4 MY OVER-THE-COUNTER ALLOWANCE $ monthly allowance toward OTC items MEDICATIONS AND HEALTH PRODUCTS 201 catalog MCDTX_1_5652 2017
All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including HealthSpring Life & Health Insurance Company, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. 2017 Cigna
MY OVER-THE-COUNTER (OTC) ALLOWANCE Use your $ monthly allowance to help pay for many over-the-counter medicines and health products that Medicaid does not cover and enjoy delivery right to your home at no cost. 5 STEPS TO SAVE MONEY STEP 1 Use your rollover $ allowance toward OTC items once a month. STEP 2 Choose OTC items from the list that begins on page 7. STEP 3 Order by calling 1-66-575-3744 (TTY: 7-1-1) Monday to Friday, 7 a.m. to p.m. Central Time. STEP 4 Check that your address is correct while you re on the phone. STEP 5 Get your OTC items delivered to your door at no cost. 3
QA & over-the-counter Common questions about my allowance What can I use my $ monthly allowance toward? You can use your allowance to help pay for medicine and health items such as aspirin, vitamins, dental care, bandages and much more. See page 7. Can I use my $ OTC allowance toward prescription drugs? No. Your $ monthly allowance is for items that can be bought without a prescription. Can a family member use my $ OTC allowance? No. An OTC allowance can only be used by a Member. If 2 people in a house are Members, each will have their own OTC allowance. Does my allowance add up if I don t use it? Yes. Unused funds will roll over from month to month beginning September 1, 2017 and end on August 31, 201. Can I use parts of my allowance to order at different times throughout a month? No. You can use your $ monthly allowance once a month. Can my total order be more than $? The total cost of your order should be equal to or less than your roll over allowance amount. How long will my order take? Your order will take up to 2 weeks to arrive. If you have any questions about your order, call 1-66-575-3744 (TTY: 7-1-1), Monday to Friday, 7 a.m. to p.m. Central Time. Can I return my items? No. Received items cannot be returned. 4
BRAND NAME INDEX Brand Catalog Item Page 21st Century Glucosamine / Chondroitin Glucosamine Joint/Muscle Abreva Abreva 7 Ace Ankle Support Elastic Bandage 2 in x 5 yd Elastic Bandage 3 in x 5 yd Elastic Bandage 4 in x 5 yd Elastic Bandage 6 in x 5 yd Anbesol Oral Pain Relief Band-Aid BD Digital Thermometer Benadryl Anti-Itch Bengay Braun Breathe Right Sheer Adhesive Bandages 11 11 Thermometer, Digital Diphenhydramine HCL / Zinc Acetate Pain Relieving Muscle Rub Thermometer, Digital Ear Nasal Strips, Small / Medium Nasal Strips, Medium / Large Carex Bath Tub Safety Rail 9 Cepacol Sore Throat Lozenges 7 ChloesTrak Citrucel Home Access Cholesterol Test Methlcellulose Fiber Therapy Colace Docusate Sodium 7 Colgate Toothbrush, Colgate, Adult Soft 9 9 9 9 7 11 11 7 Brand Catalog Item Page Compound W Wart Remover (liquid) 11 Coppertone Sunscreen Lotion SPF 30 Curad Alcohol Pads 11 First Aid Kit, 4 pcs 9 First Aid Kit, 175 pcs 9 Dr. Scholls Callus Remover Pads Dramamine Drive Medical Efferdent Essential Shower Bench Corn Remover Pads Diabetic Socks, White, Medium Diabetic Socks, White, Large Diabetic Socks, Black, Medium Diabetic Socks, Black, Large Dramamine Chewables, Orange Cushion, Gel / Foam Seat Denture Cleaning Tablets Bath Bench with Back 9 Bath Bench without Back Fibercon Fiber Tablets 11 Fixodent Fixodent 7 Fruit of the Earth Aloe Vera Cream Hall s Cough Drops, Cherry 7 Herpecin-L Herpecin-L Lip Balm 7 Hydrogen Peroxide Hydrogen Peroxide 9 Lactaid Lactase Capsules 7 Metamucil Natural Vegetable Laxative Nature s Bounty Fish Oil Tablets 11 9 7 9 7 5
BRAND NAME INDEX Brand Catalog Item Page Nexcare Nix Hot/Cold Packs 1 small and 1 large Permethrin Lice Treatment Ocean Nasal Spray, Saline 7 Omron Desktop Blood Pressure Monitor Replacement Cuff Wrist Blood Pressure Monitor Orajel Orajel Pain Relief Oral-B Interdental Flossups 7 Toothbrush, Rechargeable Pepsodent Toothpaste - Pepsodent ProCheck Thermometer, Flexible Tip, Digital -seconds 9 Purell Hand Sanitizer 11 Q-Tips Cotton Tipped Swabs Quick-Lock Raised Toilet Seat Brand Catalog Item Page Reach Dental Floss Reach Waxed Dental Floss - Mint Releev Cold Sore Treatment 7 Renu Reveal Rid Robitussin Multi-Purpose Contact Lens Solution EZ Detect Colon Cancer Test Kit Lice Treatment Shampoo Guaifenesin Cough Expectorant Salonpas Pain Relief Patches Tek-Pro Tucks Toothbrush, Tek Pro, Straight Soft Pre-Moist Hemorrhoidal Pads Vicks NyQuil All-Nite Cold/Flu 7 7 Vitamin D Vitamin D 11 1-66-575-3744 (TTY: 7-1-1) You can place your order Monday to Friday, 7 a.m. to p.m. Central Time 6
MEDICATIONS AND PRODUCTS Before ordering any of the items below, you should talk with your doctor. Category Product Item # Brand/Description Cost Allergy, Cold, Flu Decongestant and Sinus Anti-diarrheal, Laxatives, and Digestive Health Anti-fungal and Anti-itch Cold Sore and Medicated Lip Products Dental and Denture Care All-Nite Cold/Flu 1361 Compare to Vicks NyQuil Cough, 6 oz per bottle; A registered trademark of Procter & Gamble Cough Drops, Cherry Guaifenesin Cough Expectorant 56 Compare to Hall s Cough Drops, 30 ct per bottle; A registered trademark of Mondelēz International, Inc. 110 Compare to Robitussin, 60 ct per bottle; A registered trademark of Pfizer-Wyeth Consumer Healthcare Nasal Spray, Saline 52 Compare to Ocean Premium Saline Nasal Spray, 1.5 oz spray; A registered trademark of Fleming Pharmaceuticals Sore Throat Lozenges 1360 Compare to Cepacol, 16 ct per box; A registered trademark of Rickett Benckiser Docusate Sodium 1126 Compare to Colace, 0 mg capsules, 0 ct per bottle; A registered trademark of Purdue Products Lactase Capsules 67 Compare to Lactaid, 9000 ICC, 60 tablets; A registered trademark of McNeil Nutritionals, LLC Methylcellulose Fiber Therapy Natural Vegetable Laxative Diphenhydramine HCL / Zinc Acetate 1354 Compare to Citrucel, 16 oz per bottle; A registered trademark of GlaxoSmithKline 1340 Compare to Metamucil, 13 oz powder per bottle; A registered trademark of Procter & Gamble 1140 Compare to Benadryl Anti-Itch, 1 oz per tube; A registered trademark of Pfizer Consumer Healthcare Abreva 1152 Compare to Abreva, %, 2 gm per tube; A registered trademark of GlaxoSmithKline Herpecin-L Lip Balm Releev Cold Sore Treatment Denture Cleaning Tablets 1153 Compare to Herpecin-L Lip Balm, 0.1 oz per stick; A registered trademark of Chattem, Inc. 1359 Releev Cold Sore Treatment, Strength 0.13%, Quantity 6 ml; A registered trademark of Merix Pharmaceutical Corporation 32 Compare to Efferdent Anti-Bacterial Denture Cleanser, 40 ct per box; A registered trademark of Medtech Products Fixodent 117 Compare to Fixodent, 0.75 oz per tube; A registered trademark of Procter & Gamble Interdental Flossups 1751 Compare to Oral-B, Complete Floss Picks, 90 ct; A registered trademark of Procter & Gamble $9 $5 $ $12 $ $5 $26 $ $25 $ 7
MEDICATIONS AND PRODUCTS Category Product Item # Brand/Description Cost Dental and Denture Care (continued) Diabetes Ear Care Eye Care First Aid and Medical Supplies Orajel Pain Relief 1454 Compare to Orajel, 7 gm tube; A registered trademark of Church & Dwight Co., Inc. Oral Pain Relief 126 Compare to Anbesol,.5 oz; A registered trademark of American Home Products Corporation Reach Waxed Dental Floss - Mint Toothpaste - Pepsodent Toothbrush, Rechargeable Toothbrush, Tek Pro, Straight Soft Toothbrush, Colgate, Adult Soft Diabetic Socks, White, Medium Diabetic Socks, White, Large Diabetic Socks, Black, Medium Diabetic Socks, Black, Large Cotton Tipped Swabs Multi-Purpose Contact Lens Solution Adhesive Bandages* 1455 Compare to Reach Dental Floss 55 Yards, Quantity 1; A registered trademark of Johnson & Johnson Consumer Products Co. 1414 Compare to Pepsodent Toothpaste, 6 oz per tube; A registered trademark of Church & Dwight Co., Inc. 1450 Compare to Oral B Vitality 1 ct; A registered trademark of Procter & Gamble 1412 Compare to Tek-Pro Toothbrush 1 ct; A registered trademark of Dr. Fresh 1413 Compare to Colgate Toothbrush 1 ct; A registered trademark of Procter & Gamble 149 Compare to Dr. Scholls, White, Size Medium, Quantity 1 pair; A registered trademark of MSD Consumer Care Inc. 1490 Compare to Dr. Scholls, White, Size Large, Quantity 1 pair; A registered trademark of MSD Consumer Care Inc. 1491 Compare to Dr. Scholls, Black, Size Medium, Quantity 1 pair; A registered trademark of MSD Consumer Care Inc. 1492 Compare to Dr. Scholls, Black, Size Large, Quantity 1 pair; A registered trademark of MSD Consumer Care Inc. 1742 Compare to Q-Tips Cotton Swabs, 300 ct; A registered trademark of Unilever 146 Compare to Renu Multi-Purpose Solution, 4 oz per bottle; A registered trademark of Bausch & Lomb 1344 Compare to Band-Aid Sheer, 60 ct per box; A registered trademark of Johnson & Johnson Consumer Products Alcohol Pads* 1200 Compare to Curad Alcohol Swabs, 0 ct per box; A registered trademark of Medline Inc. Ankle Support 1225 Compare to Ace Elastic Ankle Support, 1 ct per pack; A registered trademark of 3M Consumer Healthcare $11 $5 $40 $4 $5 $ $ $ $ $
Category Product Item # Brand/Description Cost First Aid and Medical Supplies (continued) Bath Bench with Back Bath Bench without Back 172 Compare to Essential Shower Bench with back; A registered trademark of Essential Medical Supply 1727 Compare to Essential Shower Bench; A registered trademark of Essential Medical Supply Bath Tub Safety Rail 1730 Compare to Carex Bathrub Rail with chrome finish; A registered trademark of Carex Health Brands Cushion, Gel / Foam Seat Elastic Bandage - 2 in x 5 in* Elastic Bandage - 3 in x 5 in* Elastic Bandage - 4 in x 5 in* Elastic Bandage - 6 in x 5 in* First Aid Kit, 4 Pieces First Aid Kit, 175 Pieces Hot / Cold Pack, 1 small and 1 large 1466 Compare to Drive Medical ; A registered trademark of Drive Medical Design and Manufacturing 1207 Compare to Ace Elastic Bandage, 1 ct per pack; A registered trademark of 3M Consumer Healthcare 1209 Compare to Ace Elastic Bandage, 1 ct per pack; A registered trademark of 3M Consumer Healthcare 1211 Compare to Ace Elastic Bandage, 1 ct per pack; A registered trademark of 3M Consumer Healthcare 1213 Compare to Ace Elastic Bandage, 1 ct per pack; A registered trademark of 3M Consumer Healthcare 1215 Compare to Curad, 1 ct; A registered trademark of Medline Industries 173 Compare to Curad First Aid Kit, 175 pieces; A registered trademark of Medline Industries. 62 Compare to Nexcare, 1 ct per pack; A registered trademark of 3M Consumer Healthcare Hydrogen Peroxide 122 Compare to Hydrogen Peroxide, oz / 236 ml $5 5 $55 $37 $42 $4 $4 $5 $5 $ $19 1-66-575-3744 (TTY: 7-1-1) You can place your order Monday to Friday, 7 a.m. to p.m. Central Time 9
MEDICATIONS AND PRODUCTS Category Product Item # Brand/Description Cost First Aid and Medical Supplies (continued) Foot Care Hemorrhoidal Preparations In-Home Diagnostics Motion Sickness Pain Relievers and Fever Reducers Pediculicide (lice treatment) Raised Toilet Seat 1729 Compare to Quick-Lock Raised Toilet Seat; A registered trademark of Carex Health Brands Thermometer, Digital Thermometer, Digital Ear Thermometer, Flexible Tip, Digital -seconds Callus Remover Pads 63 Compare to BD Digital Thermometer, 1 ct per pack; A registered trademark of Becton Dickinson and Company 125 Compare to Braun ThermoScan Compact Ear Thermometer, 1 per pack; A registered trademark of Procter & Gamble 1697 Compare to ProCheck ; A registered trademark of Microlife Corporation 123 Compare to Dr. Scholls 6 ct; A registered trademark of Schering-Plough Healthcare Products, Inc. Corn Remover Pads 1236 Compare to Dr. Scholls 9 ct; A registered trademark of Schering-Plough Healthcare Products, Inc. Pre-Moist Hemorrhoid Pads Desktop Blood Pressure Monitor Replacement Cuff EZ Detect Colon Cancer Test Kit Home Access Cholesterol Test Wrist Blood Pressure Monitor Dramamine Chewables, Orange 1364 Compare to Tucks, 0 ct per box; A registered trademark of Johnson & Johnson Consumer 1504 Compare to Omron ; A registered trademark of Omron Healthcare, Inc. 1416 Compare to Reveal Colon Disease Test ; A registered trademark of American Screening Corp. 1251 Compare to CholesTrak, 1 piece; A registered trademark of AccuTech, LLC 1501 Compare to Omron ; A registered trademark of Omron Healthcare, Inc. 1264 Compare to Dramamine, ct per pack; A registered trademark of Medtech Products Pain Relief Patches 1739 Compare to Salonpas Pain Relief Patch, 5 per box; A registered trademark of Hisamitsu America, Inc. Pain Relieving Muscle Rub Lice Treatment Shampoo Permethrin Lice Treatment 1475 Compare to Bengay, 2 oz bottle; A registered trademark of Johnson & Johnson Consumer Companies, Inc. 1271 Compare to Rid, 4 oz per bottle; A registered trademark of Pfizer Consumer Healthcare 1269 Compare to Nix, 1%, 59 ml per bottle; A registered trademark of Insight Pharmaceuticals Corporation Personal Care Aloe Vera Cream 70 Compare to Fruit of the Earth, oz per tube; A registered trademark of Fruit of the Earth, Inc. $35 $5 $24 $12 $ $19 $13 $35 $40 $14 $9 $14
Category Product Item # Brand/Description Cost Personal Care (continued) Sleep Aids Vitamins and Minerals Wart Remover Hand Sanitizer 65 Compare to Purell, oz per bottle; A registered trademark of GOJO Ind. Sunscreen Lotion SPF 30 Nasal Strips, Small / Medium Nasal Strips, Medium / Large 124 Compare to Coppertone, 3.5 oz per bottle; A registered trademark of Bayer AG 1724 Compare to Breathe Right, 30 ct per box; A registered trademark of Glaxo Smith Kline 1725 Compare to Breathe Right, 30 ct per box; A registered trademark of Glaxo Smith Kline Fiber Tablets 1155 Compare to Fibercon, 500 mg tablets, 60 ct per bottle; A registered trademark of Pfizer Wyeth Consumer Healthcare Fish Oil Tablets 1741 Compare to Nature s Bounty, 00 mg tablets, 60 per bottle; A registered trademark of Nature s Bounty, Inc. Glucosamine / Chondroitin Glucosamine Joint / Muscle 03 Compare to 21st Century Glucosamine & Chondroitin Original Formula, 250-200 mg capsules, 60 per bottle; A registered trademark of 21st Century HealthCare, Inc. 1114 Compare to 21st Century; 60 ct per bottle; A registered trademark of 21st Century Healthcare, Inc. Vitamin D 133 Compare to Vitamin D 400 iu 0, 0 ct per bottle $5 Wart Remover (Liquid) 75 Compare to Compound W Wart Remover, 9 ml; A registered trademark of Medtech Products, Inc. $12 $12 $ $12 $11 $ $9 1-66-575-3744 (TTY: 7-1-1) You can place your order Monday to Friday, 7 a.m. to p.m. Central Time 11
KEEP TRACK OF YOUR ORDERS Date Item 12
KEEP TRACK OF YOUR ORDERS Date Item 13
Notice of Nondiscrimination: Discrimination is Against the Law Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Cigna-HealthSpring does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Cigna-HealthSpring: Provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters Written information in other formats (large print, audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages If you need these services, contact Member Services. If you believe that Cigna-HealthSpring has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Cigna-HealthSpring Attention: Appeals, Complaints, and Grievances Department P.O. Box 21 Bedford, Texas 76095 1-77-653-0327 (TTY: 7-1-1) 7 days a week a.m. to p.m. Central Time Fax: 1-77-09-073 You can file a grievance in writing by mail or fax. If you need help filing a grievance, Member Services is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-00-36-19, 00-537-7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html. 14
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