mg 100/Btl $3.00 Generic Vitamin B-6 50 Mg (Pyridoxine) 100/Btl $3.50 Visit us online at 23

28 Vitamins & Minerals Special Supplements Generic Stress Formula Tablets 60/Btl $5.00 Sundown Glucosamine Plus D 1500 Mg $11.75 Sundown Prostate Health 75/Btl $9.25 Glucosamines & Chondroitin Extra Strength 60/Btl $9.50 Glucoflex Glucosamine & Chondroitin 60/Btl $13.75 Dual- 24 Mail in the postage paid order form for fast and easy delivery of your OTC items

29 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: ) 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 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-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 2015 benefit year** Visit us online at 25

30 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, Prophlactics Scales, Fans, Magnifying Glasses, Ear Plugs, Insoles, Arch Supports and Gloves Mouthwashes, Bad Breath Remedies, Deodrants, 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 postage paid order form for fast and easy delivery of your OTC items

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32 Ordering is Easy! You can fill out and mail the enclosed order form or place your order online at Please see complete step-by-step instructions inside. Visit us online at 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. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits may change on January 1 of each year. Y0089_MPINFO4446FH (11/14)

33 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. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments, and restrictions may apply. Benefits may change on January 1 of each year. Y0089_MPINFO4446FH (11/14) 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:

34 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 Customer Service toll free at (TTY/TDD relay: ) weekdays from 8 am to 8 pm and Saturdays from 8 am to noon. From October 1 February 14, we re available seven days a week from 8 am to 8 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 Call us toll-free at (TTY ) weekdays from 8 am to 8 pm and Saturdays from 8 am to noon. From October 1 February 14, we re available seven days a week from 8 am to 8 pm. Or visit us online at 3. Total all the items. Be sure to stay within your available allowance. 2. Choose the items you would like from the Over-The-Counter (OTC) Benefit Catalog and write the number on your order form, or have them available when you call or go online. 1. Be sure to have your Member ID number (found on the front of your ID card). You will need to provide your Member ID number and your birth date to access your account. Simply choose one of the options: Mail order form, call toll free, or go online. Ordering is Easy! Over-The-Counter (OTC) Benefit Order Form