Welcome to Over-the-Counter Essentials

1 Welcome to Over-the-Counter Essentials 2016 Over-the-Counter Essentials Over-the-Counter (OTC) Essentials allows you to purchase health and wellness products from the enclosed product listing. How to order: You can place an order by mailing the order form in the supplied postage paid envelope or by going to If your total order exceeds your credit amount limit, please be sure to include a check or money order to pay the remaining amount due. Failure to submit payment in full will lead to a delay in shipment. Ordering is easy: Part of your UnitedHealthcare health plan. Online: Go to Mail: Fill out the Order Form and mail only the order form page in the postage paid envelope.

2 Mail orders must be postmarked by March 31, June 30, September 30 and December 31 of each year. Keep this catalog. You'll need it to look up the health and wellness products you want to order. <FLM Code> <Print Code> Y0066_150812_105106 Accepted 2016 Over-the-Counter Essentials | 3. 2016 Over-the-Counter Essentials Stomach Remedies Your UnitedHealthcare health plan offers Over-the-Counter (OTC) Essentials that allows Item # Product name Compare to Count Price you to purchase health and wellness products from the enclosed catalog. Each quarter, $50 in Benefit Credits are loaded into your account to purchase health and wellness products.

3 1878* Acid Reducer Tablets Pepcid AC 30 $ All orders are shipped right to you at no additional cost for shipping, handling and taxes. 1881 Antacid Tablets Fruit TUMS 150 $ Benefit Credits expire at the end of each quarter and cannot be redeemed for cash. You cannot 1890 Antacid Tablets Fruit Extra Strength TUMS Extra Strength 96 $ apply future credits to your order and each order must total at least $30 in Benefit Credits. Only products in the catalog are covered under this benefit and items offered under this 1884 Antacid Mint Maalox Regular Strength 12 fl oz $ plan benefit may only be used by the plan member. 1792 Gas Relief Softgels Ultra Strength Phazyme 60 $ How to order: 1816 Antacid Plus Gas Relief Mylanta Regular Strength 12 fl oz $ You can place an order by mailing the order form in the supplied postage paid envelope or 1579 Bismuth Liquid Pepto-Bismol 8 fl oz $ by going to If your total order exceeds your credit amount limit, please be sure to include a check or money order to pay the remaining amount due.

4 Failure to 1584 Stomach Relief Chewable Tablets Pepto-Bismol 30 $ submit payment in full will lead to a delay in shipment. 1592 Loperamide Hydrochloride Anti-Diarrheal Imodium A-D 4 fl oz $ 1603 Anti-Diarrheal Caplets Imodium A-D 12 $ Ordering is easy: 1571 Natural Vegetable Laxative Tablets Senokot 100 $ 1619 LaxaClear Powder Miralax oz $ Online: Go to 1624 Milk of Magnesia Phillips 12 fl oz $ 1660 Enema Fleet 3 pack $ Mail: Fill out the Order Form and mail only the 1558 Stool Softener Softgels Colace 100 $ order form page in the postage paid envelope. Mail orders must be postmarked by March 31, June 30, September 30 and December 31 of each year.

5 Keep this catalog. You'll need it to look up the health and wellness products you want to order. If you have questions around products or delivery, please call FirstLine Medical customer service * In certain circumstances some items on this page may be covered by the plan, or Original Medicare if you are not enrolled at 1-877-795-4521 (TTY: 711), 7 7 Monday Friday, CT and 7 4 Saturday, CT. in the plan, and if item is determined to be medically necessary. Please check with your healthcare provider before ordering. This order form is for the 2016 benefit year. Please do not submit your first order until after January 1, 2016.

6 If you need additional order forms, you can go to our website to download or you can call FirstLine Medical customer service. If your item is not in stock, an item of similar or greater value may be substituted in your order. Exchange Policy: If you receive a damaged item, please call FirstLine Medical immediately. The item will be exchanged for an identical item at no cost to you. Please note: only damaged products can be exchanged within 30 days of FirstLine Medical is the supplier of all products within this mailing. UnitedHealthcare Insurance purchase, no other returns are allowed. Company manages FirstLine Medical through its affiliate OptumRx.

7 This catalog contains a listing of all products offered through FirstLine Medical. Benefit Credit amounts vary by health Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, plan and some products in this catalog may not be available to all members. a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on The health information provided in the catalog is general in nature and is not medical advice or a substitute for professional the plan's contract renewal with Medicare. health care. It is provided for your information and convenience only. UnitedHealthcare Insurance Company (UHIC) does not guarantee the accuracy or completeness of the information, and does not recommend or endorse the products This information is not a complete description of benefits.

8 Contact the plan for more information. which are referenced in the catalog. Limitations, co-payments, and restrictions may apply. Benefits, premium and/or co-payments/. co-insurance may change on January 1 of each year. Note: Your OTC benefit only covers items listed in this catalog and does not cover alternative medicines, baby items, contraceptives, convenience items, cosmetics, food supplements, replacement items, attachments and peripherals. 4 | 2016 Over-the-Counter Essentials 2016 Over-the-Counter Essentials | 5. Pain Management Cold, Cough & Allergy Item # Product name Compare to Count Price Item # Product name Compare to Count Price 2716 Aspirin 81 mg Enteric Coated Bayer Low Strength Aspirin 120 $ 2972 Medicated Chest Rub Vicks Vaporub oz $ 2680 Aspirin 81 mg Chewable Tablets 36 $ Tylenol Cold Multi-Symptom 3001 Day/Night Combo Pack 20 $ Day & Night 2664 Pain Relief 325 mg Tablets Regular Strength Tylenol 100 $ 2 packs 2703 Pain Relief PM Extra Strength Tylenol PM 50 $ 3082 Cough Drops Honey Lemon Halls Regular $ 30 ct 2588 Ibuprofen 200 mg Coated Tablets Advil 100 $ 2 packs 3081 Cough Drops Black Cherry Sugar-Free Halls Sugar-Free $ 25 ct 2760 All

9 Day Relief Aleve 100 $ 3360 DM Cough Syrup Sugar-Free Robitussin DM Sugar-Free 16 fl oz $ 2352 Pain Reliever Plus Excedrin 100 $ 3364 DM Cough Syrup Sugar-Free Robitussin DM Sugar-Free 4 fl oz $ 2610 Motion Sickness Tablets Dramamine Original 12 $ 3375 CF Cough & Cold Robitussin Cough & Cold CF 4 fl oz $ 2366 Fast Freeze Roll On BioFreeze 3 oz $ 2837 Sore Throat Lozenges Cepacol 18 $ 2357 Mineral Freez Gel Mineral Ice 8 oz $ 2388 Capsaicin Pain Relief Cream Capzasin 2 fl oz $ 3119 Sore Throat Spray Menthol Chloraseptic 6 fl oz $ 3097 Muscle and Joint Gel Vanishing Scent Bengay 3 oz $ 2943 Sore Throat Spray Cherry Chloraseptic 6 fl oz $ 3113 Muscle Rub Ultra Strength Bengay 3 oz $ Eye & Ear Care 2753 Medicated Pads Tucks 100 $ Item # Product name Compare to Count Price 3138 Hemorrhoidal Ointment Preparation H 2 oz $ 3232 Earwax Treatment Drops Debrox.

10 5 fl oz $ 3099 Miconazole Vaginal Cream Monistat 7 oz $ 5124 Eye Drops AC Visine AC .5 fl oz $ Cold, Cough & Allergy 3346 Artificial Tears Visine Tears .5 fl oz $ Item # Product name Compare to Count Price 2998 Itchy Eye Drops Zyrtec .17 fl oz $ 3204* All Day Allergy Tablets Zyrtec 30 $ Oral Care 3202* All Day Allergy Tablets Zyrtec 90 $ Item # Product name Compare to Count Price 3235* Allergy Relief Tablets Claritin 30 $ 5280 Battery Power Toothbrush 1 $ 3167 Allergy Tablets 4 Hour Chlor-Trimeton 24 $ 5281 Replacement Heads for 5280 2 ct $ 2969 Children's Allergy Children's Benadryl Allergy Liquid 4 fl oz $ 4949 Toothbrush 1 $ 3282 Allergy Relief Tablets Benadryl Allergy Ultratab 24 $ 5063 Tongue Cleaner 1 $ 3193 Allergy Relief Tablets Benadryl Allergy Ultratab 100 $ 5177 Denture Adhesive Fixodent Original 2 oz $ 3355 Mucus Relief Tablets 100 $ 4968