Over-the-Counter (OTC) Covered Items

1 emblemhealth VIP Dual (HMO SNP) and emblemhealth Affinity Medicare Ultimate (HMO SNP) Over-the-Counter (OTC) Covered ItemsAs a member of emblemhealth VIP Dual (HMO SNP) and emblemhealth Affinity Medicare Ultimate (HMO SNP), you can use your Over-the-Counter (OTC) debit card to buy Covered Items from any participating OTC pharmacy. For more information about participating OTC pharmacies, please visit note you can only use this card to buy Items for yourself. Over-the-Counter (OTC) Covered Drugs and ItemsAbdominal Supports & Rib BeltsAcid ControllersAllergyAllergy Liquids, Tabs & CapsAllergy Nasal Sprays, Drops & InhalersAnti-DiarrhealsAnti-Diarrheal Tabs, Liquids & CapsAntifungal TreatmentsAntifungal Powders, Creams, Liquids & SpraysNail Fungus TreatmentsAnti-GasMixed/Miscellaneous Anti-GasAnti-Itch TreatmentsAnti-Itch Treatments (Excluding Hydrocortisone)

2 , Jock Itch & Insect Bite RemediesHydrocortisone ProductsAntiparasitic TreatmentsLice Treatments & AccessoriesBracesAnkle & FootElbow & ArmHand & WristJoint Warmers & ArthritisKneeThigh, Calf & ShinContact Lens CareGas Permeable & Hard Lens CareSoft Lens CleanersSoft Lens Multi-Purpose & Saline SolutionsSoft Lens Rewetting DropsCough, Cold, Flu & SinusCold & Flu Preventatives/Symptom ReducersCough, Cold, Flu & Sinus Liquids, Tabs & CapsCough Drops, Sore Throat ReliefSore Throat Pain ReliefThroat & Cough DropsOver-the- counter (OTC) Covered Drugs and ItemsDenture CareAlcohol Swabs and WipesDenture AdhesivesDenture Repair & Pain ReliefDiabetes Health & Personal CareDiabetes Cough, Cold & AllergyDiabetes Skin Care & External Pain ReliefDiabetes SupplementsDigestive AidsLactose IntolerancePrebiotics & ProbioticsDiuretics & Weight Loss Cleansing & DetoxDiureticsWeight Loss Cleansing & DetoxEar CareEar Drops & SyringesHearing AidsLipoflavonoidsElastic Bandages & Athletic TreatmentsAthletic TreatmentsElastic BandagesProtective GuardsElectrical & AudioHearing Aid Batteries (Standard & High Performance)

3 External Pain ReliefExternal Muscle/Joint Pain Relief Patches, Pads, Creams, Ointments, Gels, Lotions, Liquids, Roll-Ons & SpraysEye CareMagnifying GlassesReading GlassesEye Preparations (Includes Sleep Masks)Dry Eye ReliefEye Relief ProductsEye WashFacial & Body Acne MedicationsAcne Creams, Gels, Lotions, Patches, Soaps, Cleansers, Astringents, Toners & PadsOver-the- counter (OTC) Covered Drugs and ItemsFeminine AntifungalFirst Aid DressingsAdhesive & Liquid BandagesFinger Cots & SplintsFirst Aid Kits, Supplies & TapesGauze Pads, Dressings & RollsSurgical Bandages & DressingsFirst Aid TreatmentsAntiseptics & Medicated Products (Includes Alcohol, Peroxide, Epsom Salt, Etc.)

4 Skin Protectants (Includes Petroleum Jelly)Skin Treatments (Includes Burn & Scar)Topical AntibioticsWound CleansersFloss & Gum CareDental GumFloss & FlossersGum CareFoot Cushioning & TreatmentsCorn, Callus & Bunion PadsCorn & Callus RemoversFoot Pain ReliefAthletic Support SocksGeneral Compression Sleeves & GarmentsGeneral Support - Low Compression (8-15 mmHg) & Medical Support High Compression ( over 8-15 mmHg)Lymphedema Treatments (Sleeves, Socks, Pumps, Etc.) Medical Compression Sleeves & Garments Mixed/Miscellaneous General Support - Low Compression (8-15mmHg)Medical Support & Accessories (Knee High, Thigh High & Waist High)

5 Men s Support HoseWomen s High Compression Support Hose - Full & Maternity Women s Support Hose - Knee High, Thigh High, Full & MaternityHemorrhoid PreparationsHemorrhoid Treatments, Wipes & WashesHome Diagnostics and Aids for Daily LivingBathing & Oral Hygiene AidsBlood Pressure Kits & AccessoriesDrug & Alcohol TestsElectric Heating PadsGrooming & Dressing AidsMedical Alert IDs & DevicesMedicine Dosers, Pillboxes, Organizers & RemindersMobility Safety: Stair Rails, Stair Treads, Temporary Mobility RampsNightlights, Safety Lights, Pill CuttersReachers, Grippers & LiftsReading, Writing & Telephone AidsStethoscopes & AccessoriesThermometers, Fever Strips & AccessoriesHome Health CareBathtub Safety & AccessoriesBathtub & Toilet Rails & FramesElevated Toilet Seats & AccessoriesGrab Bars & HandlesHand Held ShowersMixed/Miscellaneous Bathroom SafetySitz Baths & BidetsIncontinence Personal CareDeodorizersDisposable Underwear, Briefs, Undergarments, Underpads, Pads, Shields.

6 Guards & Drip CollectorsPerineal - Only AntifungalsPerineal - Only Cleansers & WashesPerineal - Only Moisturizers, Barriers & ProtectantsPerineal - Only Wipes & NovelettesLaxativesEnemas, Laxative Suppositories, Kits, ProductsLaxative Liquids & Combination Stool-Softener ProductsNon-Liquid Laxatives (Non-Fiber) & Combination Stool-Softener ProductsStool SoftenersLip CareMedicated Lip TreatmentsNasalDecongestant Nasal Sprays, Drops & InhalersNasal Moisturizers, Washes, Strips & Snore ReliefOral Remedies (Includes Fluoride Treatments)Dry MouthOral Pain Relief & Mouth SoresTemporary Dental RepairOrthopedic & Surgical SupportArm Slings & Cervical CollarsHernia Supports & SuspensoriesSacro & Back BracesShoulder & Clavicle BracesPain ReliefAdult AcetaminophenAdult Aspirin & CombinationsAdult Ibuprofen & Other Anti-InflammatoriesAdult Nighttime Pain ReliefAdult Specialty Pain ReliefFeminine Pain ReliefPatient Skin SupportAntifungalsMoisturizers.

7 Barriers & ProtectantsPhysical Fitness & Exercise EquipmentFitness Trackers & PedometersRespiratory TreatmentsAsthma PreparationsHumidifiers & Accessories Repository TreatmentsVapor Products (Includes Waterless Vaporizers)Reusable IncontinenceReusable Garments & UnderpadsSleep Aids, Stimulants & Motion SicknessMotion Sickness & VertigoSleep Aids, Sedatives & StimulantsSmoking DeterrentsNicotine Patches, Gums & LozengesOver-the- counter (OTC) Covered Drugs and Items (Continued)Specialized Orthopedic Braces/Supports/SplintsSpecialized Ankle & Foot Braces/Supports/SplintsSpecialized Elbow & Arm Braces/Supports/SplintsSpecialized Hinged Knee Braces/Supports/SplintsSpecialized Knee Immobilizer Braces/Supports/SplintsSpecialized Shoulder & Clavicle Braces/Supports/SplintsSpecialized Thigh & Calf Braces/Supports/SplintsSpecialized Wrist & Hand Braces/Supports/SplintsSpecialized Wound CareAlginate DressingsCollagen DressingsFoam DressingsGauze Dressings, Pads, Sponges & PackingHydrocolloid/Hydrogel DressingsTapes.

8 Wraps & CompressionTransparent DressingsWound Cleansers, Treatments & AccessoriesStomach RemediesAntacidsAntacid Liquids, Tabs & CapsEffervescent Antacids & CombinationsMulti-Symptom & Nausea ProductsSun ProtectionSport Sun ProtectionSun Protection (< SPF 50)Sun Protection (SPF 50+)SupplementsEnzymes, Amino Acids & HormonesEye Health VitaminsGeneral Health Prebiotics & ProbioticsMenopause Support (Soy)Weight Management Tabs & CapsToothbrushesBattery & Rechargeable Toothbrushes & RefillsManual Toothbrushes & AccessoriesOver-the- counter (OTC) Covered Drugs and Items (Continued)Toothpastes & TreatmentsRegular & Sensitive Toothpastes Tooth Powders & TreatmentsWhitening Toothpastes Urine TestingUrine Test Strips & TabsVitaminsCalcium CoQ10 Only (UBIQUINOL)Eye Health Vitamins Heart Health & Essential Fatty Acids (Fish Oil, Flax, GLA, Etc.)

9 Iron Joint Health (Including Glucosamine)Multi-Minerals Vitamin B & Vitamin B ComplexVitamin CVitamin DVitamin EWart RemoversLiquids & PadsOver-the- counter (OTC) Covered Drugs and Items (Continued)HIP Health Plan of New York (HIP) is an HMO plan with a Medicare contract. Enrollment in HIP depends on contract renewal. HIP is an emblemhealth company. Group Health Incorporated (GHI), Health Insurance Plan of Greater New York (HIP), HIP Insurance Company of New York and emblemhealth Services Company, LLC are emblemhealth companies. emblemhealth Services Company, LLC provides administrative services to the emblemhealth NS 86-9378 1/19