2019 Get Over-the-Counter Products Every Quarter OVER-THE-COUNTER BENEFITS As a member of Brand New Day, you have an Over-the-Counter (OTC) benefit every quarter This benefit allows you to get OTC products you may need Be sure to use your benefit amounts before the end of every quarter Simply order online, call 1-855-804-3555, TTY 711 or mail your completed order form Your order will be shipped directly to your door Order Online: wwwbndhmocom/otc H0838_804BNDOTCOrdFmPt1181128_C BND_7983
Item # Description Packaging Strength To Active Ingredients Price Allergy, Cold, Flu, Decongestant & Sinus 1166 Cough & Cold for High Blood Pressure 16 ct - Coricidin HBP Chlorpheniramine Maleate, Dextromethorphan $700 1056 Cough Drops, Cherry 30 ct 58 mg Halls Menthol $300 1182 Cough Drops, Sugar Free, Cherry 25 ct 58 mg Halls Sugar Free Menthol $300 1833 Cough Drops, Honey Lemon 30 ct - 1834 Cough Drops, Menthol 30 ct - Halls Halls Menthol $300 Menthol $300 1054 Cough Syrup, Expectorant 4 oz 200 mg / 10 ml Robitussin Guaifenesin $400 1323 Diabetic Tussin DM 4 oz - Robitussin Sugar Free DM Dextromethorphan, Guaifenesin $600 1308 Diphenhydramine Antihistamine 100 ct 25 mg Benadryl Diphenhydramine $1000 1180 Guaifenesin Cough Expectorant 60 ct 200 mg Guaifenesin $1000 1091 Nasal Decongestant Spray, 12 Hour 1 oz 005% Afrin Oxymetazoline Hydrochloride $500 1052 Nasal Spray, Saline 15 oz 065% Ocean Saline Nasal Spray Sodium Chloride $500 2 2019 Over-the-Counter (OTC) Benefit Catalog
Item # Description Packaging Strength To Active Ingredients Price Allergy, Cold, Flu, Decongestant & Sinus (continued) 1176 Sore Throat Lozenges, Cherry 18 ct - Cepacol Benzocaine, Menthol $500 1164 Vapor Rub 35 oz 47%, 1% to Vicks VapoRub Camphor, Menthol, Eucalyptus Oil $600 Antacids & Acid Reducers 1006 Antacid / Anti-Gas Liquid 12 oz - Maalox Aluminum Hydroxide, Magnesium, Hydroxide, Simethicone $750 1800 Simethicone Anti-Gas Chewables 100 ct 80 mg to Gas-X Chewables Simethicone $800 Anti-diarrheal, Laxatives & Digestive Health 1316 Beano 30 ct - Alpha- Galactosidase Enzyme $800 1045 Bismatrol Chewable Tablets 30 ct 262 mg Pepto-Bismol Chewable Bismuth Subsalicylate $600 1126 Docusate Sodium Stool Softener 100 ct 100 mg Colace Docusate Sodium $650 1733 Enema 45 oz - Fleet Monobasic Sodium Phosphate, Dibasic Sodium Phosphate $500 1067 Lactase Capsules 60 ct 9000 FCC Units Lactaid Lactase Enzyme $1000 1011 Milk of Magnesia 12 oz 400 mg Phillips Magnesium Hydroxide $600 * See Page 10 3
Item # Description Packaging Strength To Active Ingredients Price Anti-diarrheal, Laxatives & Digestive Health (continued) 1318 Pink Bismuth 8 oz 525 mg / 30 ml Pepto-Bismol Bismuth Subsalicylate $600 1012 Polycarbophil Fiber Tablets 90 ct 625 mg FiberCon Calcium Polycarbophil $1000 1130 Senna Plus Stool Softener Plus Laxative 60 ct 86 mg, 50 mg Senekot-S Docusate Sodium, Sennosides $700 Anti-fungal & Anti-itch 1047 Clotrimazole Antifungal Athlete s Foot Cream 15 oz 1% Lotrimin AF Clotrimazole $700 1140 Diphenhydramine HCL / Zinc Acetate Anti-Itch Cream 1 oz - to Benadryl Cream Diphenhydramine Hydrochloride, Zinc Acetate $400 1074 Hydrocortisone 1% Cream 1 oz 1% 1064 Tolnaftate Antifungal Cream 125 oz 1% Cortaid Tinactin Hydrocortisone $500 Tolnaftate $700 1817 Biotene Dry Mouth Oral Rinse Dental & Denture Care 16 oz - $1300 1747 Denture Brush 1 ct - 1032 Denture Cleaning Tablets 40 ct - G-U-M Polident $600 $500 1843 Effergrip Denture Cream Adhesive 25 oz - $900 1187 Fixodent 75 oz - $650 1751 Interdental Flossups 90 ct - G-U-M $550 4 2019 Over-the-Counter (OTC) Benefit Catalog
Item # Description Packaging Strength To Active Ingredients Price 1455 1413 Reach Waxed Dental Floss - Mint Toothbrush, Colgate, Adult Soft Dental & Denture Care (continued) 55 yd - $400 1 ct - $300 1414 Toothpaste, Pepsodent 55 oz - Sodium Fluoride $400 Ear Care 1742 Cotton Tipped Swabs 300 ct - Johnson & Johnson $400 1190 Ear Wax Removal Drops 15 ml 65% Debrox Carbamide Peroxide $600 1363 Ear Wax Removal System with Rubber Bulb 15 ml 65% Debrox Carbamide Peroxide $700 Eye Care 1192 Artificial Tears Drops 5 oz - Visine Tears Glycerin, Hypromellose, Polyethylene Glycol $600 1468 Multi-Purpose Contact Lens Solution 4 oz - to Renu Multipurpose Solution $800 First Aid & Medical Supplies 1344 Adhesive Bandages * 60 ct - Band-Aid Plastic Strips $300 1020 Bacitracin Ointment 1 oz 500 U / gm Bacitracin Zinc $600 1763 Cotton Balls 200 ct - $450 * See Page 10 5
Item # Description Packaging Strength To Active Ingredients Price First Aid & Medical Supplies (continued) 1947 First Aid Kit, 20 piece 1 ct - $600 1228 Hydrogen Peroxide 16 oz 3% Hydrogen Peroxide $500 1229 Isopropyl Alcohol, Wintergreen 16 oz 70% Isopropyl Alcohol $650 1014 Triple Antibiotic Ointment 1 oz - Neosporin Bacitracin Zinc, Neomycin Sulfate, Polymyxin $500 Hemorrhoidal Preparations 1066 Hemorrhoidal Ointment 2 oz - Preparation H Mineral Oil, Petrolatum, Phenylephrine HCL $700 1247 Hemorrhoidal Suppository 12 ct - Preparation H Phenylephrine HCL $600 1303 1304 1305 1811 1810 1813 1815 Adult Briefs, Medium - 32 to 44 * Adult Briefs, Large - 45 to 58 * Adult Briefs, X-Large - 59 to 64 * Attends Discreet Men s Guard Attends Discreet Men s Shield Attends Discreet Women s Moderate Bladder Control Pad Attends Discreet Women s Panty Liner Incontinence Supplies 12 ct - $1600 12 ct - $1600 15 ct - $1600 20 ct - $1400 20 ct - $1300 20 ct - $1550 28 ct - $900 6 2019 Over-the-Counter (OTC) Benefit Catalog
Item # Description Packaging Strength To Active Ingredients Price 1816 Attends Discreet Women s Ultrathin Pad Incontinence Supplies (continued) 20 ct - $1100 Pain Relievers & Fever Reducers 1001 Acetaminophen 100 ct 325 mg 1600 Acetaminophen 100 ct 500 mg Tylenol Tylenol Extra Strength Acetaminophen $500 Acetaminophen $400 1924 Aspercreme 125 oz - Trolamine Salicylate $800 1096 Aspirin, Enteric Coated 100 ct 325 mg Ecotrin Aspirin $550 1002 Aspirin, Enteric Coated, Low Dose 120 ct 81 mg Bayer Low Dose Aspirin $350 1802 Aspirin, Low Dose, Chewables 36 ct 81 mg to Bayer Chewable Low Dose Aspirin Aspirin $325 1871 Lidocaine Patch 5 ct 4% Aspercreme Lidocaine Patch Lidocaine $1000 1739 Salonpas Pain Relief Patches 5 ct - Therapeutic Skin & Sun Care 1821 Calamine Lotion 6 oz - Menthol, Methyl Salicylate Calamine, Zinc Oxide $1100 $600 * See Page 10 7
Item # Description Packaging Strength To Active Ingredients Price Vitamins & Minerals 1373 Calcium + Vitamin D 60 ct 600 mg / 400 IU Caltrate-D Vitamin D-3, Calcium $550 1829 Coenzyme Q-10 30 ct 50 mg Coenzyme Q-10 $1000 1393 Daily Multivitamin 100 ct - One-A-Day Essential Vitamin A, C, D-3, E, Thiamine, Riboflavin, Niacin, Vitamin B-6, Folic Acid, Vitamin B-12, Calcium $600 1741 Fish Oil, Soft Gels 60 ct 1000 mg Fish Oil Concentrate, EPA, DHA, Omega-3 Fatty Acids $700 1114 Glucosamine Joint / Muscle 60 ct 500 mg Glucosamine Sulfate $1100 1975 Healthy Eyes with Lutein 60 ct - Ocuvite Vitamin A, Vitamin C, Vitamin E, Zinc, Selenium, Copper, Lutein $700 1392 Senior Multivitamin 90 ct - to Centrum Silver Vitamin A, C, D-3, E, K, B-1, B-6, B-12, Riboflavin, Niacinamide, Folic Acid, Biotin $800 1389 Vitamin B-12 100 ct 500 mcg Vitamin B-12 $600 1017 Vitamin C 100 ct 500 mg Vitamin C $500 1390 Vitamin D 100 ct 1000 IU Vitamin D-3 $700 1973 Vitamin D 100 ct 5000 IU Vitamin D-3 $800 1384 Vitamin E, Soft Gels 100 ct 400 IU Vitamin E $800 8 2019 Over-the-Counter (OTC) Benefit Catalog
ORDER GUIDELINES Order items using one of these options: Order Online You may place an order online using your Brand New Day OTC website at wwwbndhmocom/otc Remember to save your username and password to order again during your next benefit period Order By Mail You may place your order by mailing in the order form that comes with your catalog If the end of the benefit period is approaching and you do not think your order form will be received in time, you may order online or call in your order Order By Phone If you have questions or would like to place an order over the phone, OTC Advocates are available Monday Friday, 5AM to 8PM PT at 1-855-804-3555, TTY 711 For delivery, please allow 7-10 business days from the time your order is placed Your order total may not exceed your benefit amount Cash, checks, credit cards or money orders are not accepted under this OTC benefit Your order total will be applied to the benefit period in which the order is received OTC products are intended for member use only to help with a health or medical need Brand New Day prohibits the use of this benefit to order OTC items for family members and friends Due to the personal nature of these products, returns are not accepted Items in the OTC catalog may change throughout the year For the most up-to-date listing of OTC products available, go to wwwbndhmocom/otc OTC items are available through home delivery only Products may not be purchased at a local retail pharmacy or through any source other than the Brand New Day OTC benefit channels listed above * See Page 10 9
NOTICES If you disenroll from Brand New Day, your OTC benefit will automatically terminate Brand New Day is an HMO/SNP with a Medicare Contract Enrollment in Brand New Day depends on contract renewal This information is available for free in other languages Please call our customer service number at 1-866-255-4795, TTY 711 Monday Friday, 8 am 8 pm PT and 7 days a week from October 1 to March 31 from 8 am 8 pm PT This information is available in other formats, such as large print, and audio The health information provided in the catalog is general in nature and is not medical advice or a substitute for professional health care ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística Llame al 1-866-255-4795, TTY 711 * Part B/D - Under certain circumstances some items may be covered under either Part B or Part D When you are eligible to receive these items under Part B or Part D you may not purchase these items through your Part C supplemental OTC benefit For your convenience, we ve marked these items with an (*) Dual-purpose items are medicines and products that can be used for either a medical condition or for general health and well-being 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 10 2019 Over-the-Counter (OTC) Benefit Catalog
2019 OVER THE COUNTER (OTC) PRODUCT ORDER FORM STEP 1 - COMPLETE YOUR INFORMATION BELOW Member ID (found on plan member ID card) Date of Birth First Name Last Name MI Street Number Street Name Apt/Suite # City State Zip Code Daytime Phone Email (Optional) Please check box if this is a new address @ STEP 2 - PRODUCT SELECTION Cash, checks, credit cards or money orders are not accepted under this OTC benefit 1 2 3 4 5 Item # Product Quantity Unit Price TOTAL $ $ $ $ $ $ $ $ $ $ Subtotal from Other Side $ Total Order $ If you place your order using an order form, your order total will be applied to the quarter in which we receive your form For example, if you mail your order form on June 29, but we receive it on July 1, your order total will be applied to your July benefit, not your June benefit
STEP 2 - PRODUCT SELECTION (Continued) Cash, checks, credit cards or money orders are not accepted under this OTC benefit Item # Product Quantity Unit Price TOTAL 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Subtotal $ Please mail the completed form back in by tearing this form out of the booklet along the side edge perferation Fold the form along the dotted line on the back cover and seal the top with tape to mail in If you place your order using an order form, your order total will be applied to the quarter in which we receive your form For example, if you mail your order form on June 29, but we receive it on July 1, your order total will be applied to your July benefit, not your June benefit
Directions on how to order by mail: To place your order by mail please fill out the order form by opening this page Fill out the form and then tear it out of the booklet along the side edge perforation Fold the form along the dotted line on the back cover and seal the top with tape to mail it in
wwwbndhmocom/otc