2017 over-the-counter health products catalog 2017 over ... fida otc catalog.pdf · la lista de...

Questions about the VNSNY CHOICE FIDA Complete Medicare-Medicaid health plan? Call CHOICE toll-free:

1-866-783-1444TTY: 711

8 am – 8 pm, 7 days a week

1250 Broadway, New York, NY 10001vnsnychoice.org

2017 Over-the-Counter H

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2017 Over-the-CounterHealth Products Catalog

De Venta Libre (OTC)2017 Catálogo

de Productos Médicos

2017 成藥保健產品目錄

H8490_2017 OTC Catalog_Approved11282016

To enroll in VNSNY CHOICE FIDA Complete and learn more about other options for your health care,

call the Enrollment Broker (New York Medicaid Choice) toll-free at: 1-855-600-FIDA

TTY for the hearing impaired: 1-888-329-1541 8:30 am – 8:00 pm, Monday – Friday

10 am – 6 pm, Saturday or visit nymedicaidchoice.com

VNSNY CHOICE FIDA Complete(Medicare-Medicaid Plan)


1-866-783-1444TTY: 711





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VNSNY CHOICE FIDA Complete (Medicare-Medicaid Plan)

Any Questions? Call Participant Services Toll-Free1-866-783-1444 (TTY for the hearing impaired 711)

8 am – 8 pm, 7 days a weekParticipant Services also has free language interpreter services

available for non-English speakers.

1250 Broadway, 11th floor, New York, NY 10001www.vnsnychoice.org

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Get the most from your OTC benefit!

An important benefit of enrolling in VNSNY CHOICE FIDA Complete is coverage for hundreds of over-the-counter (OTC) health items. Each month, you can purchase items from the VNSNY CHOICE FIDA Complete product list. There is no out-of-pocket cost to you, up to the maximum benefit amount.

This package includes important information about how to use this benefit. Please save this information in a convenient place, so you can refer to it when you need to purchase additional OTC items. The following information is included:

online

Your Monthly BenefitsYou can receive $100 in OTC health products each month.

*Your monthly benefit does not carry over from month to month.

You can always call Participant Services to find out your current available balance or go on the web site at https://www.otcnetwork.com/member and log in with your OTC card number and Participant ID.

This benefit is for use by the VNSNY CHOICE FIDA Complete participant only. You cannot use this to buy items for your dependents or anyone else. Your balance will not accumulate month-to-month. Any unused amount will be returned to VNSNY CHOICE FIDA COMPLETE. Please note that at the end of each calendar year, your benefits will expire, and they may not be carried over into future years.

Using Your OTC BenefitThere are three convenient ways to use your OTC benefit. You can:

Complete to reimburse you.

There is more information below about each of these options.

You Can Purchase OTC Products at a Participating StoreYou may buy OTC products in person at participating retailers, simply by using your OTC card.

Before you use your card the first time, you must call to activate it. To activate your card, please follow the enclosed instructions in this packet. There is a toll-free phone number on your card that you will need to call.

As soon as this step is completed, you can start shopping with your OTC card.

Your card can be used at certain stores that are part of our network. This network includes CVS, Duane Reade, Walgreens, and Family Dollar Stores, plus a number of local pharmacies. Please call Participant Services toll-free at 1-866-783-1444, 7 days a week from 8 am – 8 pm for a list of participating retailers. (TTY users call 711.) We are available to help you. And if your card is ever lost or stolen, please contact us at this number immediately. We will cancel your card and send you a new one.

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You Can Order OTC Products for Delivery to Your HomeYou can also order OTC products by phone or online, and they will be mailed directly to you.

The website includes all of the products that are available through your OTC benefit. When you order through the web site, please be sure to have your Participant ID number available.

Our staff are available to assist you 7 days a week from 8 am – 8 pm.

When you order by phone, please be prepared with a list of the products you need. You will be asked for the name of the product, the quantity, and any other information about the product you are ordering to be sure you get the right item (for example whether you prefer tablets or caplets, cream or ointment, etc.)

If you order by phone or through the website please allow approximately 5 to 7 days for delivery. Please note that you are limited to one order by phone or through the website each month. You Can Request Reimbursement for Products that You Purchase on Your OwnYou can also purchase OTC products that are available through this benefit at any local store, and ask VNSNY CHOICE FIDA Complete to reimburse you for the costs. You are still limited to the total amount available in your monthly benefit. To request reimbursement for items that are covered by the OTC benefit, please follow these steps:

store, where the purchase was made, the date of purchase, the specific name of the product(s) that were purchased and the price paid.

sure to include: 1. The Participant’s name and ID number. 2. The complete address where your reimbursement should be sent. 3. Your phone number, so we can contact you if there are any questions about the information you submitted.

All requests for reimbursement should be sent* to the following address: VNSNY CHOICE FIDA Complete Participant Services 1250 Broadway, 11th Floor New York, NY 10001 ATTN: OTC Reimbursements or Faxed to: 646-524-8338 All requests must be submitted within 60 days of purchase. Please allow up to 30 days to process your request and mail a check to you. You may also follow the steps above, but fax your request instead of mailing it. The fax number is: 646-524-8338.

Questions?If you have any questions about your OTC benefit (or any VNSNY CHOICE FIDA Complete benefit) please call Participant Services at 1-866-783-1444. TTY users should call 711. Calls to these numbers are free. Our staff is available to assist you, 7 days a week from 8 am – 8 pm.

VNSNY CHOICE FIDA Complete is a managed care plan that contracts with both Medicare and New York State Department of Health (Medicaid) to provide benefits of both programs to Participants through the Fully Integrated Duals Advantage (FIDA) Demonstration.

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The State of New York has created a participant ombudsman program called the Independent Consumer Advocacy Network (ICAN) to provide Participants free, confidential assistance on any services offered by VNSNY CHOICE FIDA Complete. ICAN may be reached toll-free at 1-844-614-8800 or online at icannys.org. (TTY users call 711, then follow the prompts to dial 844-614-8800.)

The Visiting Nurse Service of New York and all of its subsidiaries and affiliates (“VNSNY”) 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 1-866-783-1444 (TTY: 711).

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-866-783-1444 (телетайп: 711).

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-866-783-1444 (TTY: 711)번으로 전화해 주십시오.

ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-866-783-1444 (TTY: 711).

Chiamare il numero 1-866-783-1444 (TTY: 711).

Limitations and restrictions may apply. For more information, call VNSNY CHOICE FIDA Complete Participant Services or read the VNSNY CHOICE FIDA Complete Participant Handbook.

Benefits may change on January 1 of each year..

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¡Obtenga la mayor ventaja de su beneficio de OTC!

Un beneficio importante al inscribirse en VNSNY CHOICE FIDA Complete es la cobertura de cientos de artículos médicos de venta libre (OTC, por sus siglas en inglés). Cada mes, usted puede comprar artículos de la lista de productos de VNSNY CHOICE FIDA Complete y su costo es cubierto por su plan. No hay costo de desembolso directo para usted, hasta el monto máximo del beneficio.

Este paquete incluye información importante acerca de cómo usar este beneficio. Guarde esta información en un lugar conveniente, para que pueda consultarlo cuando necesite comprar artículos OTC adicionales. Se incluye la siguiente información:

Sus beneficios mensualesPuede recibir $100 en productos médicos de OTC cada mes.

*Su beneficio mensual no se traslada al siguiente mes.

También puede comunicarse con nosotros para saber su saldo actual disponible.

comprar artículos para sus dependientes ni para alguien más. Cualquier saldo en su cuenta se colocará en $0

se pueden trasladar a años venideros.

Usar su beneficio de OTCHay tres maneras convenientes de aprovechar su beneficio de OTC. Usted puede:

Complete.

CHOICE FIDAComplete le reembolse. A continuación encontrará más información acerca de cada una de estas opciones.

Puede comprar productos de OTC en una tienda participante

Walgreens, Family Dollar Stores además de una cantidad de farmacias locales. Llame a Servicios al participante

deben llamar al 711.) Nuestro personal está disponible los 7 días de la semana, de 8:00 a. m. a 8:00 p. m. para

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Puede hacer pedidos de productos de OTC para que los envíen a su casaTambién puede hacer pedidos de productos OTC por teléfono o en línea, y ellos se los enviarán directamente a usted.

1-866-783-1444. Los usuarios de TTY deben llamar al 711. Nuestro personal está disponible para ayudarle los 7 días de la semana, de 8:00 a. m. a 8:00 p. m.Cuando haga su pedido por teléfono, tenga una lista de los productos que necesita. Se le pedirá el nombre

Si hace su pedido por teléfono o a través del Internet, permita de 5 a 7 días aproximadamente para la entrega. Tenga en cuenta que cada mes tiene límite de un pedido por teléfono o a través de Internet.

Puede solicitar reembolsos para los productos que compre por su cuentaTambién puede comprar productos de OTC que estén disponibles a través de este beneficio en cualquier tienda local y pedir a VNSNY CHOICE FIDA Complete el reembolso por los costos. Incluso así, su límite es el monto total disponible en su beneficio mensual. Para solicitar el reembolso, siga los pasos que se resumen a continuación.

(de los) producto(s) que se compró y el precio que se pagó.

2. La dirección completa a donde debe enviarse el reembolso.

pregunta sobre la información que envió.

Todas las solicitudes de reembolso se deben enviar a la siguiente dirección:VNSNY CHOICE FIDA Complete Participant Services1250 Broadway, 11th FloorNew York, NY 10001ATTN: OTC Reimbursements

días para procesar su solicitud y enviarle un cheque.

¿Tiene preguntas?Si tiene preguntas acerca de su beneficio de OTC (o cualquier beneficio de VNSNY CHOICE FIDA Complete), llame a Servicios al participante al 1-866-783-1444, los usuarios TTY deben llamar al 711. Las llamadas a

a.m. a 8:00 p.m.

VNSNY CHOICE FIDA Complete es un plan de atención médica administrada que contrata con Medicare y el Departamento de Salud del Estado de New York (Medicaid) para proveer beneficios de los dos programas a

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El Estado de Nueva York ha creado un programa de defensa para los participantes, denominado Red Independiente de Defensa del Consumidor (Consumer Advocacy Network, ICAN) para proporcionara los participantes ayuda gratuita y confidencial en todos los servicios que ofrece VNSNY CHOICE FIDA Complete. Puede comunicarse con ICAN llamando gratuitamente al 1-844-614-8800 o en su página web en en icannys.org. (Los usuarios de TTY deben llamar al 711 y seguir las indicaciones para marcar el 844-614-8800).

El Servicio de Enfermeras Visitantes de Nueva York y todas sus subsidiarias y afiliadas (VNSNY) cumple con

edad, discapacidad o sexo.

Usted puede obtener este documento en inglés o hablar con alguna persona sobre esta información en otros idiomas de manera gratuita. Llame al 1-866-783-1444 y (TTY es 711) de 8 am a 8 pm, 7 días a la semana. La llamada es gratis.

Puede haber ciertas limitaciones y restricciones. Para obtener más información, llame a Servicios para participantes de VNSNY CHOICE FIDA Complete o lea el Manual para participantes de VNSNY CHOICE FIDA Complete.

Los beneficios, la Lista de medicamentos cubiertos y las redes de farmacias y proveedores pueden cambiar en cualquier momento durante el año y el 1º de enero de cada año.

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VNSNY CHOICE FIDA Complete (OTC)VNSNY CHOICE FIDA Complete

OTC

OTCVNSNY CHOICE FIDA Complete

100 OTC

VNSNY CHOICE FIDA Complete0

OTCOTC

VNSNY CHOICE FIDA Complete OTC OTC

OTC VNSNY CHOICE FIDA Complete

OTCOTC OTC

OTC

CVS Duane Reade Walgreens Family Dollar Stores 1-866-783-1444

TTY/TDD 711 8:00 8:00

OTCOTC

(Drug Source)https://shopping.drugsourceinc.com/VNSNYFIDA

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1-866-783-1444 TTY 7118 8

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OTC VNSNY CHOICE FIDAComplete

1. ID2.3.

VNSNY CHOICE FIDA Complete Participant Services1250 Broadway, 11th FloorNew York, NY 10001ATTN: OTC Reimbursements

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OTC VNSNY CHOICE FIDA Complete1-866-783-1444 TTY 711

VNSNY CHOICE FIDA Complete Medicar Medicaid (New York State Department of Health) (Fully Integrated Duals Advantage FIDA)

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(Participant Ombudsman Program)(Independent Consumer Advocacy

Network ICAN) VNSNY CHOICE FIDA Complete

1-844-614-8800 ICAN icannys.org (TTY 711844-614-8800

8 81-866-783-1444 (TTY 711)

VNSNY CHOICE FIDA CompleteVNSNY CHOICE FIDA Complete

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Non-Eligible Products

Category

AlternativeMedicines

Homeopathic and alternative medicines includingbotanicals, herbals, probiotics and neutraceuticals

Examples of Excluded Items

Baby Items

Contraceptives

Convenience and Comfort

Cosmetics

Food product or supplements

Replacementitems,attachments,peripherals

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,

protein bars, power drinks

Hearing aid batteries, contact-lens containers, etc. when not factory packaged with the original item

See Appendix for Over-the-Counter Covered Health Items (by category)

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Productos no elegibles:

Categoría Ejemplos de artículos excluidos

Medicinasalternativas

Medicinas homeopáticas y alternativas incluso productos botánicos, hierbas, probióticos y neutracéuticos

Artículos para bebés

Anticonceptivos

Conveniencia ycomodidad

Cosméticos

Productosalimenticios osuplementos

Artículos,accesorios,componentesperiféricos derepuesto

Pañales, fórmula

Píldoras anticonceptivas, espermicidas y profilácticos

para labios, dispositivos para higiene personal, humectantes para la piel, productos para blanquear los dientes

barras de proteína, bebidas energéticas

Baterías para prótesis auditivas, estuches para lentes de contacto, etc. cuando el artículo original no tenga el empaque de fábrica

Vea el Anexo para los artículos médicos de venta libre cubiertos (por categoría)

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Table of Contents

Eligible Over-the-Counter (OTC) Items

Anti-Arthritic .....................................................................17

Dental/Denture ................................................................17

Diabetic ...............................................................................17

Ear Care ...............................................................................17

Eye Care ..............................................................................18

First Aid ...............................................................................18

Foot Care ............................................................................18

Incontinence Supplies ...................................................19

Lactose Intolerance Supplements .............................19

Medicated Lip Products ................................................20

Pain Reliever ......................................................................20

Skin Care/Sunscreen ......................................................20

Support Items ...................................................................21

Topical Steroids ................................................................21

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Artículos de Venta Libre (OTC)

Anti Artrítico .....................................................................17

Dental/Dentadura ..........................................................17

Diabético ............................................................................17

Cuidado del Oído ...........................................................17

Cuidado de la Vista ........................................................18

Primeros Auxilios ...........................................................18

Cuidado del Pie ..............................................................18

Artículos para la Incontinencia ...................................19

Suplementos para Intolerancia a la Lactosa ..........20

Productos con MedicaMento para los Labios ......20

Analgésicos ........................................................................20

Cuidado de la Piel/Filtro Solar ....................................20

Artículos de Apoyo ........................................................21

Esteroides Tópicos .........................................................21

Tabla de Contenido

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(OTC)

............................................................................17

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.................................................................................17

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Anti-Arthritic

Item # Generic Price

141-1743 Glucosamine Chondroitin 500/400 mg. / 60 Capsules $19.58

Item # Brand Price

479-0283 Murine Ear Wax Removal System / 0.5 oz. $7.76

Ear Care

Diabetic

Item # Brand Price

148-4575 Diabetiderm Foot Rejuvenating Cream / 4 oz. $12.38

Please call 1-866-783-1444 for more details (TTY users call 711).

Dental/Denture

SKU Generic Price

359-2920 Dental Floss / 100 Yd. $2.99

554-5710 Toothbrush Full Head / Soft $1.50

SKU Brand Price

109-0166 Anbesol Gel Regular Strength Cool Mint / 0.33 oz. $6.99

109-0141 Anbesol Liquid Regular Strength Cool Mint / 0.41 oz. $6.99

558-1525 Orajel Mouth Sore Gel / 0.18 oz. $6.68

435-0153 Orajel Mouth Sore Gel / 0.42 oz. $7.13

552-5837 Polident Overnight Cleanser / 120 ct. $10.38

308-0553 Sensodyne Toothpaste Original Flavor / 4 oz. $7.79

308-0397 Super Poligrip Denture Adhesive Cream Zinc Free Formula / 2.4 oz. $7.99

532-0080 Toothpaste Crest Large / 4.6 oz. $3.50

566-0444 Toothpaste Colgate Regular / 6.4 oz. $5.03

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Eye Care


133-7096 Eye Drops 0.5 oz. $2.77

Item # Brand Price

129-1038 B&L Renu Contact Lens / Case $4.69

306-0308 Bausch & Lomb Sensitive Eyes Daily Cleanser / 30 ml. $9.48

First Aid


133-8110 Adhesive Fabric Strips Assorted / 30 ct. $3.49

133-7617 Cotton Swabs / 300 ct. $4.50

Item # Brand Price

287-5417 Ace Elastic Bandage / 3 Inch $7.89

230-9557 Hot And Cold Mircro Therapy Gel Pack / 5x10 $4.60

110-0080 Ice Bag / 9 Inch $9.58

546-8038 Johnson & Johnson First Aid Kit / 125 Items $14.45

133-8060 Thermometer Digital Flexible Tip $8.00

229-5905 Vicks Comfortfl ex Thermometer $16.57


Item # Brand Price

550-4725 Dr Scholl Callous Remover One Step $5.30

550-4501 Dr Scholl Corn Remover Extra Thick Pads $3.55

Foot Care

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Incontinence Supplies

SKU Brand Price

098-1241 A & D Ointment / 4 oz. $5.85

148-2942 Balmex Clear Protection Ointment / 3.5 oz. $6.39

308-3052 Balmex Diaper Rash Cream With Zinc Oxide / 2 oz. $4.89

308-3326 Balmex Diaper Rash Cream With Zinc Oxide /4 oz. $5.99

455-0380 Desitin Ointment / 2 oz. $5.49

146-2316 Fitted Briefs Extra Large / 15 ct. (Diapers) $15.00

193-3761 Fitted Briefs Large / 18 ct. (Diapers) $15.00

193-3720 Fitted Briefs Medium / 16 ct. (Diapers) $15.00

175-7400 Perfi t Protective Underwear / 14 ct. Extra Large $15.00

175-7392 Perfi t Protective Underwear / 18 ct. Large $15.00

175-7376 Perfi t Protective Underwear / 20 ct. Medium $15.00

146-2571 Prevail Bladder Control Pads, Moderate / 20 ct. $15.00

146-2621 Prevail Underpad 30x36 / 10 ct. $10.00

187-4866 Surecare Protective Underwear / 14 ct. Extra Large $20.00

187-4841 Surecare Protective Underwear / 18 ct. Large $20.00

187-4858 Surecare Protective Underwear / 18 ct. Medium $20.00

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457-4471 Lip Balm Regular Twin Pack / Spf 4 $1.99

Medicated Lip Products


Pain Relievers

Item # Brand Price

121-4733 Icy Hot Patches Arm/Neck/Leg / 5 ct. $7.00

SKU Brand Price

172-2073 Lactaid Fast Act Caplets / 32ct. $11.72

Lactose Intolerance Supplements

Skin Care / Sunscreen

SKU Brand Price

229-7067 Banana Boat Sport Sunblock Spf 30 / 8 oz. $11.21

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Support Items

Item # Brand Price

259-0305 Futuro Ankle Support Wrap Around / Medium $10.80

259-0313 Futuro Ankle Support Wrap Around / Large $10.80

152-9627 Futuro Knee Support Stabilizing / Medium $15.79

152-9635 Futuro Knee Support Stabilizing / Large $15.79

135-5791 Futuro Wrist Stabilizer Deluxe Right /Small/Medium $28.00

135-5783 Futuro Wrist Stabilizer Deluxe Left / Small/Medium $28.00

242-7607 Futuro Wrist Stabilizer Deluxe Right / Large/X-Large $28.00

254-1282 Futuro Wrist Stabilizer Deluxe Left / Large/X-Large $28.00

Item # Brand Price

196-9070 Activon Ultra Strength Arthritis Topical Analgesic / 2 oz. $11.68

Topical Steroids



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Appendix: Over-the-Counter Covered Health Items

Eligible OTC Products by Category

Please note that the generic version of any products listed are also covered. This OTCProduct Listing provides examples of the brands that are covered for the symptoms that arelisted, but it is not meant to be a comprehensive list. Other brands of similar products arealso covered, as well as generics and store-brands of the same kinds of items.

Category Examples of Covered Brands Examples of Treatments and Symptoms

(Medicated) lactose intolerance products Lactaid Tablets

Eye/Ear Care Ear dropsEye drops

Baush & Lomb, Murine

Digestive Health

Corns

Foot pain

Supplement

Dr. Scholl’s, Diabetiderm

Diabetiderm Foot

Glucosamine/Chondroitin, Activon

Pain Relief

SunscreenLotion

Icy HotPain

Banana Boat

FuturoCompression HosieryOrthopedic supports

Teeth-RelatedItems, Denturesand Mouth Care

ToothbrushesToothpasteFlossDental adhesivesGum problemsThrushMouth sores

Anbesol, Crest, Colgate,

Sensodyne

Support Items

Foot Care

Diabetic

Anti-Arthritic

First Aid Supplies BandagesDressingsCotton Swabs, Thermometer

Johnson & Johnson

IncontinenceSupplies

Incontinence Balmex, Perfit, Prevail

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Baush & Lomb, Murine

Dolor de pie

Suplemento

Diabetiderm Foot


Futuro

Anti-Arthritic

Suministros de primeros auxilios

Vendas

Cintas adhesivas no deportivasEsteroides

Johnson & Johnson

Suministrospara incontinencia

Incontinencia Balmex, Perfit, Prevail

Categoría Ejemplos de marcas cubiertasEjemplos de síntomas

Productos (medicados) contra la intolerancia a la lactosa

Lactaid Tablets

Cuidado de los ojos/oídos

Gotas para los oídos

Anexo: artículos médicos de venta libre cubiertos

Observe que la versión genérica de cualquier producto enumerado también está cubierta. Esta lista de

no significa que sea una lista integral. Otras marcas de productos similares también están cubiertas, así como los artículos del mismo tipo genéricos y de marca.

Productos elegibles OTC por categoría

Salud digestive

Callos Dr. Scholl’s, Diabetiderm

Bloqueadorsolar

Banana Boat

Icy Hot

Medias y calcetas de compresiónSoportes ortopédicos

Artículos relacionados con los dientes, atención para dentaduras y boca

Cepillos de dientesPasta de dientesHilo dentalAdhesivos dentales para problemas de encíasAftasÚlceras bucales

Anbesol, Crest, Colgate,

Sensodyne

Artículos de apoyo

Cuidado de los pies

Alivio del dolor

Diabético

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Lactaid Tablets

Baush & Lomb Murine

OTC

Johnson & Johnson

Balmex Perfit Prevail

Dr. Scholl’s Diabetiderm

Anbesol Crest Colgate Polident Poligrip Sensodyne

Banana Boat

Icy Hot

Diabetiderm Foot


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Notes

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Notes

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Notes


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