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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) 010Alignment Health Plan AllCare Preferred (HMO) 011Alignment Health Plan Platinum (HMO) 016 H3815_IR20085EN_C
2020Grocery Benefit
Catalog
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ON-DEMAND CONCIERGE
Your Name HereGroceriesHOW TO USE YOUR BLACK CARD TO BUY
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.
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
PARTICIPATING RETAILERSMore 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.com1-833-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 -
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ELIGIBLE GROCERY BENEFIT ITEMSPlease 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.
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.
Y0141_IR20050EN_C
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).
Bottled waters
Breakfast foods (toaster pastries, cereal bars, granola & granola bars)
Canned meat
Canned seafood
Canned/jarred fruits and vegetables includes salsa & non-processed beans
Cereal (hot & cold), pancakes & waffles
Cocoa, coffee & tea (dry or liquid)
Dairy (milk, cheese, butter, sour cream & whipping cream)
Dried fruit, fruit snacks
Dry and liquid/concentrated drink mixes
Dry beans
Dry pasta
Enhanced waters
Fruits & vegetables
Herbs, spices & seasoning
Ice
Juice blends, drinks & punches (includes sparkling)
Juices (includes sparkling)
Margarine
Meats
Meats - poultry, ground beef, beef
Meats - processed (sausage, jerky, lunch meat)
Nuts, seeds & trail mix
Oils & shortening
Peanut butter (and other nut butters)
Produce (fruits & vegetables)
Rice & whole grains
Seafood
Soy & other nut milks
Sparkling water
Sport drinks - Gatorade & others
Tomato/spaghetti/Alfredo nutritionally significant sauce
Whole eggs & egg substitutes
Yogurt
Diabetes Candy
Diabetes Nutritional Bars
Diabetes Nutritional Liquids
Diabetes Supplements
Mixed/Miscellaneous Diabetes Health & Wellness
Mixed/Miscellaneous Diabetes Nutritionals
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HOW TO USE THIS CARD to buy eligible items:
Step 1Check 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 2Visit 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 3Pay 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. Applicable benefits will reload monthly on the first day of the month.
• If applicable, the grocery or over-the-counter benefit on your card does not carry forward from month to month. Any amount that is not spent each month is forfeited.
• Product availability and price may vary by retailer and is completely controlled by the retailer.
• This card cannot be used to pay for your prescription drug copays or anything else that is not on the list of eligible items.
• The card is not a credit card nor a gift card. Cash cannot be obtained using this card.
• The card may not be loaned to other people. Eligible items may only be purchased for the personal use of the plan member. Purchases for family members or friends are not allowed.
• If you have any questions about your ACCESS card, please contact your ACCESS concierge at 1-833-242-2223 (TTY 711).
*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 -
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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)
2020 Grocery Benefit Catalog
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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
2020 Grocery Benefit Catalog
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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
2020 Grocery Benefit Catalog
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Revised: 08/07/2019H3815_IR20001EN_CH4961_IR20001EN_C
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: [email protected]
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.
Discrimination is against the law
H3815_IR20001EN_C H4961_IR20001EN_C Revised: 08/07/2019
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Español (Spanish): ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-399-2247 (TTY: 711).
ةیبرعلا (Arabic): مصلا فتاھ مقر( 2247-634-866-1 مقرب لصتا .ناجملاب كل رفاوتت ةیوغللا ةدعاسملا تامدخ نإف ،ةغللا ركذا ثدحتت تنك اذإ :ةظوحلم .)711 :مكبلاو
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。1-866-634-2247 (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.
ែខ#រ (Cambodian): %បយ័ត*៖ េប-សិន1អ*កនិ4យ 56ែខ#រ, េស7ជំនួយែផ*ក56 េ