2020 Grocery Benefit

Catalog

A P P L I C A B L E T O :

Alignment Health Plan CalPlus (HMO) 009 Alignment Health Plan Heart & Diabetes (HMO SNP) 010 Alignment Health Plan AllCare Preferred (HMO) 011 Alignment Health Plan Platinum (HMO) 016 H3815_IR20085EN_C

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ON DEMAND CONCIERGE

Your Name Here

HOW TO USE YOUR BLACK CARD TO BUY

Groceries A NEW benefit exclusively for qualified members of:

CalPlus (HMO) 009 • $20/month

Heart & Diabetes (HMO SNP) 010 • $20/month

AllCare Preferred (HMO) 011 • $10/month

Platinum (HMO) 016 • $10/month

To help Alignment members with chronic illnesses meet their nutritional needs, we’ve added a new grocery benefit for select plans in 2020! Qualified members can use their ACCESS On-Demand Concierge card to buy eligible items at any participating retailer nationwide.

Qualifying conditions* include chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), dementia, diabetes and stroke. Other chronic conditions may apply.

PARTICIPATING RETAILERS More retailers may be added in the future.

GROCERY SHOPPING ON US!

Gather your eligible items

Proceed to the store check-out lanes

Swipe your card for payment

DO YOU QUALIFY? Your ACCESS On-Demand Concierge is Here to Help

https://members.alignmenthealthplan.com 1-833-AHC-ACCESS

1-833-242-2223, TTY 711

24 hours a day, 7 days a week

*Medical records are used to establish qualification and, once qualified, you will qualify for the remainder of the plan year. We will automatically qualify you based on your medical records. To ensure continued eligibility, please schedule your free annual wellness visit to ensure your medical records are up to date. Benefits vary by plan. Please check your evidence of coverage for more information about your specific plan benefits. - 2 -

http:https://members.alignmenthealthplan.com

ELIGIBLE GROCERY BENEFIT ITEMS Please keep for future reference. Product availability and price may vary by retailer and is completely controlled by the retailer. You may view a more comprehensive list of eligible items by visiting www.alignmenthealthplan.com/access.

Bottled waters Meats - poultry, ground beef, beef

Breakfast foods (toaster pastries, Meats - processed (sausage, jerky, cereal bars, granola & granola bars) lunch meat)

Canned meat Nuts, seeds & trail mix

Canned seafood Oils & shortening

Canned/jarred fruits and vegetables Peanut butter (and other nut butters) includes salsa & non-processed beans Produce (fruits & vegetables)

Cereal (hot & cold), pancakes & waffles Rice & whole grains

Cocoa, coffee & tea (dry or liquid) Seafood

Dairy (milk, cheese, butter, sour cream Soy & other nut milks

& whipping cream) Sparkling water

Dried fruit, fruit snacks Sport drinks - Gatorade & others

Dry and liquid/concentrated drink Tomato/spaghetti/Alfredo nutritionally mixes

significant sauce Dry beans

Whole eggs & egg substitutes Dry pasta

Yogurt Enhanced waters

Fruits & vegetables Diabetes Candy

Herbs, spices & seasoning Diabetes Nutritional Bars

Ice Diabetes Nutritional Liquids

Juice blends, drinks & punches Diabetes Supplements (includes sparkling) Mixed/Miscellaneous Diabetes Juices (includes sparkling)

Health & Wellness Margarine

Mixed/Miscellaneous Diabetes Meats Nutritionals

Eligible items can be paid for with the ACCESS On-Demand Concierge card up to the available monthly benefit. Any remaining allowance does not carry forward from month to month. Any amount that is not spent each month is forfeited.

Alignment Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-866-634-2247 (TTY 711). ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-399-2247 (TTY 711). Alignment Health Plan 遵守適用的聯邦民權法律規定，不因種族、膚色、民族血統、年齡、殘障 或性別而歧視任何人。注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-866-634-2247 (TTY 711). Y0141_IR20050EN_C

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www.alignmenthealthplan.com/access

HOW TO USE THIS CARD to buy eligible items:

Step 1 Check Your Balance and Find an Eligible Item. There are several ways to check your card balance or find eligible items to buy with your card:

• Download the OTC Network® mobile app to your mobile device to check your balance and scan the item’s UPC barcode to check eligibility

• Log on to your Alignment Member Portal account at https://members.alignmenthealthplan.com and click on “ACCESS CARD BALANCE”

• Refer to your plan’s benefit catalog* on www.alignmenthealthplan.com/access

• Call your ACCESS On-Demand Concierge team at 1-833-242-2223 to request a hard-copy of your benefit catalog* to be mailed to you or to look up an item for you

Step 2 Visit a Participating Retailer. You may use your card at any participating retailer listed in your benefit catalog.* Remember to take your card with you – you will need the card to pay for your eligible items. If you are unsure if an item is eligible for purchase, please ask the cashier to swipe your card to verify eligibility.

Step 3 Pay Cashier. Gather your eligible items and proceed to the store check-out lanes. When you check out, swipe your black ACCESS card for payment. While you may include both eligible and non-eligible items in one transaction, the available balance on your ACCESS card will apply toward the cost of eligible items only. Please have another form of payment (cash or credit) available to pay for any costs beyond the balance available on your ACCESS card and/or for non-eligible items.

• Do NOT lose or throw away this card. • The card is not a credit card nor a gift card. Applicable benefits will reload monthly Cash cannot be obtained using this card. on the first day of the month.

• The card may not be loaned to other • If applicable, the grocery or over-the- people. Eligible items may only be purchased

counter benefit on your card does not for the personal use of the plan member. carry forward from month to month. Purchases for family members or friends Any amount that is not spent each are not allowed. month is forfeited.

• If you have any questions about your • Product availability and price may vary ACCESS card, please contact your

by retailer and is completely controlled ACCESS concierge at 1-833-242-2223 (TTY by the retailer. 711).

• This card cannot be used to pay for your prescription drug copays or anything else that is not on the list of eligible items.

*Benefits vary by plan. Please refer to the grocery benefit, healthy rewards and/or over-the-counter catalog that pertains to your plan. Alignment Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. ATTENTION: If you speak a language other than English, language assistance services,free of charge, are available to you. Call 1-866-634-2247 (TTY 711). ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-399-2247 (TTY 711). Alignment Health Plan 遵守適用的聯邦民權法律規定，不因種族、膚色、民族血統、年齡、殘障 或性別而歧視任何人。注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-866-634-2247 (TTY 711). - 4 -

www.alignmenthealthplan.com/accesshttp:https://members.alignmenthealthplan.com

2020 Grocery Benefit Catalog

G R O C E R Y B E N E F I T C A T A L O G C A T E G O R I E S

D I A B E T E S C A R E

Diabetes Health & Wellness

Mixed/Miscellaneous Diabetes Health & Wellness

Diabetes Nutritionals

Diabetes Candy

Diabetes Nutritional Bars

Diabetes Nutritional Liquids

Mixed/Miscellaneous Diabetes Nutritionals

F O O D & B E V E R A G E S

Beverages

Bottled Waters

Cocoa, Coffee & Tea (Dry or Liquid)

Dry & Liquid/Concentrated Drink Mixes

Enhanced Waters

Ice

Juice Blends, Drinks & Punches (Includes Sparkling)

Juices (Includes Sparkling)

Sparkling Water

Sport Drinks - Gatorade & Others

Frozen Food

Fruits & Vegetables

Juices

Meats

Prepared Food (Stews, Pizza, Heat & Eat, Soy Burgers)

Seafood

Non-Perishable Food

Breakfast Foods (Toaster Pastries, Cereal Bars, Granola & Granola Bars)

Canned Meat

Canned Seafood

Canned/Jar Fruits and Vegetables (Includes Salsa & Non-Processed Beans)

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2020 Grocery Benefit Catalog

Cereal (Hot & Cold), Pancakes & Waffles

Dried Fruit, Fruit Snacks

Dry Beans

Dry Pasta

Herbs, Spices & Seasoning

Oils & Shortening

Peanut Butter (& Other Nut Butters)

Prepared Food (Canned Stews, Heat & Eat)

Rice & Whole Grains

Soup

Tomato/Spaghetti/Alfredo/Nutritionally Significant Sauce

Perishable Food

Dairy - (Milk, Cheese, Butter, Sour Cream & Whipping Cream)

Margarine

Meats - Poultry, Ground Beef, Beef

Meats - Processed (Sausage, Jerky, Lunch Meat)

Produce (Fruits & Vegetables)

Seafood

Soy & Other Nut Milks

Whole Eggs & Egg Substitutes

Yogurt

Snacks & Desserts

Nuts, Seeds & Trail Mix

V I T A M I N S & D I E T A R Y S U P P L E M E N T S

Children’s Vitamins & Dietary Supplements

Children's Herbals

Children's Vitamins & Minerals

Mixed/Miscellaneous Children's Vitamins & Dietary Supplements

Herbals & Botanicals

Colon Cleanse & Detox (Non-Weight Loss)

Echinacea

Garlic

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2020 Grocery Benefit Catalog

Ginkgo Biloba

Ginseng

Mixed/Miscellaneous Herbals & Botanicals

St. John's Wort

Multivitamins

Prenatal Vitamins

Specialty Supplements

Mixed/Miscellaneous Specialty Supplements

W E I G H T M A N A G E M E N T & N U T R I T I O N A L F O O D S

Nutritional Foods

General Health Oral Rehydration Therapy

Mixed/Miscellaneous Nutritional Foods

Nutritional Bars

Nutritional Liquids

Nutritional Powders

Thickeners & Pre-Thickened Beverages/Foods

Sport/Energy

Mixed/Miscellaneous Sport/Energy

Sport/Energy Bars

Sport/Energy Liquids

Sport/Energy Powders

Sport/Energy Tabs & Caps

Sugar & Salt Substitutes

Mixed/Miscellaneous Sugar & Salt Substitutes

Sugar & Salt Substitutes

Weight Management

Mixed/Miscellaneous Weight Management

Weight Management Bars

Weight Management Foods, Liquids & Powders

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H3815_IR20001EN_CH4961_IR20001EN_C

Revised: 08/07/2019

Discrimination is against the law Alignment Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Alignment Health Plan does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

Alignment Health Plan:

• Provides free aids and services to people with disabilities to communicate effectively with us, such as:

o Qualified sign language interpreters

o 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:

o Qualified interpreters

o Information written in other languages

If you need these services, contact Member Services at 1-866-634-2247 (TTY 711).

If you believe that Alignment Health Plan 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:

Compliance and Regulatory Affairs 1100 W. Town and Country Rd, Suite 1600 Orange, CA 92868 Phone: 1-844-297-5948, TTY: 711 Fax: 562-207-4621 Email: Compliance@ahcusa.com

You can file a grievance in person or by mail, fax, or email. 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 1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

H3815_IR20001EN_C H4961_IR20001EN_C Revised: 08/07/2019

http://www.hhs.gov/ocr/office/file/index.htmlmailto:Compliance@ahcusa.com

Español (Spanish): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-399-2247 (TTY: 711).

لاو

(Arabic): ةمصلاقر(2247-634-866-1 مقربل صتا .ناجملااوتتةیوغللاتامدخن إف،ةغلاركذا ثدحتتتنك اذإ :ةظوحلم افتھ مبكلرفا ةدعاسملل

یبرعلا

.)711:ب مك

Հայերեն (Armenian): ՈՒՇԱԴՐՈՒԹՅՈՒՆ՝ Եթե խոսում եք հայերեն, ապա ձեզ անվճար կարող են տրամադրվել լեզվական աջակցության ծառայություններ: Զանգահարեք 1-866-634-2247 (TTY (հեռատիպ)՝ 711):

繁體中文(Chinese):注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-866-634-2247 (TTY: 711).。

%िहंदी (Hindi): !ान द% : यिद आप िहंदी बोलते ह2 तो आपके िलए मु7 म% भाषा सहायता सेवाएं उपल= ह2। 1-866-634-2247 (TTY: 711).पर कॉल कर।

Hmoob (Hmong): LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-866-634-2247 (TTY: 711).

日本語 (Japanese):注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1866-634-2247 (TTY: 711)まで、お電話にてご連絡ください。

한국어(Korean): 주의: 한국어를 사용하시는 경우 , 언어 지원 서비스를 무료로 이용하실 수 있습니다 . 1-866-634-2247 (TTY: 711) 번으로 전화해 주십시오 .

ស័ំFប់បំេរHអ*ក។ ចូរ ទូរ ពM័ត*៖ េប-សិន1អ*កនិ4យ 56ែខរ, េស7ជំនួយែផ*ក56 េ#រ (Cambodian): %បយែខ#1-866-634-2247 (TTY: 711)។