over-the-counter booklet 2019 cigna-healthspring · 2018-12-13 · 2 3 4 save money and time. ......
TRANSCRIPT
INT_19_65379 _C Approved 08302018 920824
OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS
Your 2019 catalog
2
YOUR OVER-THE-COUNTER (OTC)
MEDICATIONS AND PRODUCTS
Check your Cigna-HealthSpring Evidence of Coverage to see
your quarterly OTC allowance
Choose from the list of covered medications and products in
this catalog
Order in the way that works for you
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
CLICK to order through our all-new OTC products website at wwwCignaHealthSpringOTCcom
Its easy to
bull Create a personal log-in profile Its quick and securebull View your balance Unused funds roll over during a calendar year bull Track your available funds in real time as you add products
to your cartbull Review your order history throughout the yearbull Get email with tracking number when your order ships
Address change Call to check that we have your current mailing address 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
1
2
3
4
SAVE MONEY AND TIMEYou can get OTC items sent right to your door ndash with FREE delivery
3
Q What can I order
A You can order from the list of covered items in this catalog Covered items may include
OTC medications bull Aspirinbull Acetaminophenbull Vitaminsbull Cold and flu medicine
Health-related productsbull Nicotine patchesbull Disposable underpadsbull Compression socksbull Nasal strips
Q How much is my quarterly allowance
A The dollar value of your quarterly allowance depends on your plan Check your Cigna-HealthSpring Evidence of Coverage to see your quarterly OTC allowance
Q When can I spend my quarterly allowance
A Your allowance goes into your
account quarterly on January 1
April 1 July 1 and October 1
You canbull Spend your full quarterly
allowance as soon as it is in your account
bull Save up your allowances
to order higher-priced items later in the year
bull Order once a month
up to 12 times a year
Unused balances roll forward each quarter However balances do not carry over to the next year
Q Who can get items through my OTC benefit
A You can order items that help you
with a medical need every month you are a Cigna-HealthSpring customer Cigna-HealthSpring prohibits the purchase of OTC items for family customers or friends
Q How do I get my order
A The cost of your order must be less than or equal to the account balance for items to ship OTC medications are only available for home delivery Covered items are sent to you free of delivery charge Please allow 7-10 business days for home delivery
QAamp Common questions about
your OTC benefit
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
4
CATEGORY INDEXPlease use the index below for ease in locating available OTC items
Category Products include PageAllergy Cold Flu Decongestant and Sinus
Antihistamines decongestants cough suppressantsexpectorants nasal sprays cough drops throat lozenges and other products
5
Antacids and
Acid ReducersLiquids chewables capsules gas pain relievers and other products to treat symptoms of stomach upset heartburn and acid indigestion
6
Anticandidal (yeast) Vaginal cream with applicator 7Anti-diarrheal Laxatives and Digestive Health
Tablets capsules and powders to treat symptoms of constipation upset stomach bloating cramping gas and diarrhea
7
Anti-fungal and Anti-itch
Topical creams and powders to treat symptoms of athletersquos foot jock itch poison ivy insect bites and other applications
8
Bathroom Safety Bath benches mats safety rails and raised toilet seats 8Cold Sore and Medicated Lip Products
Lip balmscream to treat cold sores fever blisters and chapped lips
9
Dental and Denture Care
Mouthwash toothbrushes cleaning tablets and creams adhesive cream floss and oral pain relief gel
9
Diabetic Foot Care Socks for people with diabetics circulatory problems edema and neuropathy 10Ear Care Cotton swabs drops for earaches and wax removal treatments 10Eye Care Eye drops for lubricating and cleansing 10First Aid and Medical Supplies
First aid products and medical supplies including CPAP pillows face mask humidifier insect spray pill crushercutter thermometers and other products
11
Foot Care Foot powder pads to remove calluses and corns 13Hemorrhoidal Preparations Ointment suppository pads and wipes for temporary relief from hemorrhoids 13Hormone Replacement A hormone supplement 13Incontinence Supplies Wipes bed pads pads disposable briefsunderwear cleanser and skin protectant 13In-home Diagnostic Equipment Scales blood pressure monitors finger pulse oximeter and heart rate monitor 14In-home Diagnostic Tests Tests for colon cancer and cholesterol 15Lice Treatment (Pediculicide) 3-step kit shampoo and conditioning treatment for lice treatment 15Mobility Canes and cushions 15Motion Sickness Tablets used to prevent and treat nausea vomiting dizziness
and vertigo associated with motion sickness15
Pain Relievers and Fever Reducers
Tablets capsules chewables patches heating pads and wraps to temporarily relieve pain and reduce fever
15
Personal Care Acne care moisturizer for dry skin and hand sanitizer 17Skin and Sun Care Creams lotions and gels for moisturizing and protecting
skin including sunscreen and scar gel17
Sleep Aids Nasal strips 17Smoking Cessation Nicotine lozenges and patches 17Supportive Items Bracessupports gloves compression socks for
ankles back hands hips knees and ribs17
Vitamins and Minerals Dietary supplements 19Wart Remover Liquid to remove warts 21Weight Loss Chewable fiber 21
5
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item PriceAllergy Cold Flu Decongestant and Sinus
Allergy Relief Nasal Spray 24-hr Fluticasone Propionate - Compare to Flonasereg
- 120 spray50 mcg
1946 $2500
All-Nite ColdFlu - Compare to Vicks NyQuilreg - 4 oz125 mg 30 mg 650 mg
1361 $600
Cepacolreg Sore Throat Lozenges - 16 ct
1360 $700
Cetirizine HCL Allergy Relief - Compare to Zyrtecreg
- 14 ct10 mg
1090 $700
Chlorpheniramine Maleate Antihistamine - 100 ct4 mg
1008 $500
Cough and Cold for High Blood Pressure - Compare to Coricidin HBPreg
- 16 ct
1166 $700
Cough DropsCherry (Compare to Hallsreg)
- 30 ct58 mgSugar Free Cherry (Compare to Halls Sugar Freereg)
- 25 ct58 mgMenthol (Compare to Hallsreg)
- 30 ct
1056
1182
1834
$400
$500
$400
Cough Syrup Expectorant - Compare to Robitussinreg
- 4 oz200 mg 10 ml
1054 $500
Cromolyn Sodium Allergy Nasal Spray - Compare to Nasalcromreg
- 26 ml
1356 $1800
Diabetic Tussin DM - Compare to Robitussin Sugar Free DMreg
- 4 oz
1323 $1000
Diphenhydramine Antihistamine - Compare to Benadrylreg - 100 ct25 mg
1308 $600
Diphenhydramine Antihistamine - Compare to Benadrylreg - 24 ct25 mg
1009 $500
Guaifenesin Cough Expectorant - 60 ct200 mg
1180 $900
Loratadine Allergy Relief - Compare to Claritinreg
- 100 ct10 mg
1611 $2000
Mucus Relief DM Expectorant and Cough Suppressant(Compare to Mucinexreg)
- 30 ct400 mg 20 mgExtended Release
- 14 ct1200 mg 60 mg
1178
1965
$1200
$1600
- 60 spray1881 $2200
- Compare to NeilMed Sinus Rinsereg
- 1 kit
1931 $1800
- Compare to Vicks Personal Steam Inhalerreg
- 1 ct
1792 $5000
- Compare to Chlorasepticreg
- 6 oz
1904 $800
- Compare to Vicks VapoRubreg
- 35 oz47 1
1164 $750
- Compare to Tumsreg
- 150 ct500 mg
1346 $600
- Compare to Nexiumreg
- 42 ct20 mg
1949 $2300
- Compare to Prilosecreg
- 42 ct20 mg
1970 $2600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item Price Allergy Cold Flu Decongestant and Sinus (Continued)
Multi-Symptom Cold Formula - Compare to Tylenol Cold Multi-Symptom Daytimereg
- 24 ct10 mg 5 mg 325 mg
1357 $600
Nasal Decongestant Spray 12 Hour - Compare to Afrinreg
- 1 oz005
1091 $500
Nasal Spray Saline - Compare to Ocean Saline Nasal Sprayreg
- 15 oz065
1052 $500
Sore Throat Lozenges Cherry - Compare to Cepacolreg
- 18 ct
1176 $700
Sudogest PE Nasal and Sinus Decongestant - Compare to Sudafed PEreg
- 36 ct10 mg
1352 $500
AntacidAnti-Gas Liquid- Compare to Maaloxreg
- 12 oz
1006 $600
Effervescent Pain Reliever - Compare to Alka-Seltzerreg
- 36 ct
1314 $800
Famotidine Acid Reducer - Compare to Pepcid ACreg
- 30 ct10 mg
1108 $600
Omeprazole Acid Reducer
6
Omeprazole Acid Reducer - Compare to Prilosecreg
- 42 ct20 mg
1970 $2600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Nasacortreg
- 60 spray1881 $2200
Nasal Rinse Kit Saline - Compare to NeilMed Sinus Rinsereg
- 1 kit
1931 $1800
Personal Steam Inhaler - Compare to Vicks Personal Steam Inhalerreg
- 1 ct
1792 $5000
Sore Throat Spray Cherry - Compare to Chlorasepticreg
- 6 oz
1904 $800
Vapor Rub - Compare to Vicks VapoRubreg
- 35 oz47 1
1164 $750
Antacids and Acid Reducers
Antacid Chewables - Compare to Tumsreg
- 150 ct500 mg
1346 $600
Esomeprazole Magnesium 24-hr Delayed Release Acid Reducer
- Compare to Nexiumreg
- 42 ct20 mg
1949 $2300
- Compare to Zantacreg
- 30 ct75 mg
1900 $800
- Compare to Monistat 7reg
- 45 gm1
1115 $800
- Compare to Monistat 1reg
- 1 ct65
1119 $2000
- Compare to Pepto-Bismol Chewablereg
- 30 ct262 mg
1045 $600
- Compare to Colacereg
- 100 ct100 mg
1126 $600
- Compare to Lactaidreg
- 60 ct9000 FCC units
1067 $1000
- Compare to Citrucelreg - 16 oz
1354 $1200
- Compare to Metamucilreg - 13 oz
1340 $1000
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Category Description Item Price Antacids and Acid Reducers (Continued)
Omeprazole Acid Reducer Delayed Release Dissolvable - Compare to Prilosecreg
- 42 ct20 mg
1966 $2600
Simethicone Anti-Gas Chewables - Compare to Gas-X Chewablesreg
- 100 ct80 mg
1800 $1000
Anticandidal (yeast)
Miconazole 3-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 3reg
- 1 kit2
1117 $1400
Bisacodyl Enteric Coated Laxative- Compare to Dulcolaxreg
- 100 ct5 mg
1128 $600
ClearLax Unflavored Powder - Compare to MiraLAXreg
- 83 oz17 g
1969 $1350
Glycerin Suppository - Compare to Fleetreg
- 25 ct2 gm
1125 $500
Milk of Magnesia- Compare to Phillipsreg
- 12 oz400 mg
1011 $600
Natural Vegetable Laxative
7
Natural Vegetable Laxative - Compare to Metamucilreg - 13 oz
1340 $1000
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Loperamide HCL Anti-Diarrheal - Compare to Imodium A-Dreg
- 12 ct2 mg
1133 $500
Methylcellulose Fiber Therapy - Compare to Citrucelreg - 16 oz
1354 $1200
Lactase Capsules - Compare to Lactaidreg
- 60 ct9000 FCC units
1067 $1000
Docusate Sodium Stool Softener - Compare to Colacereg
- 100 ct100 mg
1126 $600
Bismatrol Chewable Tablets - Compare to Pepto-Bismol Chewablereg
- 30 ct262 mg
1045 $600
Tioconazole 1-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 1reg
- 1 ct65
1119 $2000
Anti-diarrheal Laxatives and Digestive Health
Clotrimazole 7-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 7reg
- 45 gm1
1115 $800
Ranitidine Acid Reducer - Compare to Zantacreg
- 30 ct75 mg
1900 $800
- Compare to Metamucilreg
- 304 oz
1967 $1600
- Compare to Pepto-Bismolreg - 8 oz525 mg 30 ml
1318 $600
- Compare to Senokot-Sreg
- 60 ct86 mg 50 mg
1130 $600
- Compare to Lotrimin AFreg
- 15 oz1
1047 $600
- Compare to Cortaidreg
- 1 oz1
1074 $600
- Compare to Micatinreg
- 1 oz2
1135 $800
- Compare to Tinactinreg
- 125 oz1
1064 $500
- 1 ct1728 $6500
- 1 ct1459 $1700
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item Price Anti-diarrheal Laxatives and Digestive Health (Continued)
Natural Vegetable Laxative Sugar free - Compare to Metamucil Sugar Freereg
- 15 oz
1968 $1300
Polycarbophil Fiber Tablets - Compare to FiberConreg
- 90 ct625 mg
1012 $1000
Caldyphen Clear Lotionreg Local Analgesic - 6 oz1
1144 $900
Diphenhydramine HCLZinc Acetate Anti-Itch Cream - Compare to Benadryl Creamreg
- 1 oz
1140 $500
Medicated Antifungal Foot Powder Spray - Compare to Lotrimin AFreg
- 46 oz
1874 $1000
Terbinafine HCL Antifungal Cream - Compare to Lamisil ATreg
- 5 oz1
1046 $1200
Adjustable Transfer Bench- 1 ct
1764 $8000
Bath Bench without Back - 1 ct
1727 $5500
Bath Mat Non-Skid
8
Bath Mat Non-Skid - 1 ct
1459 $1700
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Natural Vegetable Laxative - Compare to Metamucilreg - 304 oz
1967 $1600
Pink Bismuth - Compare to Pepto-Bismolreg - 8 oz525 mg 30 ml
1318 $600
1130 $600
Anti-fungal and Anti-itch
Senna Plus Stool Softener Plus Laxative - Compare to Senokot-Sreg
- 60 ct86 m
Clotrimazole Antifungal Athletersquos Foot Cream - Compare to Lotrimin AFreg
- 15 oz1
1047 $600
Hydrocortisone 1 Cream - Compare to Cortaidreg
- 1 oz1
1074 $600
Bath Bench with Back - 1 ct
1728 $6500
Tolnaftate Antifungal Cream - Compare to Tinactinreg
- 125 oz1
1064 $500
Bathroom Safety
Miconazole Nitrate 2 Antifungal Cream - Compare to Micatinreg
- 1 oz2
1135 $800
9
Category Description Item PriceBathroom Safety (Continued)
Bath Tub Safety Rail - 1 ct
1730 $3700
Raised Toilet Seat - 1 ct
1729 $3500
Raised Toilet Seat with Arms - 1 ct
1950 $6500
Shower Mat Non-Skid - 1 ct
1460 $1400
Toilet Safety Rails - 1 set
1779 $5000
Cold Sore and Medicated Lip Products
Abrevareg
- 2 gm101152 $2600
Carmexreg
- 75 gm1255 $400
Herpecin-Lreg Lip Balm - 1 oz1
1153 $800
Releevreg Cold Sore Treatment - 6 ml013
1359 $2500
Dental and Denture Care Biotenereg Dry Mouth Oral Rinse - 16 oz
1817 $1400
Denture Brush - Compare to G-U-Mreg
- 1 ct
1747 $650
Denture Cleaning Tablets - Compare to Polidentreg
- 40 ct
1032 $700
Efferdent Plusreg Mint Tablets - 36 ct
1653 $800
Effergripreg Denture Cream Adhesive - 25 oz
1843 $900
Fixodentreg
- 75 oz1187 $700
Interdental Flossups - Compare to G-U-Mreg
- 90 ct
1751 $700
Orajelreg Pain Relief - 7 gm20
1454 $1100
Oral Pain Relief - Compare to Orajelreg - 5 oz20
1286 $600
Polidentreg Denture Cream - 39 oz
1324 $800
Polidentreg Overnight - 84 ct
1892 $1250
Reachreg Waxed Dental Floss - Mint - 55 yd
1455 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
10
Category Description Item PriceDental and Denture Care (Continued)
ToothbrushColgatereg Adult Soft
- 1 ctRechargeable
- 1 ctSoft 2-pack
- 2-packTek Pro Angled Soft
- 1 ct
1413
1450
1948
1412
$300
$4000
$600
$300
Toothpaste Crest Sensi-Reliefreg
- 41 oz1838 $950
Toothpaste Pepsodentreg
- 55 oz1414 $500
Water Jet - 1 ct
1744 $3900
Water Jet Replacement Tips - 5 ct
1743 $1800
Diabetic Foot Care Diabetic SocksBlack Medium 3-packBlack Large 3-packBlack X-Large 3-pack
195619571958
$900 $900 $900
Diabetic Socks White Medium 3-packWhite Large 3-packWhite X-Large 3-pack
195319541955
$900 $900 $900
Ultra Soft Padded Diabetic SockBlack Medium 2-packBlack Large 2-packBlack X-Large 2-pack
195919601961
$1100 $1100 $1100
Ultra Soft Padded Diabetic SockWhite Medium 2-packWhite Large 2-packWhite X-Large 2-pack
196219631964
$1100 $1100 $1100
Ear Care Cotton Tipped Swabs - 300 ct
1742 $600
Ear Pain Relief Ear Drops - Compare to Hylandrsquos Ear Reliefreg
- 10 ml
1841 $1300
Ear Wax Removal Drops - Compare to Debroxreg
- 15 ml65
1190 $500
Ear Wax Removal System with Rubber Bulb - Compare to Debroxreg
- 15 ml65
1363 $700
Eye Care Artificial Tears Drops - Compare to Visine Tearsreg
- 5 oz
1192 $600
Artificial Tears Ointment - Compare to Refresh PMreg
- 35 gm
1194 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
11
Category Description Item PriceEye Care(Continued)
Eye Wash Solution - Compare to Bausch and Lombreg
- 4 oz
1196 $800
Multi-Purpose Contact Lens Solution - Compare to Renu Multipurpose Solutionreg
- 4 oz
1468 $600
Redness Relief Eye Drops - Compare to Visine Original Redness Reliefreg
- 15 ml005
1061 $500
First Aid and Medical Supplies
Adhesive Bandages - Compare to Band-Aid Plastic Stripsreg
- 60 ct
1344 $600
After Bite Reliefreg
- 5 oz1803 $900
Alcohol Pads - 100 ct70
1200 $600
Antiseptic Towelettes - 100 ct
1201 $700
Bacitracin Ointment - 1 oz500 Ugm
1020 $600
Cotton Balls - 200 ct
1763 $600
CPAP Pillow Fiber Filled - 1 ct
1836 $6000
CPAP Pillow Memory Foam - 1 ct
1837 $10000
Elastic Bandage (Compare to Acereg)
2rdquo x 45 yd - 1 ct
3rdquo x 5 yd - 1 ct
4rdquo x 5 yd - 1 ct
6rdquo x 5 yd - 1 ct
1207
1209
1211
1213
$400
$400
$500
$500
Fast Freeze Pain Relief Spray - Compare to Biofreeze Pain Relief Sprayreg
- 4 oz
1846 $1400
First Aid Kit 20 Pieces - 1 ct
1947 $700
First Aid Kit 75 Pieces - 1 ct
1215 $1000
First Aid Kit 175 Pieces - 1 ct
1738 $1700
HotCold Pack 1 small and 1 large - 1 ct
1062 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Humidifier Ultra-Sonic Cool Mist - Compare to Vicks Ultrasonic Humidifierreg
- 1 ct
1795 $6000
Hydrogen Peroxide - 16 oz3
1228 $500
Ice Bag - 1 ct
1761 $900
Insect Repellant Spray - Deet - 4 oz30
1796 $1200
Isopropyl Alcohol Wintergreen - 16 oz70
1229 $600
Liquid Bandage - 45 oz
1872 $850
Neosporin Plusreg
- 5 oz1326 $1100
Nitrile Exam Gloves - 100 ct
1840 $1200
Pill Crusher with Storage - 1 ct
1933 $1000
Pill Cutter with Safety Shield - 1 ct
1932 $1000
Povidone Iodine Solution Antiseptic - 4 oz
1203 $800
Procedural Face Masks with Earloops - 50 ct
1896 $1400
Tape Paper Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1217
1218
$600
$600
Tape Silk Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1219
1220
$600
$700
Tape Transparent Surgical(Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1221
1222
$600
$600
Thermometer Digital 60 seconds - 1 ct
1063 $500
Thermometer Digital Ear - 1 ct
1285 $2400
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
13
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Thermometer Flexible Tip Digital 10 seconds - 1 ct
1697 $1000
Thermometer Talking Ear and Forehead - 1 ct
1925 $4500
Triple Antibiotic Ointment - Compare to Neosporinreg
- 1 oz
1014 $700
Foot Care Callus Remover Pads - Compare to Dr Schollrsquosreg
- 6 ct
1238 $700
Corn Remover Pads - Compare to Dr Schollrsquosreg
- 9 ct
1236 $700
Medicated Foot Powder - 5 oz
1240 $700
Hemorrhoidal Preparations
Hemorrhoidal Ointment - Compare to Preparation Hreg
- 2 oz
1066 $700
Hemorrhoidal Suppository - 12 ct
1247 $700
Pre-moist Hemorrhoid Pads - Compare to Tucksreg
- 100 ct
1364 $800
Preparation Hreg Medicated Wipes - 48 ct
1895 $1300
Hormone Replacement DHEADagger
- 50 ct50 mg1737 $1200
Incontinence Supplies A and D Ointment - Compare to AandD Ointmentreg
- 2 oz
1300 $800
Adult Briefs(Compare to Dependreg)
Medium - 32rdquo to 44rdquo - 12 ct
Large - 45rdquo to 58rdquo - 12 ct
X-Large - 59rdquo to 64rdquo - Compare to Dependreg
- 15 ct
1303
1304
1305
$1000
$1200
$1200
Menrsquos Attends Discreet (Compare to Dependreg)
Guard - 20 ct
Shield - 20 ct
1811
1810
$1600
$1500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Category Description Item PriceIncontinence Supplies (Continued)
Womenrsquos Attends Discreet(Compare to Dependreg)
Moderate Bladder Control Pad - 20 ct
Maximum Bladder Control Pad - 20 ct
Ultimate Bladder Control Pad - 20 ct
Ultrathin Pad - 20 ct
Panty Liner - 28 ct
1813
1812
1814
1816
1815
$1800
$2000
$2000
$1400
$1400
Barrier Cream - Compare to Lantiseptic Barrier Creamreg
- 4 oz
1302 $1000
Bladder Control Shaped Pad(Compare to Dependreg)
Moderate Absorbency - 24 ct
Heavy Absorbency - 24 ct
Maximum Absorbency - 18 ct
1478
1479
1480
$1700
$1900
$1600
Disposable Underwear(Compare to Dependreg)
Medium - 34rdquo to 44rdquo - 20 ct
Large - 44rdquo to 58rdquo - 18 ct
X-Large - 58rdquo to 68rdquo - 14 ct
1021
1026
1027
$1600
$1600
$1600
Flushable Wipes - 24 ct
1928 $750
Underpad Disposable(Compare to Dependreg)
23rdquo x 24rdquo - 50 ct
23rdquo x 36rdquo - 25 ct
30rdquo x 30rdquo - 10 ct
1476
1299
1477
$1500
$1000
$800
Washcloth with Lanolin - 64 ct
1348 $900
In-home Diagnostic Equipment
Bathroom ScaleDaggersect
- 1 ct1935 $3500
Blood Pressure Monitor (1 ct)Desktop AutomaticDagger
Desktop TalkingDagger
Replacement CuffDagger
WristDagger
Wrist TalkingDagger
12531503150415011502
$6000 $7000 $1500 $4000 $5000
your doctor before starting a new product regime
OTC MTalk with
EDICATIONS AND PRODUCTS
15
Category Description Item PriceIn-home Diagnostic Equipment (Continued)
Finger Pulse OximeterDagger
- 1 ct1505 $5200
Heart Rate Monitor WatchDagger
- 1 ct1771 $4000
In-home Diagnostic Tests
EZ Detect Colon Cancer Test KitDagger
- 1 ct1416 $1300
Home Access Cholesterol TestDagger
- 1 kit1251 $3300
Lice Treatment (Pediculicide)
Lice Elimination Kit - Compare to RIDreg
- 1 kit
1929 $2700
Lice Treatment Shampoo - Compare to RIDreg
- 4 oz
1271 $900
Permethrin Lice Treatment - Compare to Nixreg
- 59 ml1
1269 $1400
Mobility Cushion Foam Ring - 1 ct
1732 $2100
Cushion GelFoam Seat - 1 ct
1466 $4200
Cushion Lumbar - 1 ct
1731 $2700
Folding Cane Ergonomic Handle - 1 ct
1726 $2000
Quad Cane (1 ct) Small BaseLarge Base
17771776
$2500 $3000
Motion Sickness Dramamine Chewablesreg Orange - 8 ct50 mg
1264 $700
Driminate Antiemetic - Compare to Dramaminereg
- 12 ct50 mg
1263 $500
Meclizine HCL Antiemetic - 100 ct125 mg
1366 $800
Pain Relievers and Fever Reducers
AcetaminophenCompare to Tylenolreg
- 100 ct325 mg
1001
$600
Compare to Tylenol Extra Strengthreg
- 100 ct500 mg1600 $1000
Arthritis Pain Reliever - Compare to Tylenol Arthritisreg
- 100 ct650 mg
1311 $1200
Aspirin - Compare to Bayerreg
- 100 ct325 mg
1095 $500
Aspirin Enteric Coated - Compare to Bayerreg
- 100 ct325 mg
1096 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
- Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
- Compare to Capzasinreg
- 2 oz0025
1367 $1000
- 1 ct1943 $5500
(Compare to ThermaCarereg)Back and Hip
- 2 ctNeck Shoulder and Wrist
- 3 ct
1859
1860
$1300
$1300
- Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
- Compare to Alevereg
- 100 ct220 mg
1097 $1100
- Compare to Bengayreg
- 2 oz25
1475 $600
Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Pain Relievers and Fever Reducers (Continued)
Category Description Item Price
Aspirin Low Dose Chewables - Compare to Bayer Aspirin Chewable Low Dosereg
- 36 ct81 mg
1802 $500
ColdHot Menthol Medicated Patch- Compare to IcyHotreg
- 5 ct5
1944 $1000
Heating Pad 12rdquo x 15rdquo- 1 ct
1861 $2600
Ibuprofen - Compare to Advilreg
- 100 ct200 mg
1004 $700
Migraine Relief- Compare to Excedrinreg
- 100 ct250 mg 250 mg 65 mg
1365 $700
Pain Reliever PM - Extra Strength - Compare to Tylenol PMreg
- 100 ct
1332 $1000
Salonpas Pain Relief Patchesreg
- 5 ct 1739 $1400
XL Heating Pad 12rdquo x 24rdquo- 1 ct
1942 $3500
16
HeatWraps(Compare to ThermaCarereg)
Back and Hip - 2 ct
Neck Shoulder and Wrist - 3 ct
1859
1860
$1300
$1300
ThermaCarereg Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Naproxen - Compare to Alevereg
- 100 ct220 mg
1097 $1100
Lidocaine Patch - Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
Capsaicin External Analgesic - Compare to Capzasinreg
- 2 oz0025
1367 $1000
Aspirin Enteric Coated Low Dose - Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
Heating Pad Wrap for Shoulder Neck and Back 25rdquo x 26rdquo - 1 ct
1943 $5500
Pain Relieving Muscle Rub - Compare to Bengayreg
- 2 oz25
1475 $600
17
Category Description Item PricePersonal Care Acne Gel 10 Benzoyl Peroxide
- Compare to Persa-Gelreg - 15 oz10
1076 $700
Ammonium Lactate Moisturizing Lotion - Compare to AmLactinreg
- 8 oz12
1368 $900
Hand Sanitizer - Compare to Purellreg - 8 oz
1065 $500
Skin and Sun Care Aloe Vera Cream - 8 oz
1070 $600
Calamine Lotion - 6 oz
1821 $600
Moisturizing Body Lotion with Aloe - 8 oz
1893 $800
Scar Gel - 50 gm
1852 $1200
Sunscreen Lotion SPF 30 - 35 oz
1284 $600
Sleep Aids Nasal Strips (Compare to Breathe Rightreg)
Medium - 30 ct
Large - 30 ct
1724
1725
$1200
$1200
Sleep Tablets - Compare to Sominexreg
- 50 ct25 mg
1276 $600
Smoking Cessation Nicorelief GumDagger
- Compare to Nicorettereg
- 50 ct4 mg
1372 $2500
Nicotine LozengesDagger
- Compare to Nicorettereg
- 72 ct4 mg
1281 $4400
Nicotine PatchStep 1Dagger
- Compare to NicoDerm CQ Step 1reg
- 14 ct21 mg 24 hrStep 2Dagger
- Compare to NicoDerm CQ Step 2reg
- 14 ct14 mg 24 hrStep 3Dagger
- Compare to NicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
1369
1370
1371
$4500
$4500
$4500
Supportive Items Ankle Support - Compare to Acereg
- 1 ct
1225 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
2
YOUR OVER-THE-COUNTER (OTC)
MEDICATIONS AND PRODUCTS
Check your Cigna-HealthSpring Evidence of Coverage to see
your quarterly OTC allowance
Choose from the list of covered medications and products in
this catalog
Order in the way that works for you
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
CLICK to order through our all-new OTC products website at wwwCignaHealthSpringOTCcom
Its easy to
bull Create a personal log-in profile Its quick and securebull View your balance Unused funds roll over during a calendar year bull Track your available funds in real time as you add products
to your cartbull Review your order history throughout the yearbull Get email with tracking number when your order ships
Address change Call to check that we have your current mailing address 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
1
2
3
4
SAVE MONEY AND TIMEYou can get OTC items sent right to your door ndash with FREE delivery
3
Q What can I order
A You can order from the list of covered items in this catalog Covered items may include
OTC medications bull Aspirinbull Acetaminophenbull Vitaminsbull Cold and flu medicine
Health-related productsbull Nicotine patchesbull Disposable underpadsbull Compression socksbull Nasal strips
Q How much is my quarterly allowance
A The dollar value of your quarterly allowance depends on your plan Check your Cigna-HealthSpring Evidence of Coverage to see your quarterly OTC allowance
Q When can I spend my quarterly allowance
A Your allowance goes into your
account quarterly on January 1
April 1 July 1 and October 1
You canbull Spend your full quarterly
allowance as soon as it is in your account
bull Save up your allowances
to order higher-priced items later in the year
bull Order once a month
up to 12 times a year
Unused balances roll forward each quarter However balances do not carry over to the next year
Q Who can get items through my OTC benefit
A You can order items that help you
with a medical need every month you are a Cigna-HealthSpring customer Cigna-HealthSpring prohibits the purchase of OTC items for family customers or friends
Q How do I get my order
A The cost of your order must be less than or equal to the account balance for items to ship OTC medications are only available for home delivery Covered items are sent to you free of delivery charge Please allow 7-10 business days for home delivery
QAamp Common questions about
your OTC benefit
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
4
CATEGORY INDEXPlease use the index below for ease in locating available OTC items
Category Products include PageAllergy Cold Flu Decongestant and Sinus
Antihistamines decongestants cough suppressantsexpectorants nasal sprays cough drops throat lozenges and other products
5
Antacids and
Acid ReducersLiquids chewables capsules gas pain relievers and other products to treat symptoms of stomach upset heartburn and acid indigestion
6
Anticandidal (yeast) Vaginal cream with applicator 7Anti-diarrheal Laxatives and Digestive Health
Tablets capsules and powders to treat symptoms of constipation upset stomach bloating cramping gas and diarrhea
7
Anti-fungal and Anti-itch
Topical creams and powders to treat symptoms of athletersquos foot jock itch poison ivy insect bites and other applications
8
Bathroom Safety Bath benches mats safety rails and raised toilet seats 8Cold Sore and Medicated Lip Products
Lip balmscream to treat cold sores fever blisters and chapped lips
9
Dental and Denture Care
Mouthwash toothbrushes cleaning tablets and creams adhesive cream floss and oral pain relief gel
9
Diabetic Foot Care Socks for people with diabetics circulatory problems edema and neuropathy 10Ear Care Cotton swabs drops for earaches and wax removal treatments 10Eye Care Eye drops for lubricating and cleansing 10First Aid and Medical Supplies
First aid products and medical supplies including CPAP pillows face mask humidifier insect spray pill crushercutter thermometers and other products
11
Foot Care Foot powder pads to remove calluses and corns 13Hemorrhoidal Preparations Ointment suppository pads and wipes for temporary relief from hemorrhoids 13Hormone Replacement A hormone supplement 13Incontinence Supplies Wipes bed pads pads disposable briefsunderwear cleanser and skin protectant 13In-home Diagnostic Equipment Scales blood pressure monitors finger pulse oximeter and heart rate monitor 14In-home Diagnostic Tests Tests for colon cancer and cholesterol 15Lice Treatment (Pediculicide) 3-step kit shampoo and conditioning treatment for lice treatment 15Mobility Canes and cushions 15Motion Sickness Tablets used to prevent and treat nausea vomiting dizziness
and vertigo associated with motion sickness15
Pain Relievers and Fever Reducers
Tablets capsules chewables patches heating pads and wraps to temporarily relieve pain and reduce fever
15
Personal Care Acne care moisturizer for dry skin and hand sanitizer 17Skin and Sun Care Creams lotions and gels for moisturizing and protecting
skin including sunscreen and scar gel17
Sleep Aids Nasal strips 17Smoking Cessation Nicotine lozenges and patches 17Supportive Items Bracessupports gloves compression socks for
ankles back hands hips knees and ribs17
Vitamins and Minerals Dietary supplements 19Wart Remover Liquid to remove warts 21Weight Loss Chewable fiber 21
5
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item PriceAllergy Cold Flu Decongestant and Sinus
Allergy Relief Nasal Spray 24-hr Fluticasone Propionate - Compare to Flonasereg
- 120 spray50 mcg
1946 $2500
All-Nite ColdFlu - Compare to Vicks NyQuilreg - 4 oz125 mg 30 mg 650 mg
1361 $600
Cepacolreg Sore Throat Lozenges - 16 ct
1360 $700
Cetirizine HCL Allergy Relief - Compare to Zyrtecreg
- 14 ct10 mg
1090 $700
Chlorpheniramine Maleate Antihistamine - 100 ct4 mg
1008 $500
Cough and Cold for High Blood Pressure - Compare to Coricidin HBPreg
- 16 ct
1166 $700
Cough DropsCherry (Compare to Hallsreg)
- 30 ct58 mgSugar Free Cherry (Compare to Halls Sugar Freereg)
- 25 ct58 mgMenthol (Compare to Hallsreg)
- 30 ct
1056
1182
1834
$400
$500
$400
Cough Syrup Expectorant - Compare to Robitussinreg
- 4 oz200 mg 10 ml
1054 $500
Cromolyn Sodium Allergy Nasal Spray - Compare to Nasalcromreg
- 26 ml
1356 $1800
Diabetic Tussin DM - Compare to Robitussin Sugar Free DMreg
- 4 oz
1323 $1000
Diphenhydramine Antihistamine - Compare to Benadrylreg - 100 ct25 mg
1308 $600
Diphenhydramine Antihistamine - Compare to Benadrylreg - 24 ct25 mg
1009 $500
Guaifenesin Cough Expectorant - 60 ct200 mg
1180 $900
Loratadine Allergy Relief - Compare to Claritinreg
- 100 ct10 mg
1611 $2000
Mucus Relief DM Expectorant and Cough Suppressant(Compare to Mucinexreg)
- 30 ct400 mg 20 mgExtended Release
- 14 ct1200 mg 60 mg
1178
1965
$1200
$1600
- 60 spray1881 $2200
- Compare to NeilMed Sinus Rinsereg
- 1 kit
1931 $1800
- Compare to Vicks Personal Steam Inhalerreg
- 1 ct
1792 $5000
- Compare to Chlorasepticreg
- 6 oz
1904 $800
- Compare to Vicks VapoRubreg
- 35 oz47 1
1164 $750
- Compare to Tumsreg
- 150 ct500 mg
1346 $600
- Compare to Nexiumreg
- 42 ct20 mg
1949 $2300
- Compare to Prilosecreg
- 42 ct20 mg
1970 $2600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item Price Allergy Cold Flu Decongestant and Sinus (Continued)
Multi-Symptom Cold Formula - Compare to Tylenol Cold Multi-Symptom Daytimereg
- 24 ct10 mg 5 mg 325 mg
1357 $600
Nasal Decongestant Spray 12 Hour - Compare to Afrinreg
- 1 oz005
1091 $500
Nasal Spray Saline - Compare to Ocean Saline Nasal Sprayreg
- 15 oz065
1052 $500
Sore Throat Lozenges Cherry - Compare to Cepacolreg
- 18 ct
1176 $700
Sudogest PE Nasal and Sinus Decongestant - Compare to Sudafed PEreg
- 36 ct10 mg
1352 $500
AntacidAnti-Gas Liquid- Compare to Maaloxreg
- 12 oz
1006 $600
Effervescent Pain Reliever - Compare to Alka-Seltzerreg
- 36 ct
1314 $800
Famotidine Acid Reducer - Compare to Pepcid ACreg
- 30 ct10 mg
1108 $600
Omeprazole Acid Reducer
6
Omeprazole Acid Reducer - Compare to Prilosecreg
- 42 ct20 mg
1970 $2600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Nasacortreg
- 60 spray1881 $2200
Nasal Rinse Kit Saline - Compare to NeilMed Sinus Rinsereg
- 1 kit
1931 $1800
Personal Steam Inhaler - Compare to Vicks Personal Steam Inhalerreg
- 1 ct
1792 $5000
Sore Throat Spray Cherry - Compare to Chlorasepticreg
- 6 oz
1904 $800
Vapor Rub - Compare to Vicks VapoRubreg
- 35 oz47 1
1164 $750
Antacids and Acid Reducers
Antacid Chewables - Compare to Tumsreg
- 150 ct500 mg
1346 $600
Esomeprazole Magnesium 24-hr Delayed Release Acid Reducer
- Compare to Nexiumreg
- 42 ct20 mg
1949 $2300
- Compare to Zantacreg
- 30 ct75 mg
1900 $800
- Compare to Monistat 7reg
- 45 gm1
1115 $800
- Compare to Monistat 1reg
- 1 ct65
1119 $2000
- Compare to Pepto-Bismol Chewablereg
- 30 ct262 mg
1045 $600
- Compare to Colacereg
- 100 ct100 mg
1126 $600
- Compare to Lactaidreg
- 60 ct9000 FCC units
1067 $1000
- Compare to Citrucelreg - 16 oz
1354 $1200
- Compare to Metamucilreg - 13 oz
1340 $1000
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Category Description Item Price Antacids and Acid Reducers (Continued)
Omeprazole Acid Reducer Delayed Release Dissolvable - Compare to Prilosecreg
- 42 ct20 mg
1966 $2600
Simethicone Anti-Gas Chewables - Compare to Gas-X Chewablesreg
- 100 ct80 mg
1800 $1000
Anticandidal (yeast)
Miconazole 3-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 3reg
- 1 kit2
1117 $1400
Bisacodyl Enteric Coated Laxative- Compare to Dulcolaxreg
- 100 ct5 mg
1128 $600
ClearLax Unflavored Powder - Compare to MiraLAXreg
- 83 oz17 g
1969 $1350
Glycerin Suppository - Compare to Fleetreg
- 25 ct2 gm
1125 $500
Milk of Magnesia- Compare to Phillipsreg
- 12 oz400 mg
1011 $600
Natural Vegetable Laxative
7
Natural Vegetable Laxative - Compare to Metamucilreg - 13 oz
1340 $1000
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Loperamide HCL Anti-Diarrheal - Compare to Imodium A-Dreg
- 12 ct2 mg
1133 $500
Methylcellulose Fiber Therapy - Compare to Citrucelreg - 16 oz
1354 $1200
Lactase Capsules - Compare to Lactaidreg
- 60 ct9000 FCC units
1067 $1000
Docusate Sodium Stool Softener - Compare to Colacereg
- 100 ct100 mg
1126 $600
Bismatrol Chewable Tablets - Compare to Pepto-Bismol Chewablereg
- 30 ct262 mg
1045 $600
Tioconazole 1-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 1reg
- 1 ct65
1119 $2000
Anti-diarrheal Laxatives and Digestive Health
Clotrimazole 7-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 7reg
- 45 gm1
1115 $800
Ranitidine Acid Reducer - Compare to Zantacreg
- 30 ct75 mg
1900 $800
- Compare to Metamucilreg
- 304 oz
1967 $1600
- Compare to Pepto-Bismolreg - 8 oz525 mg 30 ml
1318 $600
- Compare to Senokot-Sreg
- 60 ct86 mg 50 mg
1130 $600
- Compare to Lotrimin AFreg
- 15 oz1
1047 $600
- Compare to Cortaidreg
- 1 oz1
1074 $600
- Compare to Micatinreg
- 1 oz2
1135 $800
- Compare to Tinactinreg
- 125 oz1
1064 $500
- 1 ct1728 $6500
- 1 ct1459 $1700
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item Price Anti-diarrheal Laxatives and Digestive Health (Continued)
Natural Vegetable Laxative Sugar free - Compare to Metamucil Sugar Freereg
- 15 oz
1968 $1300
Polycarbophil Fiber Tablets - Compare to FiberConreg
- 90 ct625 mg
1012 $1000
Caldyphen Clear Lotionreg Local Analgesic - 6 oz1
1144 $900
Diphenhydramine HCLZinc Acetate Anti-Itch Cream - Compare to Benadryl Creamreg
- 1 oz
1140 $500
Medicated Antifungal Foot Powder Spray - Compare to Lotrimin AFreg
- 46 oz
1874 $1000
Terbinafine HCL Antifungal Cream - Compare to Lamisil ATreg
- 5 oz1
1046 $1200
Adjustable Transfer Bench- 1 ct
1764 $8000
Bath Bench without Back - 1 ct
1727 $5500
Bath Mat Non-Skid
8
Bath Mat Non-Skid - 1 ct
1459 $1700
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Natural Vegetable Laxative - Compare to Metamucilreg - 304 oz
1967 $1600
Pink Bismuth - Compare to Pepto-Bismolreg - 8 oz525 mg 30 ml
1318 $600
1130 $600
Anti-fungal and Anti-itch
Senna Plus Stool Softener Plus Laxative - Compare to Senokot-Sreg
- 60 ct86 m
Clotrimazole Antifungal Athletersquos Foot Cream - Compare to Lotrimin AFreg
- 15 oz1
1047 $600
Hydrocortisone 1 Cream - Compare to Cortaidreg
- 1 oz1
1074 $600
Bath Bench with Back - 1 ct
1728 $6500
Tolnaftate Antifungal Cream - Compare to Tinactinreg
- 125 oz1
1064 $500
Bathroom Safety
Miconazole Nitrate 2 Antifungal Cream - Compare to Micatinreg
- 1 oz2
1135 $800
9
Category Description Item PriceBathroom Safety (Continued)
Bath Tub Safety Rail - 1 ct
1730 $3700
Raised Toilet Seat - 1 ct
1729 $3500
Raised Toilet Seat with Arms - 1 ct
1950 $6500
Shower Mat Non-Skid - 1 ct
1460 $1400
Toilet Safety Rails - 1 set
1779 $5000
Cold Sore and Medicated Lip Products
Abrevareg
- 2 gm101152 $2600
Carmexreg
- 75 gm1255 $400
Herpecin-Lreg Lip Balm - 1 oz1
1153 $800
Releevreg Cold Sore Treatment - 6 ml013
1359 $2500
Dental and Denture Care Biotenereg Dry Mouth Oral Rinse - 16 oz
1817 $1400
Denture Brush - Compare to G-U-Mreg
- 1 ct
1747 $650
Denture Cleaning Tablets - Compare to Polidentreg
- 40 ct
1032 $700
Efferdent Plusreg Mint Tablets - 36 ct
1653 $800
Effergripreg Denture Cream Adhesive - 25 oz
1843 $900
Fixodentreg
- 75 oz1187 $700
Interdental Flossups - Compare to G-U-Mreg
- 90 ct
1751 $700
Orajelreg Pain Relief - 7 gm20
1454 $1100
Oral Pain Relief - Compare to Orajelreg - 5 oz20
1286 $600
Polidentreg Denture Cream - 39 oz
1324 $800
Polidentreg Overnight - 84 ct
1892 $1250
Reachreg Waxed Dental Floss - Mint - 55 yd
1455 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
10
Category Description Item PriceDental and Denture Care (Continued)
ToothbrushColgatereg Adult Soft
- 1 ctRechargeable
- 1 ctSoft 2-pack
- 2-packTek Pro Angled Soft
- 1 ct
1413
1450
1948
1412
$300
$4000
$600
$300
Toothpaste Crest Sensi-Reliefreg
- 41 oz1838 $950
Toothpaste Pepsodentreg
- 55 oz1414 $500
Water Jet - 1 ct
1744 $3900
Water Jet Replacement Tips - 5 ct
1743 $1800
Diabetic Foot Care Diabetic SocksBlack Medium 3-packBlack Large 3-packBlack X-Large 3-pack
195619571958
$900 $900 $900
Diabetic Socks White Medium 3-packWhite Large 3-packWhite X-Large 3-pack
195319541955
$900 $900 $900
Ultra Soft Padded Diabetic SockBlack Medium 2-packBlack Large 2-packBlack X-Large 2-pack
195919601961
$1100 $1100 $1100
Ultra Soft Padded Diabetic SockWhite Medium 2-packWhite Large 2-packWhite X-Large 2-pack
196219631964
$1100 $1100 $1100
Ear Care Cotton Tipped Swabs - 300 ct
1742 $600
Ear Pain Relief Ear Drops - Compare to Hylandrsquos Ear Reliefreg
- 10 ml
1841 $1300
Ear Wax Removal Drops - Compare to Debroxreg
- 15 ml65
1190 $500
Ear Wax Removal System with Rubber Bulb - Compare to Debroxreg
- 15 ml65
1363 $700
Eye Care Artificial Tears Drops - Compare to Visine Tearsreg
- 5 oz
1192 $600
Artificial Tears Ointment - Compare to Refresh PMreg
- 35 gm
1194 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
11
Category Description Item PriceEye Care(Continued)
Eye Wash Solution - Compare to Bausch and Lombreg
- 4 oz
1196 $800
Multi-Purpose Contact Lens Solution - Compare to Renu Multipurpose Solutionreg
- 4 oz
1468 $600
Redness Relief Eye Drops - Compare to Visine Original Redness Reliefreg
- 15 ml005
1061 $500
First Aid and Medical Supplies
Adhesive Bandages - Compare to Band-Aid Plastic Stripsreg
- 60 ct
1344 $600
After Bite Reliefreg
- 5 oz1803 $900
Alcohol Pads - 100 ct70
1200 $600
Antiseptic Towelettes - 100 ct
1201 $700
Bacitracin Ointment - 1 oz500 Ugm
1020 $600
Cotton Balls - 200 ct
1763 $600
CPAP Pillow Fiber Filled - 1 ct
1836 $6000
CPAP Pillow Memory Foam - 1 ct
1837 $10000
Elastic Bandage (Compare to Acereg)
2rdquo x 45 yd - 1 ct
3rdquo x 5 yd - 1 ct
4rdquo x 5 yd - 1 ct
6rdquo x 5 yd - 1 ct
1207
1209
1211
1213
$400
$400
$500
$500
Fast Freeze Pain Relief Spray - Compare to Biofreeze Pain Relief Sprayreg
- 4 oz
1846 $1400
First Aid Kit 20 Pieces - 1 ct
1947 $700
First Aid Kit 75 Pieces - 1 ct
1215 $1000
First Aid Kit 175 Pieces - 1 ct
1738 $1700
HotCold Pack 1 small and 1 large - 1 ct
1062 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Humidifier Ultra-Sonic Cool Mist - Compare to Vicks Ultrasonic Humidifierreg
- 1 ct
1795 $6000
Hydrogen Peroxide - 16 oz3
1228 $500
Ice Bag - 1 ct
1761 $900
Insect Repellant Spray - Deet - 4 oz30
1796 $1200
Isopropyl Alcohol Wintergreen - 16 oz70
1229 $600
Liquid Bandage - 45 oz
1872 $850
Neosporin Plusreg
- 5 oz1326 $1100
Nitrile Exam Gloves - 100 ct
1840 $1200
Pill Crusher with Storage - 1 ct
1933 $1000
Pill Cutter with Safety Shield - 1 ct
1932 $1000
Povidone Iodine Solution Antiseptic - 4 oz
1203 $800
Procedural Face Masks with Earloops - 50 ct
1896 $1400
Tape Paper Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1217
1218
$600
$600
Tape Silk Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1219
1220
$600
$700
Tape Transparent Surgical(Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1221
1222
$600
$600
Thermometer Digital 60 seconds - 1 ct
1063 $500
Thermometer Digital Ear - 1 ct
1285 $2400
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
13
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Thermometer Flexible Tip Digital 10 seconds - 1 ct
1697 $1000
Thermometer Talking Ear and Forehead - 1 ct
1925 $4500
Triple Antibiotic Ointment - Compare to Neosporinreg
- 1 oz
1014 $700
Foot Care Callus Remover Pads - Compare to Dr Schollrsquosreg
- 6 ct
1238 $700
Corn Remover Pads - Compare to Dr Schollrsquosreg
- 9 ct
1236 $700
Medicated Foot Powder - 5 oz
1240 $700
Hemorrhoidal Preparations
Hemorrhoidal Ointment - Compare to Preparation Hreg
- 2 oz
1066 $700
Hemorrhoidal Suppository - 12 ct
1247 $700
Pre-moist Hemorrhoid Pads - Compare to Tucksreg
- 100 ct
1364 $800
Preparation Hreg Medicated Wipes - 48 ct
1895 $1300
Hormone Replacement DHEADagger
- 50 ct50 mg1737 $1200
Incontinence Supplies A and D Ointment - Compare to AandD Ointmentreg
- 2 oz
1300 $800
Adult Briefs(Compare to Dependreg)
Medium - 32rdquo to 44rdquo - 12 ct
Large - 45rdquo to 58rdquo - 12 ct
X-Large - 59rdquo to 64rdquo - Compare to Dependreg
- 15 ct
1303
1304
1305
$1000
$1200
$1200
Menrsquos Attends Discreet (Compare to Dependreg)
Guard - 20 ct
Shield - 20 ct
1811
1810
$1600
$1500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Category Description Item PriceIncontinence Supplies (Continued)
Womenrsquos Attends Discreet(Compare to Dependreg)
Moderate Bladder Control Pad - 20 ct
Maximum Bladder Control Pad - 20 ct
Ultimate Bladder Control Pad - 20 ct
Ultrathin Pad - 20 ct
Panty Liner - 28 ct
1813
1812
1814
1816
1815
$1800
$2000
$2000
$1400
$1400
Barrier Cream - Compare to Lantiseptic Barrier Creamreg
- 4 oz
1302 $1000
Bladder Control Shaped Pad(Compare to Dependreg)
Moderate Absorbency - 24 ct
Heavy Absorbency - 24 ct
Maximum Absorbency - 18 ct
1478
1479
1480
$1700
$1900
$1600
Disposable Underwear(Compare to Dependreg)
Medium - 34rdquo to 44rdquo - 20 ct
Large - 44rdquo to 58rdquo - 18 ct
X-Large - 58rdquo to 68rdquo - 14 ct
1021
1026
1027
$1600
$1600
$1600
Flushable Wipes - 24 ct
1928 $750
Underpad Disposable(Compare to Dependreg)
23rdquo x 24rdquo - 50 ct
23rdquo x 36rdquo - 25 ct
30rdquo x 30rdquo - 10 ct
1476
1299
1477
$1500
$1000
$800
Washcloth with Lanolin - 64 ct
1348 $900
In-home Diagnostic Equipment
Bathroom ScaleDaggersect
- 1 ct1935 $3500
Blood Pressure Monitor (1 ct)Desktop AutomaticDagger
Desktop TalkingDagger
Replacement CuffDagger
WristDagger
Wrist TalkingDagger
12531503150415011502
$6000 $7000 $1500 $4000 $5000
your doctor before starting a new product regime
OTC MTalk with
EDICATIONS AND PRODUCTS
15
Category Description Item PriceIn-home Diagnostic Equipment (Continued)
Finger Pulse OximeterDagger
- 1 ct1505 $5200
Heart Rate Monitor WatchDagger
- 1 ct1771 $4000
In-home Diagnostic Tests
EZ Detect Colon Cancer Test KitDagger
- 1 ct1416 $1300
Home Access Cholesterol TestDagger
- 1 kit1251 $3300
Lice Treatment (Pediculicide)
Lice Elimination Kit - Compare to RIDreg
- 1 kit
1929 $2700
Lice Treatment Shampoo - Compare to RIDreg
- 4 oz
1271 $900
Permethrin Lice Treatment - Compare to Nixreg
- 59 ml1
1269 $1400
Mobility Cushion Foam Ring - 1 ct
1732 $2100
Cushion GelFoam Seat - 1 ct
1466 $4200
Cushion Lumbar - 1 ct
1731 $2700
Folding Cane Ergonomic Handle - 1 ct
1726 $2000
Quad Cane (1 ct) Small BaseLarge Base
17771776
$2500 $3000
Motion Sickness Dramamine Chewablesreg Orange - 8 ct50 mg
1264 $700
Driminate Antiemetic - Compare to Dramaminereg
- 12 ct50 mg
1263 $500
Meclizine HCL Antiemetic - 100 ct125 mg
1366 $800
Pain Relievers and Fever Reducers
AcetaminophenCompare to Tylenolreg
- 100 ct325 mg
1001
$600
Compare to Tylenol Extra Strengthreg
- 100 ct500 mg1600 $1000
Arthritis Pain Reliever - Compare to Tylenol Arthritisreg
- 100 ct650 mg
1311 $1200
Aspirin - Compare to Bayerreg
- 100 ct325 mg
1095 $500
Aspirin Enteric Coated - Compare to Bayerreg
- 100 ct325 mg
1096 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
- Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
- Compare to Capzasinreg
- 2 oz0025
1367 $1000
- 1 ct1943 $5500
(Compare to ThermaCarereg)Back and Hip
- 2 ctNeck Shoulder and Wrist
- 3 ct
1859
1860
$1300
$1300
- Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
- Compare to Alevereg
- 100 ct220 mg
1097 $1100
- Compare to Bengayreg
- 2 oz25
1475 $600
Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Pain Relievers and Fever Reducers (Continued)
Category Description Item Price
Aspirin Low Dose Chewables - Compare to Bayer Aspirin Chewable Low Dosereg
- 36 ct81 mg
1802 $500
ColdHot Menthol Medicated Patch- Compare to IcyHotreg
- 5 ct5
1944 $1000
Heating Pad 12rdquo x 15rdquo- 1 ct
1861 $2600
Ibuprofen - Compare to Advilreg
- 100 ct200 mg
1004 $700
Migraine Relief- Compare to Excedrinreg
- 100 ct250 mg 250 mg 65 mg
1365 $700
Pain Reliever PM - Extra Strength - Compare to Tylenol PMreg
- 100 ct
1332 $1000
Salonpas Pain Relief Patchesreg
- 5 ct 1739 $1400
XL Heating Pad 12rdquo x 24rdquo- 1 ct
1942 $3500
16
HeatWraps(Compare to ThermaCarereg)
Back and Hip - 2 ct
Neck Shoulder and Wrist - 3 ct
1859
1860
$1300
$1300
ThermaCarereg Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Naproxen - Compare to Alevereg
- 100 ct220 mg
1097 $1100
Lidocaine Patch - Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
Capsaicin External Analgesic - Compare to Capzasinreg
- 2 oz0025
1367 $1000
Aspirin Enteric Coated Low Dose - Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
Heating Pad Wrap for Shoulder Neck and Back 25rdquo x 26rdquo - 1 ct
1943 $5500
Pain Relieving Muscle Rub - Compare to Bengayreg
- 2 oz25
1475 $600
17
Category Description Item PricePersonal Care Acne Gel 10 Benzoyl Peroxide
- Compare to Persa-Gelreg - 15 oz10
1076 $700
Ammonium Lactate Moisturizing Lotion - Compare to AmLactinreg
- 8 oz12
1368 $900
Hand Sanitizer - Compare to Purellreg - 8 oz
1065 $500
Skin and Sun Care Aloe Vera Cream - 8 oz
1070 $600
Calamine Lotion - 6 oz
1821 $600
Moisturizing Body Lotion with Aloe - 8 oz
1893 $800
Scar Gel - 50 gm
1852 $1200
Sunscreen Lotion SPF 30 - 35 oz
1284 $600
Sleep Aids Nasal Strips (Compare to Breathe Rightreg)
Medium - 30 ct
Large - 30 ct
1724
1725
$1200
$1200
Sleep Tablets - Compare to Sominexreg
- 50 ct25 mg
1276 $600
Smoking Cessation Nicorelief GumDagger
- Compare to Nicorettereg
- 50 ct4 mg
1372 $2500
Nicotine LozengesDagger
- Compare to Nicorettereg
- 72 ct4 mg
1281 $4400
Nicotine PatchStep 1Dagger
- Compare to NicoDerm CQ Step 1reg
- 14 ct21 mg 24 hrStep 2Dagger
- Compare to NicoDerm CQ Step 2reg
- 14 ct14 mg 24 hrStep 3Dagger
- Compare to NicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
1369
1370
1371
$4500
$4500
$4500
Supportive Items Ankle Support - Compare to Acereg
- 1 ct
1225 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
3
Q What can I order
A You can order from the list of covered items in this catalog Covered items may include
OTC medications bull Aspirinbull Acetaminophenbull Vitaminsbull Cold and flu medicine
Health-related productsbull Nicotine patchesbull Disposable underpadsbull Compression socksbull Nasal strips
Q How much is my quarterly allowance
A The dollar value of your quarterly allowance depends on your plan Check your Cigna-HealthSpring Evidence of Coverage to see your quarterly OTC allowance
Q When can I spend my quarterly allowance
A Your allowance goes into your
account quarterly on January 1
April 1 July 1 and October 1
You canbull Spend your full quarterly
allowance as soon as it is in your account
bull Save up your allowances
to order higher-priced items later in the year
bull Order once a month
up to 12 times a year
Unused balances roll forward each quarter However balances do not carry over to the next year
Q Who can get items through my OTC benefit
A You can order items that help you
with a medical need every month you are a Cigna-HealthSpring customer Cigna-HealthSpring prohibits the purchase of OTC items for family customers or friends
Q How do I get my order
A The cost of your order must be less than or equal to the account balance for items to ship OTC medications are only available for home delivery Covered items are sent to you free of delivery charge Please allow 7-10 business days for home delivery
QAamp Common questions about
your OTC benefit
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
4
CATEGORY INDEXPlease use the index below for ease in locating available OTC items
Category Products include PageAllergy Cold Flu Decongestant and Sinus
Antihistamines decongestants cough suppressantsexpectorants nasal sprays cough drops throat lozenges and other products
5
Antacids and
Acid ReducersLiquids chewables capsules gas pain relievers and other products to treat symptoms of stomach upset heartburn and acid indigestion
6
Anticandidal (yeast) Vaginal cream with applicator 7Anti-diarrheal Laxatives and Digestive Health
Tablets capsules and powders to treat symptoms of constipation upset stomach bloating cramping gas and diarrhea
7
Anti-fungal and Anti-itch
Topical creams and powders to treat symptoms of athletersquos foot jock itch poison ivy insect bites and other applications
8
Bathroom Safety Bath benches mats safety rails and raised toilet seats 8Cold Sore and Medicated Lip Products
Lip balmscream to treat cold sores fever blisters and chapped lips
9
Dental and Denture Care
Mouthwash toothbrushes cleaning tablets and creams adhesive cream floss and oral pain relief gel
9
Diabetic Foot Care Socks for people with diabetics circulatory problems edema and neuropathy 10Ear Care Cotton swabs drops for earaches and wax removal treatments 10Eye Care Eye drops for lubricating and cleansing 10First Aid and Medical Supplies
First aid products and medical supplies including CPAP pillows face mask humidifier insect spray pill crushercutter thermometers and other products
11
Foot Care Foot powder pads to remove calluses and corns 13Hemorrhoidal Preparations Ointment suppository pads and wipes for temporary relief from hemorrhoids 13Hormone Replacement A hormone supplement 13Incontinence Supplies Wipes bed pads pads disposable briefsunderwear cleanser and skin protectant 13In-home Diagnostic Equipment Scales blood pressure monitors finger pulse oximeter and heart rate monitor 14In-home Diagnostic Tests Tests for colon cancer and cholesterol 15Lice Treatment (Pediculicide) 3-step kit shampoo and conditioning treatment for lice treatment 15Mobility Canes and cushions 15Motion Sickness Tablets used to prevent and treat nausea vomiting dizziness
and vertigo associated with motion sickness15
Pain Relievers and Fever Reducers
Tablets capsules chewables patches heating pads and wraps to temporarily relieve pain and reduce fever
15
Personal Care Acne care moisturizer for dry skin and hand sanitizer 17Skin and Sun Care Creams lotions and gels for moisturizing and protecting
skin including sunscreen and scar gel17
Sleep Aids Nasal strips 17Smoking Cessation Nicotine lozenges and patches 17Supportive Items Bracessupports gloves compression socks for
ankles back hands hips knees and ribs17
Vitamins and Minerals Dietary supplements 19Wart Remover Liquid to remove warts 21Weight Loss Chewable fiber 21
5
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item PriceAllergy Cold Flu Decongestant and Sinus
Allergy Relief Nasal Spray 24-hr Fluticasone Propionate - Compare to Flonasereg
- 120 spray50 mcg
1946 $2500
All-Nite ColdFlu - Compare to Vicks NyQuilreg - 4 oz125 mg 30 mg 650 mg
1361 $600
Cepacolreg Sore Throat Lozenges - 16 ct
1360 $700
Cetirizine HCL Allergy Relief - Compare to Zyrtecreg
- 14 ct10 mg
1090 $700
Chlorpheniramine Maleate Antihistamine - 100 ct4 mg
1008 $500
Cough and Cold for High Blood Pressure - Compare to Coricidin HBPreg
- 16 ct
1166 $700
Cough DropsCherry (Compare to Hallsreg)
- 30 ct58 mgSugar Free Cherry (Compare to Halls Sugar Freereg)
- 25 ct58 mgMenthol (Compare to Hallsreg)
- 30 ct
1056
1182
1834
$400
$500
$400
Cough Syrup Expectorant - Compare to Robitussinreg
- 4 oz200 mg 10 ml
1054 $500
Cromolyn Sodium Allergy Nasal Spray - Compare to Nasalcromreg
- 26 ml
1356 $1800
Diabetic Tussin DM - Compare to Robitussin Sugar Free DMreg
- 4 oz
1323 $1000
Diphenhydramine Antihistamine - Compare to Benadrylreg - 100 ct25 mg
1308 $600
Diphenhydramine Antihistamine - Compare to Benadrylreg - 24 ct25 mg
1009 $500
Guaifenesin Cough Expectorant - 60 ct200 mg
1180 $900
Loratadine Allergy Relief - Compare to Claritinreg
- 100 ct10 mg
1611 $2000
Mucus Relief DM Expectorant and Cough Suppressant(Compare to Mucinexreg)
- 30 ct400 mg 20 mgExtended Release
- 14 ct1200 mg 60 mg
1178
1965
$1200
$1600
- 60 spray1881 $2200
- Compare to NeilMed Sinus Rinsereg
- 1 kit
1931 $1800
- Compare to Vicks Personal Steam Inhalerreg
- 1 ct
1792 $5000
- Compare to Chlorasepticreg
- 6 oz
1904 $800
- Compare to Vicks VapoRubreg
- 35 oz47 1
1164 $750
- Compare to Tumsreg
- 150 ct500 mg
1346 $600
- Compare to Nexiumreg
- 42 ct20 mg
1949 $2300
- Compare to Prilosecreg
- 42 ct20 mg
1970 $2600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item Price Allergy Cold Flu Decongestant and Sinus (Continued)
Multi-Symptom Cold Formula - Compare to Tylenol Cold Multi-Symptom Daytimereg
- 24 ct10 mg 5 mg 325 mg
1357 $600
Nasal Decongestant Spray 12 Hour - Compare to Afrinreg
- 1 oz005
1091 $500
Nasal Spray Saline - Compare to Ocean Saline Nasal Sprayreg
- 15 oz065
1052 $500
Sore Throat Lozenges Cherry - Compare to Cepacolreg
- 18 ct
1176 $700
Sudogest PE Nasal and Sinus Decongestant - Compare to Sudafed PEreg
- 36 ct10 mg
1352 $500
AntacidAnti-Gas Liquid- Compare to Maaloxreg
- 12 oz
1006 $600
Effervescent Pain Reliever - Compare to Alka-Seltzerreg
- 36 ct
1314 $800
Famotidine Acid Reducer - Compare to Pepcid ACreg
- 30 ct10 mg
1108 $600
Omeprazole Acid Reducer
6
Omeprazole Acid Reducer - Compare to Prilosecreg
- 42 ct20 mg
1970 $2600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Nasacortreg
- 60 spray1881 $2200
Nasal Rinse Kit Saline - Compare to NeilMed Sinus Rinsereg
- 1 kit
1931 $1800
Personal Steam Inhaler - Compare to Vicks Personal Steam Inhalerreg
- 1 ct
1792 $5000
Sore Throat Spray Cherry - Compare to Chlorasepticreg
- 6 oz
1904 $800
Vapor Rub - Compare to Vicks VapoRubreg
- 35 oz47 1
1164 $750
Antacids and Acid Reducers
Antacid Chewables - Compare to Tumsreg
- 150 ct500 mg
1346 $600
Esomeprazole Magnesium 24-hr Delayed Release Acid Reducer
- Compare to Nexiumreg
- 42 ct20 mg
1949 $2300
- Compare to Zantacreg
- 30 ct75 mg
1900 $800
- Compare to Monistat 7reg
- 45 gm1
1115 $800
- Compare to Monistat 1reg
- 1 ct65
1119 $2000
- Compare to Pepto-Bismol Chewablereg
- 30 ct262 mg
1045 $600
- Compare to Colacereg
- 100 ct100 mg
1126 $600
- Compare to Lactaidreg
- 60 ct9000 FCC units
1067 $1000
- Compare to Citrucelreg - 16 oz
1354 $1200
- Compare to Metamucilreg - 13 oz
1340 $1000
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Category Description Item Price Antacids and Acid Reducers (Continued)
Omeprazole Acid Reducer Delayed Release Dissolvable - Compare to Prilosecreg
- 42 ct20 mg
1966 $2600
Simethicone Anti-Gas Chewables - Compare to Gas-X Chewablesreg
- 100 ct80 mg
1800 $1000
Anticandidal (yeast)
Miconazole 3-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 3reg
- 1 kit2
1117 $1400
Bisacodyl Enteric Coated Laxative- Compare to Dulcolaxreg
- 100 ct5 mg
1128 $600
ClearLax Unflavored Powder - Compare to MiraLAXreg
- 83 oz17 g
1969 $1350
Glycerin Suppository - Compare to Fleetreg
- 25 ct2 gm
1125 $500
Milk of Magnesia- Compare to Phillipsreg
- 12 oz400 mg
1011 $600
Natural Vegetable Laxative
7
Natural Vegetable Laxative - Compare to Metamucilreg - 13 oz
1340 $1000
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Loperamide HCL Anti-Diarrheal - Compare to Imodium A-Dreg
- 12 ct2 mg
1133 $500
Methylcellulose Fiber Therapy - Compare to Citrucelreg - 16 oz
1354 $1200
Lactase Capsules - Compare to Lactaidreg
- 60 ct9000 FCC units
1067 $1000
Docusate Sodium Stool Softener - Compare to Colacereg
- 100 ct100 mg
1126 $600
Bismatrol Chewable Tablets - Compare to Pepto-Bismol Chewablereg
- 30 ct262 mg
1045 $600
Tioconazole 1-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 1reg
- 1 ct65
1119 $2000
Anti-diarrheal Laxatives and Digestive Health
Clotrimazole 7-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 7reg
- 45 gm1
1115 $800
Ranitidine Acid Reducer - Compare to Zantacreg
- 30 ct75 mg
1900 $800
- Compare to Metamucilreg
- 304 oz
1967 $1600
- Compare to Pepto-Bismolreg - 8 oz525 mg 30 ml
1318 $600
- Compare to Senokot-Sreg
- 60 ct86 mg 50 mg
1130 $600
- Compare to Lotrimin AFreg
- 15 oz1
1047 $600
- Compare to Cortaidreg
- 1 oz1
1074 $600
- Compare to Micatinreg
- 1 oz2
1135 $800
- Compare to Tinactinreg
- 125 oz1
1064 $500
- 1 ct1728 $6500
- 1 ct1459 $1700
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item Price Anti-diarrheal Laxatives and Digestive Health (Continued)
Natural Vegetable Laxative Sugar free - Compare to Metamucil Sugar Freereg
- 15 oz
1968 $1300
Polycarbophil Fiber Tablets - Compare to FiberConreg
- 90 ct625 mg
1012 $1000
Caldyphen Clear Lotionreg Local Analgesic - 6 oz1
1144 $900
Diphenhydramine HCLZinc Acetate Anti-Itch Cream - Compare to Benadryl Creamreg
- 1 oz
1140 $500
Medicated Antifungal Foot Powder Spray - Compare to Lotrimin AFreg
- 46 oz
1874 $1000
Terbinafine HCL Antifungal Cream - Compare to Lamisil ATreg
- 5 oz1
1046 $1200
Adjustable Transfer Bench- 1 ct
1764 $8000
Bath Bench without Back - 1 ct
1727 $5500
Bath Mat Non-Skid
8
Bath Mat Non-Skid - 1 ct
1459 $1700
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Natural Vegetable Laxative - Compare to Metamucilreg - 304 oz
1967 $1600
Pink Bismuth - Compare to Pepto-Bismolreg - 8 oz525 mg 30 ml
1318 $600
1130 $600
Anti-fungal and Anti-itch
Senna Plus Stool Softener Plus Laxative - Compare to Senokot-Sreg
- 60 ct86 m
Clotrimazole Antifungal Athletersquos Foot Cream - Compare to Lotrimin AFreg
- 15 oz1
1047 $600
Hydrocortisone 1 Cream - Compare to Cortaidreg
- 1 oz1
1074 $600
Bath Bench with Back - 1 ct
1728 $6500
Tolnaftate Antifungal Cream - Compare to Tinactinreg
- 125 oz1
1064 $500
Bathroom Safety
Miconazole Nitrate 2 Antifungal Cream - Compare to Micatinreg
- 1 oz2
1135 $800
9
Category Description Item PriceBathroom Safety (Continued)
Bath Tub Safety Rail - 1 ct
1730 $3700
Raised Toilet Seat - 1 ct
1729 $3500
Raised Toilet Seat with Arms - 1 ct
1950 $6500
Shower Mat Non-Skid - 1 ct
1460 $1400
Toilet Safety Rails - 1 set
1779 $5000
Cold Sore and Medicated Lip Products
Abrevareg
- 2 gm101152 $2600
Carmexreg
- 75 gm1255 $400
Herpecin-Lreg Lip Balm - 1 oz1
1153 $800
Releevreg Cold Sore Treatment - 6 ml013
1359 $2500
Dental and Denture Care Biotenereg Dry Mouth Oral Rinse - 16 oz
1817 $1400
Denture Brush - Compare to G-U-Mreg
- 1 ct
1747 $650
Denture Cleaning Tablets - Compare to Polidentreg
- 40 ct
1032 $700
Efferdent Plusreg Mint Tablets - 36 ct
1653 $800
Effergripreg Denture Cream Adhesive - 25 oz
1843 $900
Fixodentreg
- 75 oz1187 $700
Interdental Flossups - Compare to G-U-Mreg
- 90 ct
1751 $700
Orajelreg Pain Relief - 7 gm20
1454 $1100
Oral Pain Relief - Compare to Orajelreg - 5 oz20
1286 $600
Polidentreg Denture Cream - 39 oz
1324 $800
Polidentreg Overnight - 84 ct
1892 $1250
Reachreg Waxed Dental Floss - Mint - 55 yd
1455 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
10
Category Description Item PriceDental and Denture Care (Continued)
ToothbrushColgatereg Adult Soft
- 1 ctRechargeable
- 1 ctSoft 2-pack
- 2-packTek Pro Angled Soft
- 1 ct
1413
1450
1948
1412
$300
$4000
$600
$300
Toothpaste Crest Sensi-Reliefreg
- 41 oz1838 $950
Toothpaste Pepsodentreg
- 55 oz1414 $500
Water Jet - 1 ct
1744 $3900
Water Jet Replacement Tips - 5 ct
1743 $1800
Diabetic Foot Care Diabetic SocksBlack Medium 3-packBlack Large 3-packBlack X-Large 3-pack
195619571958
$900 $900 $900
Diabetic Socks White Medium 3-packWhite Large 3-packWhite X-Large 3-pack
195319541955
$900 $900 $900
Ultra Soft Padded Diabetic SockBlack Medium 2-packBlack Large 2-packBlack X-Large 2-pack
195919601961
$1100 $1100 $1100
Ultra Soft Padded Diabetic SockWhite Medium 2-packWhite Large 2-packWhite X-Large 2-pack
196219631964
$1100 $1100 $1100
Ear Care Cotton Tipped Swabs - 300 ct
1742 $600
Ear Pain Relief Ear Drops - Compare to Hylandrsquos Ear Reliefreg
- 10 ml
1841 $1300
Ear Wax Removal Drops - Compare to Debroxreg
- 15 ml65
1190 $500
Ear Wax Removal System with Rubber Bulb - Compare to Debroxreg
- 15 ml65
1363 $700
Eye Care Artificial Tears Drops - Compare to Visine Tearsreg
- 5 oz
1192 $600
Artificial Tears Ointment - Compare to Refresh PMreg
- 35 gm
1194 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
11
Category Description Item PriceEye Care(Continued)
Eye Wash Solution - Compare to Bausch and Lombreg
- 4 oz
1196 $800
Multi-Purpose Contact Lens Solution - Compare to Renu Multipurpose Solutionreg
- 4 oz
1468 $600
Redness Relief Eye Drops - Compare to Visine Original Redness Reliefreg
- 15 ml005
1061 $500
First Aid and Medical Supplies
Adhesive Bandages - Compare to Band-Aid Plastic Stripsreg
- 60 ct
1344 $600
After Bite Reliefreg
- 5 oz1803 $900
Alcohol Pads - 100 ct70
1200 $600
Antiseptic Towelettes - 100 ct
1201 $700
Bacitracin Ointment - 1 oz500 Ugm
1020 $600
Cotton Balls - 200 ct
1763 $600
CPAP Pillow Fiber Filled - 1 ct
1836 $6000
CPAP Pillow Memory Foam - 1 ct
1837 $10000
Elastic Bandage (Compare to Acereg)
2rdquo x 45 yd - 1 ct
3rdquo x 5 yd - 1 ct
4rdquo x 5 yd - 1 ct
6rdquo x 5 yd - 1 ct
1207
1209
1211
1213
$400
$400
$500
$500
Fast Freeze Pain Relief Spray - Compare to Biofreeze Pain Relief Sprayreg
- 4 oz
1846 $1400
First Aid Kit 20 Pieces - 1 ct
1947 $700
First Aid Kit 75 Pieces - 1 ct
1215 $1000
First Aid Kit 175 Pieces - 1 ct
1738 $1700
HotCold Pack 1 small and 1 large - 1 ct
1062 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Humidifier Ultra-Sonic Cool Mist - Compare to Vicks Ultrasonic Humidifierreg
- 1 ct
1795 $6000
Hydrogen Peroxide - 16 oz3
1228 $500
Ice Bag - 1 ct
1761 $900
Insect Repellant Spray - Deet - 4 oz30
1796 $1200
Isopropyl Alcohol Wintergreen - 16 oz70
1229 $600
Liquid Bandage - 45 oz
1872 $850
Neosporin Plusreg
- 5 oz1326 $1100
Nitrile Exam Gloves - 100 ct
1840 $1200
Pill Crusher with Storage - 1 ct
1933 $1000
Pill Cutter with Safety Shield - 1 ct
1932 $1000
Povidone Iodine Solution Antiseptic - 4 oz
1203 $800
Procedural Face Masks with Earloops - 50 ct
1896 $1400
Tape Paper Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1217
1218
$600
$600
Tape Silk Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1219
1220
$600
$700
Tape Transparent Surgical(Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1221
1222
$600
$600
Thermometer Digital 60 seconds - 1 ct
1063 $500
Thermometer Digital Ear - 1 ct
1285 $2400
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
13
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Thermometer Flexible Tip Digital 10 seconds - 1 ct
1697 $1000
Thermometer Talking Ear and Forehead - 1 ct
1925 $4500
Triple Antibiotic Ointment - Compare to Neosporinreg
- 1 oz
1014 $700
Foot Care Callus Remover Pads - Compare to Dr Schollrsquosreg
- 6 ct
1238 $700
Corn Remover Pads - Compare to Dr Schollrsquosreg
- 9 ct
1236 $700
Medicated Foot Powder - 5 oz
1240 $700
Hemorrhoidal Preparations
Hemorrhoidal Ointment - Compare to Preparation Hreg
- 2 oz
1066 $700
Hemorrhoidal Suppository - 12 ct
1247 $700
Pre-moist Hemorrhoid Pads - Compare to Tucksreg
- 100 ct
1364 $800
Preparation Hreg Medicated Wipes - 48 ct
1895 $1300
Hormone Replacement DHEADagger
- 50 ct50 mg1737 $1200
Incontinence Supplies A and D Ointment - Compare to AandD Ointmentreg
- 2 oz
1300 $800
Adult Briefs(Compare to Dependreg)
Medium - 32rdquo to 44rdquo - 12 ct
Large - 45rdquo to 58rdquo - 12 ct
X-Large - 59rdquo to 64rdquo - Compare to Dependreg
- 15 ct
1303
1304
1305
$1000
$1200
$1200
Menrsquos Attends Discreet (Compare to Dependreg)
Guard - 20 ct
Shield - 20 ct
1811
1810
$1600
$1500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Category Description Item PriceIncontinence Supplies (Continued)
Womenrsquos Attends Discreet(Compare to Dependreg)
Moderate Bladder Control Pad - 20 ct
Maximum Bladder Control Pad - 20 ct
Ultimate Bladder Control Pad - 20 ct
Ultrathin Pad - 20 ct
Panty Liner - 28 ct
1813
1812
1814
1816
1815
$1800
$2000
$2000
$1400
$1400
Barrier Cream - Compare to Lantiseptic Barrier Creamreg
- 4 oz
1302 $1000
Bladder Control Shaped Pad(Compare to Dependreg)
Moderate Absorbency - 24 ct
Heavy Absorbency - 24 ct
Maximum Absorbency - 18 ct
1478
1479
1480
$1700
$1900
$1600
Disposable Underwear(Compare to Dependreg)
Medium - 34rdquo to 44rdquo - 20 ct
Large - 44rdquo to 58rdquo - 18 ct
X-Large - 58rdquo to 68rdquo - 14 ct
1021
1026
1027
$1600
$1600
$1600
Flushable Wipes - 24 ct
1928 $750
Underpad Disposable(Compare to Dependreg)
23rdquo x 24rdquo - 50 ct
23rdquo x 36rdquo - 25 ct
30rdquo x 30rdquo - 10 ct
1476
1299
1477
$1500
$1000
$800
Washcloth with Lanolin - 64 ct
1348 $900
In-home Diagnostic Equipment
Bathroom ScaleDaggersect
- 1 ct1935 $3500
Blood Pressure Monitor (1 ct)Desktop AutomaticDagger
Desktop TalkingDagger
Replacement CuffDagger
WristDagger
Wrist TalkingDagger
12531503150415011502
$6000 $7000 $1500 $4000 $5000
your doctor before starting a new product regime
OTC MTalk with
EDICATIONS AND PRODUCTS
15
Category Description Item PriceIn-home Diagnostic Equipment (Continued)
Finger Pulse OximeterDagger
- 1 ct1505 $5200
Heart Rate Monitor WatchDagger
- 1 ct1771 $4000
In-home Diagnostic Tests
EZ Detect Colon Cancer Test KitDagger
- 1 ct1416 $1300
Home Access Cholesterol TestDagger
- 1 kit1251 $3300
Lice Treatment (Pediculicide)
Lice Elimination Kit - Compare to RIDreg
- 1 kit
1929 $2700
Lice Treatment Shampoo - Compare to RIDreg
- 4 oz
1271 $900
Permethrin Lice Treatment - Compare to Nixreg
- 59 ml1
1269 $1400
Mobility Cushion Foam Ring - 1 ct
1732 $2100
Cushion GelFoam Seat - 1 ct
1466 $4200
Cushion Lumbar - 1 ct
1731 $2700
Folding Cane Ergonomic Handle - 1 ct
1726 $2000
Quad Cane (1 ct) Small BaseLarge Base
17771776
$2500 $3000
Motion Sickness Dramamine Chewablesreg Orange - 8 ct50 mg
1264 $700
Driminate Antiemetic - Compare to Dramaminereg
- 12 ct50 mg
1263 $500
Meclizine HCL Antiemetic - 100 ct125 mg
1366 $800
Pain Relievers and Fever Reducers
AcetaminophenCompare to Tylenolreg
- 100 ct325 mg
1001
$600
Compare to Tylenol Extra Strengthreg
- 100 ct500 mg1600 $1000
Arthritis Pain Reliever - Compare to Tylenol Arthritisreg
- 100 ct650 mg
1311 $1200
Aspirin - Compare to Bayerreg
- 100 ct325 mg
1095 $500
Aspirin Enteric Coated - Compare to Bayerreg
- 100 ct325 mg
1096 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
- Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
- Compare to Capzasinreg
- 2 oz0025
1367 $1000
- 1 ct1943 $5500
(Compare to ThermaCarereg)Back and Hip
- 2 ctNeck Shoulder and Wrist
- 3 ct
1859
1860
$1300
$1300
- Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
- Compare to Alevereg
- 100 ct220 mg
1097 $1100
- Compare to Bengayreg
- 2 oz25
1475 $600
Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Pain Relievers and Fever Reducers (Continued)
Category Description Item Price
Aspirin Low Dose Chewables - Compare to Bayer Aspirin Chewable Low Dosereg
- 36 ct81 mg
1802 $500
ColdHot Menthol Medicated Patch- Compare to IcyHotreg
- 5 ct5
1944 $1000
Heating Pad 12rdquo x 15rdquo- 1 ct
1861 $2600
Ibuprofen - Compare to Advilreg
- 100 ct200 mg
1004 $700
Migraine Relief- Compare to Excedrinreg
- 100 ct250 mg 250 mg 65 mg
1365 $700
Pain Reliever PM - Extra Strength - Compare to Tylenol PMreg
- 100 ct
1332 $1000
Salonpas Pain Relief Patchesreg
- 5 ct 1739 $1400
XL Heating Pad 12rdquo x 24rdquo- 1 ct
1942 $3500
16
HeatWraps(Compare to ThermaCarereg)
Back and Hip - 2 ct
Neck Shoulder and Wrist - 3 ct
1859
1860
$1300
$1300
ThermaCarereg Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Naproxen - Compare to Alevereg
- 100 ct220 mg
1097 $1100
Lidocaine Patch - Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
Capsaicin External Analgesic - Compare to Capzasinreg
- 2 oz0025
1367 $1000
Aspirin Enteric Coated Low Dose - Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
Heating Pad Wrap for Shoulder Neck and Back 25rdquo x 26rdquo - 1 ct
1943 $5500
Pain Relieving Muscle Rub - Compare to Bengayreg
- 2 oz25
1475 $600
17
Category Description Item PricePersonal Care Acne Gel 10 Benzoyl Peroxide
- Compare to Persa-Gelreg - 15 oz10
1076 $700
Ammonium Lactate Moisturizing Lotion - Compare to AmLactinreg
- 8 oz12
1368 $900
Hand Sanitizer - Compare to Purellreg - 8 oz
1065 $500
Skin and Sun Care Aloe Vera Cream - 8 oz
1070 $600
Calamine Lotion - 6 oz
1821 $600
Moisturizing Body Lotion with Aloe - 8 oz
1893 $800
Scar Gel - 50 gm
1852 $1200
Sunscreen Lotion SPF 30 - 35 oz
1284 $600
Sleep Aids Nasal Strips (Compare to Breathe Rightreg)
Medium - 30 ct
Large - 30 ct
1724
1725
$1200
$1200
Sleep Tablets - Compare to Sominexreg
- 50 ct25 mg
1276 $600
Smoking Cessation Nicorelief GumDagger
- Compare to Nicorettereg
- 50 ct4 mg
1372 $2500
Nicotine LozengesDagger
- Compare to Nicorettereg
- 72 ct4 mg
1281 $4400
Nicotine PatchStep 1Dagger
- Compare to NicoDerm CQ Step 1reg
- 14 ct21 mg 24 hrStep 2Dagger
- Compare to NicoDerm CQ Step 2reg
- 14 ct14 mg 24 hrStep 3Dagger
- Compare to NicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
1369
1370
1371
$4500
$4500
$4500
Supportive Items Ankle Support - Compare to Acereg
- 1 ct
1225 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
4
CATEGORY INDEXPlease use the index below for ease in locating available OTC items
Category Products include PageAllergy Cold Flu Decongestant and Sinus
Antihistamines decongestants cough suppressantsexpectorants nasal sprays cough drops throat lozenges and other products
5
Antacids and
Acid ReducersLiquids chewables capsules gas pain relievers and other products to treat symptoms of stomach upset heartburn and acid indigestion
6
Anticandidal (yeast) Vaginal cream with applicator 7Anti-diarrheal Laxatives and Digestive Health
Tablets capsules and powders to treat symptoms of constipation upset stomach bloating cramping gas and diarrhea
7
Anti-fungal and Anti-itch
Topical creams and powders to treat symptoms of athletersquos foot jock itch poison ivy insect bites and other applications
8
Bathroom Safety Bath benches mats safety rails and raised toilet seats 8Cold Sore and Medicated Lip Products
Lip balmscream to treat cold sores fever blisters and chapped lips
9
Dental and Denture Care
Mouthwash toothbrushes cleaning tablets and creams adhesive cream floss and oral pain relief gel
9
Diabetic Foot Care Socks for people with diabetics circulatory problems edema and neuropathy 10Ear Care Cotton swabs drops for earaches and wax removal treatments 10Eye Care Eye drops for lubricating and cleansing 10First Aid and Medical Supplies
First aid products and medical supplies including CPAP pillows face mask humidifier insect spray pill crushercutter thermometers and other products
11
Foot Care Foot powder pads to remove calluses and corns 13Hemorrhoidal Preparations Ointment suppository pads and wipes for temporary relief from hemorrhoids 13Hormone Replacement A hormone supplement 13Incontinence Supplies Wipes bed pads pads disposable briefsunderwear cleanser and skin protectant 13In-home Diagnostic Equipment Scales blood pressure monitors finger pulse oximeter and heart rate monitor 14In-home Diagnostic Tests Tests for colon cancer and cholesterol 15Lice Treatment (Pediculicide) 3-step kit shampoo and conditioning treatment for lice treatment 15Mobility Canes and cushions 15Motion Sickness Tablets used to prevent and treat nausea vomiting dizziness
and vertigo associated with motion sickness15
Pain Relievers and Fever Reducers
Tablets capsules chewables patches heating pads and wraps to temporarily relieve pain and reduce fever
15
Personal Care Acne care moisturizer for dry skin and hand sanitizer 17Skin and Sun Care Creams lotions and gels for moisturizing and protecting
skin including sunscreen and scar gel17
Sleep Aids Nasal strips 17Smoking Cessation Nicotine lozenges and patches 17Supportive Items Bracessupports gloves compression socks for
ankles back hands hips knees and ribs17
Vitamins and Minerals Dietary supplements 19Wart Remover Liquid to remove warts 21Weight Loss Chewable fiber 21
5
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item PriceAllergy Cold Flu Decongestant and Sinus
Allergy Relief Nasal Spray 24-hr Fluticasone Propionate - Compare to Flonasereg
- 120 spray50 mcg
1946 $2500
All-Nite ColdFlu - Compare to Vicks NyQuilreg - 4 oz125 mg 30 mg 650 mg
1361 $600
Cepacolreg Sore Throat Lozenges - 16 ct
1360 $700
Cetirizine HCL Allergy Relief - Compare to Zyrtecreg
- 14 ct10 mg
1090 $700
Chlorpheniramine Maleate Antihistamine - 100 ct4 mg
1008 $500
Cough and Cold for High Blood Pressure - Compare to Coricidin HBPreg
- 16 ct
1166 $700
Cough DropsCherry (Compare to Hallsreg)
- 30 ct58 mgSugar Free Cherry (Compare to Halls Sugar Freereg)
- 25 ct58 mgMenthol (Compare to Hallsreg)
- 30 ct
1056
1182
1834
$400
$500
$400
Cough Syrup Expectorant - Compare to Robitussinreg
- 4 oz200 mg 10 ml
1054 $500
Cromolyn Sodium Allergy Nasal Spray - Compare to Nasalcromreg
- 26 ml
1356 $1800
Diabetic Tussin DM - Compare to Robitussin Sugar Free DMreg
- 4 oz
1323 $1000
Diphenhydramine Antihistamine - Compare to Benadrylreg - 100 ct25 mg
1308 $600
Diphenhydramine Antihistamine - Compare to Benadrylreg - 24 ct25 mg
1009 $500
Guaifenesin Cough Expectorant - 60 ct200 mg
1180 $900
Loratadine Allergy Relief - Compare to Claritinreg
- 100 ct10 mg
1611 $2000
Mucus Relief DM Expectorant and Cough Suppressant(Compare to Mucinexreg)
- 30 ct400 mg 20 mgExtended Release
- 14 ct1200 mg 60 mg
1178
1965
$1200
$1600
- 60 spray1881 $2200
- Compare to NeilMed Sinus Rinsereg
- 1 kit
1931 $1800
- Compare to Vicks Personal Steam Inhalerreg
- 1 ct
1792 $5000
- Compare to Chlorasepticreg
- 6 oz
1904 $800
- Compare to Vicks VapoRubreg
- 35 oz47 1
1164 $750
- Compare to Tumsreg
- 150 ct500 mg
1346 $600
- Compare to Nexiumreg
- 42 ct20 mg
1949 $2300
- Compare to Prilosecreg
- 42 ct20 mg
1970 $2600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item Price Allergy Cold Flu Decongestant and Sinus (Continued)
Multi-Symptom Cold Formula - Compare to Tylenol Cold Multi-Symptom Daytimereg
- 24 ct10 mg 5 mg 325 mg
1357 $600
Nasal Decongestant Spray 12 Hour - Compare to Afrinreg
- 1 oz005
1091 $500
Nasal Spray Saline - Compare to Ocean Saline Nasal Sprayreg
- 15 oz065
1052 $500
Sore Throat Lozenges Cherry - Compare to Cepacolreg
- 18 ct
1176 $700
Sudogest PE Nasal and Sinus Decongestant - Compare to Sudafed PEreg
- 36 ct10 mg
1352 $500
AntacidAnti-Gas Liquid- Compare to Maaloxreg
- 12 oz
1006 $600
Effervescent Pain Reliever - Compare to Alka-Seltzerreg
- 36 ct
1314 $800
Famotidine Acid Reducer - Compare to Pepcid ACreg
- 30 ct10 mg
1108 $600
Omeprazole Acid Reducer
6
Omeprazole Acid Reducer - Compare to Prilosecreg
- 42 ct20 mg
1970 $2600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Nasacortreg
- 60 spray1881 $2200
Nasal Rinse Kit Saline - Compare to NeilMed Sinus Rinsereg
- 1 kit
1931 $1800
Personal Steam Inhaler - Compare to Vicks Personal Steam Inhalerreg
- 1 ct
1792 $5000
Sore Throat Spray Cherry - Compare to Chlorasepticreg
- 6 oz
1904 $800
Vapor Rub - Compare to Vicks VapoRubreg
- 35 oz47 1
1164 $750
Antacids and Acid Reducers
Antacid Chewables - Compare to Tumsreg
- 150 ct500 mg
1346 $600
Esomeprazole Magnesium 24-hr Delayed Release Acid Reducer
- Compare to Nexiumreg
- 42 ct20 mg
1949 $2300
- Compare to Zantacreg
- 30 ct75 mg
1900 $800
- Compare to Monistat 7reg
- 45 gm1
1115 $800
- Compare to Monistat 1reg
- 1 ct65
1119 $2000
- Compare to Pepto-Bismol Chewablereg
- 30 ct262 mg
1045 $600
- Compare to Colacereg
- 100 ct100 mg
1126 $600
- Compare to Lactaidreg
- 60 ct9000 FCC units
1067 $1000
- Compare to Citrucelreg - 16 oz
1354 $1200
- Compare to Metamucilreg - 13 oz
1340 $1000
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Category Description Item Price Antacids and Acid Reducers (Continued)
Omeprazole Acid Reducer Delayed Release Dissolvable - Compare to Prilosecreg
- 42 ct20 mg
1966 $2600
Simethicone Anti-Gas Chewables - Compare to Gas-X Chewablesreg
- 100 ct80 mg
1800 $1000
Anticandidal (yeast)
Miconazole 3-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 3reg
- 1 kit2
1117 $1400
Bisacodyl Enteric Coated Laxative- Compare to Dulcolaxreg
- 100 ct5 mg
1128 $600
ClearLax Unflavored Powder - Compare to MiraLAXreg
- 83 oz17 g
1969 $1350
Glycerin Suppository - Compare to Fleetreg
- 25 ct2 gm
1125 $500
Milk of Magnesia- Compare to Phillipsreg
- 12 oz400 mg
1011 $600
Natural Vegetable Laxative
7
Natural Vegetable Laxative - Compare to Metamucilreg - 13 oz
1340 $1000
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Loperamide HCL Anti-Diarrheal - Compare to Imodium A-Dreg
- 12 ct2 mg
1133 $500
Methylcellulose Fiber Therapy - Compare to Citrucelreg - 16 oz
1354 $1200
Lactase Capsules - Compare to Lactaidreg
- 60 ct9000 FCC units
1067 $1000
Docusate Sodium Stool Softener - Compare to Colacereg
- 100 ct100 mg
1126 $600
Bismatrol Chewable Tablets - Compare to Pepto-Bismol Chewablereg
- 30 ct262 mg
1045 $600
Tioconazole 1-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 1reg
- 1 ct65
1119 $2000
Anti-diarrheal Laxatives and Digestive Health
Clotrimazole 7-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 7reg
- 45 gm1
1115 $800
Ranitidine Acid Reducer - Compare to Zantacreg
- 30 ct75 mg
1900 $800
- Compare to Metamucilreg
- 304 oz
1967 $1600
- Compare to Pepto-Bismolreg - 8 oz525 mg 30 ml
1318 $600
- Compare to Senokot-Sreg
- 60 ct86 mg 50 mg
1130 $600
- Compare to Lotrimin AFreg
- 15 oz1
1047 $600
- Compare to Cortaidreg
- 1 oz1
1074 $600
- Compare to Micatinreg
- 1 oz2
1135 $800
- Compare to Tinactinreg
- 125 oz1
1064 $500
- 1 ct1728 $6500
- 1 ct1459 $1700
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item Price Anti-diarrheal Laxatives and Digestive Health (Continued)
Natural Vegetable Laxative Sugar free - Compare to Metamucil Sugar Freereg
- 15 oz
1968 $1300
Polycarbophil Fiber Tablets - Compare to FiberConreg
- 90 ct625 mg
1012 $1000
Caldyphen Clear Lotionreg Local Analgesic - 6 oz1
1144 $900
Diphenhydramine HCLZinc Acetate Anti-Itch Cream - Compare to Benadryl Creamreg
- 1 oz
1140 $500
Medicated Antifungal Foot Powder Spray - Compare to Lotrimin AFreg
- 46 oz
1874 $1000
Terbinafine HCL Antifungal Cream - Compare to Lamisil ATreg
- 5 oz1
1046 $1200
Adjustable Transfer Bench- 1 ct
1764 $8000
Bath Bench without Back - 1 ct
1727 $5500
Bath Mat Non-Skid
8
Bath Mat Non-Skid - 1 ct
1459 $1700
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Natural Vegetable Laxative - Compare to Metamucilreg - 304 oz
1967 $1600
Pink Bismuth - Compare to Pepto-Bismolreg - 8 oz525 mg 30 ml
1318 $600
1130 $600
Anti-fungal and Anti-itch
Senna Plus Stool Softener Plus Laxative - Compare to Senokot-Sreg
- 60 ct86 m
Clotrimazole Antifungal Athletersquos Foot Cream - Compare to Lotrimin AFreg
- 15 oz1
1047 $600
Hydrocortisone 1 Cream - Compare to Cortaidreg
- 1 oz1
1074 $600
Bath Bench with Back - 1 ct
1728 $6500
Tolnaftate Antifungal Cream - Compare to Tinactinreg
- 125 oz1
1064 $500
Bathroom Safety
Miconazole Nitrate 2 Antifungal Cream - Compare to Micatinreg
- 1 oz2
1135 $800
9
Category Description Item PriceBathroom Safety (Continued)
Bath Tub Safety Rail - 1 ct
1730 $3700
Raised Toilet Seat - 1 ct
1729 $3500
Raised Toilet Seat with Arms - 1 ct
1950 $6500
Shower Mat Non-Skid - 1 ct
1460 $1400
Toilet Safety Rails - 1 set
1779 $5000
Cold Sore and Medicated Lip Products
Abrevareg
- 2 gm101152 $2600
Carmexreg
- 75 gm1255 $400
Herpecin-Lreg Lip Balm - 1 oz1
1153 $800
Releevreg Cold Sore Treatment - 6 ml013
1359 $2500
Dental and Denture Care Biotenereg Dry Mouth Oral Rinse - 16 oz
1817 $1400
Denture Brush - Compare to G-U-Mreg
- 1 ct
1747 $650
Denture Cleaning Tablets - Compare to Polidentreg
- 40 ct
1032 $700
Efferdent Plusreg Mint Tablets - 36 ct
1653 $800
Effergripreg Denture Cream Adhesive - 25 oz
1843 $900
Fixodentreg
- 75 oz1187 $700
Interdental Flossups - Compare to G-U-Mreg
- 90 ct
1751 $700
Orajelreg Pain Relief - 7 gm20
1454 $1100
Oral Pain Relief - Compare to Orajelreg - 5 oz20
1286 $600
Polidentreg Denture Cream - 39 oz
1324 $800
Polidentreg Overnight - 84 ct
1892 $1250
Reachreg Waxed Dental Floss - Mint - 55 yd
1455 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
10
Category Description Item PriceDental and Denture Care (Continued)
ToothbrushColgatereg Adult Soft
- 1 ctRechargeable
- 1 ctSoft 2-pack
- 2-packTek Pro Angled Soft
- 1 ct
1413
1450
1948
1412
$300
$4000
$600
$300
Toothpaste Crest Sensi-Reliefreg
- 41 oz1838 $950
Toothpaste Pepsodentreg
- 55 oz1414 $500
Water Jet - 1 ct
1744 $3900
Water Jet Replacement Tips - 5 ct
1743 $1800
Diabetic Foot Care Diabetic SocksBlack Medium 3-packBlack Large 3-packBlack X-Large 3-pack
195619571958
$900 $900 $900
Diabetic Socks White Medium 3-packWhite Large 3-packWhite X-Large 3-pack
195319541955
$900 $900 $900
Ultra Soft Padded Diabetic SockBlack Medium 2-packBlack Large 2-packBlack X-Large 2-pack
195919601961
$1100 $1100 $1100
Ultra Soft Padded Diabetic SockWhite Medium 2-packWhite Large 2-packWhite X-Large 2-pack
196219631964
$1100 $1100 $1100
Ear Care Cotton Tipped Swabs - 300 ct
1742 $600
Ear Pain Relief Ear Drops - Compare to Hylandrsquos Ear Reliefreg
- 10 ml
1841 $1300
Ear Wax Removal Drops - Compare to Debroxreg
- 15 ml65
1190 $500
Ear Wax Removal System with Rubber Bulb - Compare to Debroxreg
- 15 ml65
1363 $700
Eye Care Artificial Tears Drops - Compare to Visine Tearsreg
- 5 oz
1192 $600
Artificial Tears Ointment - Compare to Refresh PMreg
- 35 gm
1194 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
11
Category Description Item PriceEye Care(Continued)
Eye Wash Solution - Compare to Bausch and Lombreg
- 4 oz
1196 $800
Multi-Purpose Contact Lens Solution - Compare to Renu Multipurpose Solutionreg
- 4 oz
1468 $600
Redness Relief Eye Drops - Compare to Visine Original Redness Reliefreg
- 15 ml005
1061 $500
First Aid and Medical Supplies
Adhesive Bandages - Compare to Band-Aid Plastic Stripsreg
- 60 ct
1344 $600
After Bite Reliefreg
- 5 oz1803 $900
Alcohol Pads - 100 ct70
1200 $600
Antiseptic Towelettes - 100 ct
1201 $700
Bacitracin Ointment - 1 oz500 Ugm
1020 $600
Cotton Balls - 200 ct
1763 $600
CPAP Pillow Fiber Filled - 1 ct
1836 $6000
CPAP Pillow Memory Foam - 1 ct
1837 $10000
Elastic Bandage (Compare to Acereg)
2rdquo x 45 yd - 1 ct
3rdquo x 5 yd - 1 ct
4rdquo x 5 yd - 1 ct
6rdquo x 5 yd - 1 ct
1207
1209
1211
1213
$400
$400
$500
$500
Fast Freeze Pain Relief Spray - Compare to Biofreeze Pain Relief Sprayreg
- 4 oz
1846 $1400
First Aid Kit 20 Pieces - 1 ct
1947 $700
First Aid Kit 75 Pieces - 1 ct
1215 $1000
First Aid Kit 175 Pieces - 1 ct
1738 $1700
HotCold Pack 1 small and 1 large - 1 ct
1062 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Humidifier Ultra-Sonic Cool Mist - Compare to Vicks Ultrasonic Humidifierreg
- 1 ct
1795 $6000
Hydrogen Peroxide - 16 oz3
1228 $500
Ice Bag - 1 ct
1761 $900
Insect Repellant Spray - Deet - 4 oz30
1796 $1200
Isopropyl Alcohol Wintergreen - 16 oz70
1229 $600
Liquid Bandage - 45 oz
1872 $850
Neosporin Plusreg
- 5 oz1326 $1100
Nitrile Exam Gloves - 100 ct
1840 $1200
Pill Crusher with Storage - 1 ct
1933 $1000
Pill Cutter with Safety Shield - 1 ct
1932 $1000
Povidone Iodine Solution Antiseptic - 4 oz
1203 $800
Procedural Face Masks with Earloops - 50 ct
1896 $1400
Tape Paper Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1217
1218
$600
$600
Tape Silk Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1219
1220
$600
$700
Tape Transparent Surgical(Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1221
1222
$600
$600
Thermometer Digital 60 seconds - 1 ct
1063 $500
Thermometer Digital Ear - 1 ct
1285 $2400
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
13
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Thermometer Flexible Tip Digital 10 seconds - 1 ct
1697 $1000
Thermometer Talking Ear and Forehead - 1 ct
1925 $4500
Triple Antibiotic Ointment - Compare to Neosporinreg
- 1 oz
1014 $700
Foot Care Callus Remover Pads - Compare to Dr Schollrsquosreg
- 6 ct
1238 $700
Corn Remover Pads - Compare to Dr Schollrsquosreg
- 9 ct
1236 $700
Medicated Foot Powder - 5 oz
1240 $700
Hemorrhoidal Preparations
Hemorrhoidal Ointment - Compare to Preparation Hreg
- 2 oz
1066 $700
Hemorrhoidal Suppository - 12 ct
1247 $700
Pre-moist Hemorrhoid Pads - Compare to Tucksreg
- 100 ct
1364 $800
Preparation Hreg Medicated Wipes - 48 ct
1895 $1300
Hormone Replacement DHEADagger
- 50 ct50 mg1737 $1200
Incontinence Supplies A and D Ointment - Compare to AandD Ointmentreg
- 2 oz
1300 $800
Adult Briefs(Compare to Dependreg)
Medium - 32rdquo to 44rdquo - 12 ct
Large - 45rdquo to 58rdquo - 12 ct
X-Large - 59rdquo to 64rdquo - Compare to Dependreg
- 15 ct
1303
1304
1305
$1000
$1200
$1200
Menrsquos Attends Discreet (Compare to Dependreg)
Guard - 20 ct
Shield - 20 ct
1811
1810
$1600
$1500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Category Description Item PriceIncontinence Supplies (Continued)
Womenrsquos Attends Discreet(Compare to Dependreg)
Moderate Bladder Control Pad - 20 ct
Maximum Bladder Control Pad - 20 ct
Ultimate Bladder Control Pad - 20 ct
Ultrathin Pad - 20 ct
Panty Liner - 28 ct
1813
1812
1814
1816
1815
$1800
$2000
$2000
$1400
$1400
Barrier Cream - Compare to Lantiseptic Barrier Creamreg
- 4 oz
1302 $1000
Bladder Control Shaped Pad(Compare to Dependreg)
Moderate Absorbency - 24 ct
Heavy Absorbency - 24 ct
Maximum Absorbency - 18 ct
1478
1479
1480
$1700
$1900
$1600
Disposable Underwear(Compare to Dependreg)
Medium - 34rdquo to 44rdquo - 20 ct
Large - 44rdquo to 58rdquo - 18 ct
X-Large - 58rdquo to 68rdquo - 14 ct
1021
1026
1027
$1600
$1600
$1600
Flushable Wipes - 24 ct
1928 $750
Underpad Disposable(Compare to Dependreg)
23rdquo x 24rdquo - 50 ct
23rdquo x 36rdquo - 25 ct
30rdquo x 30rdquo - 10 ct
1476
1299
1477
$1500
$1000
$800
Washcloth with Lanolin - 64 ct
1348 $900
In-home Diagnostic Equipment
Bathroom ScaleDaggersect
- 1 ct1935 $3500
Blood Pressure Monitor (1 ct)Desktop AutomaticDagger
Desktop TalkingDagger
Replacement CuffDagger
WristDagger
Wrist TalkingDagger
12531503150415011502
$6000 $7000 $1500 $4000 $5000
your doctor before starting a new product regime
OTC MTalk with
EDICATIONS AND PRODUCTS
15
Category Description Item PriceIn-home Diagnostic Equipment (Continued)
Finger Pulse OximeterDagger
- 1 ct1505 $5200
Heart Rate Monitor WatchDagger
- 1 ct1771 $4000
In-home Diagnostic Tests
EZ Detect Colon Cancer Test KitDagger
- 1 ct1416 $1300
Home Access Cholesterol TestDagger
- 1 kit1251 $3300
Lice Treatment (Pediculicide)
Lice Elimination Kit - Compare to RIDreg
- 1 kit
1929 $2700
Lice Treatment Shampoo - Compare to RIDreg
- 4 oz
1271 $900
Permethrin Lice Treatment - Compare to Nixreg
- 59 ml1
1269 $1400
Mobility Cushion Foam Ring - 1 ct
1732 $2100
Cushion GelFoam Seat - 1 ct
1466 $4200
Cushion Lumbar - 1 ct
1731 $2700
Folding Cane Ergonomic Handle - 1 ct
1726 $2000
Quad Cane (1 ct) Small BaseLarge Base
17771776
$2500 $3000
Motion Sickness Dramamine Chewablesreg Orange - 8 ct50 mg
1264 $700
Driminate Antiemetic - Compare to Dramaminereg
- 12 ct50 mg
1263 $500
Meclizine HCL Antiemetic - 100 ct125 mg
1366 $800
Pain Relievers and Fever Reducers
AcetaminophenCompare to Tylenolreg
- 100 ct325 mg
1001
$600
Compare to Tylenol Extra Strengthreg
- 100 ct500 mg1600 $1000
Arthritis Pain Reliever - Compare to Tylenol Arthritisreg
- 100 ct650 mg
1311 $1200
Aspirin - Compare to Bayerreg
- 100 ct325 mg
1095 $500
Aspirin Enteric Coated - Compare to Bayerreg
- 100 ct325 mg
1096 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
- Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
- Compare to Capzasinreg
- 2 oz0025
1367 $1000
- 1 ct1943 $5500
(Compare to ThermaCarereg)Back and Hip
- 2 ctNeck Shoulder and Wrist
- 3 ct
1859
1860
$1300
$1300
- Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
- Compare to Alevereg
- 100 ct220 mg
1097 $1100
- Compare to Bengayreg
- 2 oz25
1475 $600
Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Pain Relievers and Fever Reducers (Continued)
Category Description Item Price
Aspirin Low Dose Chewables - Compare to Bayer Aspirin Chewable Low Dosereg
- 36 ct81 mg
1802 $500
ColdHot Menthol Medicated Patch- Compare to IcyHotreg
- 5 ct5
1944 $1000
Heating Pad 12rdquo x 15rdquo- 1 ct
1861 $2600
Ibuprofen - Compare to Advilreg
- 100 ct200 mg
1004 $700
Migraine Relief- Compare to Excedrinreg
- 100 ct250 mg 250 mg 65 mg
1365 $700
Pain Reliever PM - Extra Strength - Compare to Tylenol PMreg
- 100 ct
1332 $1000
Salonpas Pain Relief Patchesreg
- 5 ct 1739 $1400
XL Heating Pad 12rdquo x 24rdquo- 1 ct
1942 $3500
16
HeatWraps(Compare to ThermaCarereg)
Back and Hip - 2 ct
Neck Shoulder and Wrist - 3 ct
1859
1860
$1300
$1300
ThermaCarereg Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Naproxen - Compare to Alevereg
- 100 ct220 mg
1097 $1100
Lidocaine Patch - Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
Capsaicin External Analgesic - Compare to Capzasinreg
- 2 oz0025
1367 $1000
Aspirin Enteric Coated Low Dose - Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
Heating Pad Wrap for Shoulder Neck and Back 25rdquo x 26rdquo - 1 ct
1943 $5500
Pain Relieving Muscle Rub - Compare to Bengayreg
- 2 oz25
1475 $600
17
Category Description Item PricePersonal Care Acne Gel 10 Benzoyl Peroxide
- Compare to Persa-Gelreg - 15 oz10
1076 $700
Ammonium Lactate Moisturizing Lotion - Compare to AmLactinreg
- 8 oz12
1368 $900
Hand Sanitizer - Compare to Purellreg - 8 oz
1065 $500
Skin and Sun Care Aloe Vera Cream - 8 oz
1070 $600
Calamine Lotion - 6 oz
1821 $600
Moisturizing Body Lotion with Aloe - 8 oz
1893 $800
Scar Gel - 50 gm
1852 $1200
Sunscreen Lotion SPF 30 - 35 oz
1284 $600
Sleep Aids Nasal Strips (Compare to Breathe Rightreg)
Medium - 30 ct
Large - 30 ct
1724
1725
$1200
$1200
Sleep Tablets - Compare to Sominexreg
- 50 ct25 mg
1276 $600
Smoking Cessation Nicorelief GumDagger
- Compare to Nicorettereg
- 50 ct4 mg
1372 $2500
Nicotine LozengesDagger
- Compare to Nicorettereg
- 72 ct4 mg
1281 $4400
Nicotine PatchStep 1Dagger
- Compare to NicoDerm CQ Step 1reg
- 14 ct21 mg 24 hrStep 2Dagger
- Compare to NicoDerm CQ Step 2reg
- 14 ct14 mg 24 hrStep 3Dagger
- Compare to NicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
1369
1370
1371
$4500
$4500
$4500
Supportive Items Ankle Support - Compare to Acereg
- 1 ct
1225 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
5
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item PriceAllergy Cold Flu Decongestant and Sinus
Allergy Relief Nasal Spray 24-hr Fluticasone Propionate - Compare to Flonasereg
- 120 spray50 mcg
1946 $2500
All-Nite ColdFlu - Compare to Vicks NyQuilreg - 4 oz125 mg 30 mg 650 mg
1361 $600
Cepacolreg Sore Throat Lozenges - 16 ct
1360 $700
Cetirizine HCL Allergy Relief - Compare to Zyrtecreg
- 14 ct10 mg
1090 $700
Chlorpheniramine Maleate Antihistamine - 100 ct4 mg
1008 $500
Cough and Cold for High Blood Pressure - Compare to Coricidin HBPreg
- 16 ct
1166 $700
Cough DropsCherry (Compare to Hallsreg)
- 30 ct58 mgSugar Free Cherry (Compare to Halls Sugar Freereg)
- 25 ct58 mgMenthol (Compare to Hallsreg)
- 30 ct
1056
1182
1834
$400
$500
$400
Cough Syrup Expectorant - Compare to Robitussinreg
- 4 oz200 mg 10 ml
1054 $500
Cromolyn Sodium Allergy Nasal Spray - Compare to Nasalcromreg
- 26 ml
1356 $1800
Diabetic Tussin DM - Compare to Robitussin Sugar Free DMreg
- 4 oz
1323 $1000
Diphenhydramine Antihistamine - Compare to Benadrylreg - 100 ct25 mg
1308 $600
Diphenhydramine Antihistamine - Compare to Benadrylreg - 24 ct25 mg
1009 $500
Guaifenesin Cough Expectorant - 60 ct200 mg
1180 $900
Loratadine Allergy Relief - Compare to Claritinreg
- 100 ct10 mg
1611 $2000
Mucus Relief DM Expectorant and Cough Suppressant(Compare to Mucinexreg)
- 30 ct400 mg 20 mgExtended Release
- 14 ct1200 mg 60 mg
1178
1965
$1200
$1600
- 60 spray1881 $2200
- Compare to NeilMed Sinus Rinsereg
- 1 kit
1931 $1800
- Compare to Vicks Personal Steam Inhalerreg
- 1 ct
1792 $5000
- Compare to Chlorasepticreg
- 6 oz
1904 $800
- Compare to Vicks VapoRubreg
- 35 oz47 1
1164 $750
- Compare to Tumsreg
- 150 ct500 mg
1346 $600
- Compare to Nexiumreg
- 42 ct20 mg
1949 $2300
- Compare to Prilosecreg
- 42 ct20 mg
1970 $2600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item Price Allergy Cold Flu Decongestant and Sinus (Continued)
Multi-Symptom Cold Formula - Compare to Tylenol Cold Multi-Symptom Daytimereg
- 24 ct10 mg 5 mg 325 mg
1357 $600
Nasal Decongestant Spray 12 Hour - Compare to Afrinreg
- 1 oz005
1091 $500
Nasal Spray Saline - Compare to Ocean Saline Nasal Sprayreg
- 15 oz065
1052 $500
Sore Throat Lozenges Cherry - Compare to Cepacolreg
- 18 ct
1176 $700
Sudogest PE Nasal and Sinus Decongestant - Compare to Sudafed PEreg
- 36 ct10 mg
1352 $500
AntacidAnti-Gas Liquid- Compare to Maaloxreg
- 12 oz
1006 $600
Effervescent Pain Reliever - Compare to Alka-Seltzerreg
- 36 ct
1314 $800
Famotidine Acid Reducer - Compare to Pepcid ACreg
- 30 ct10 mg
1108 $600
Omeprazole Acid Reducer
6
Omeprazole Acid Reducer - Compare to Prilosecreg
- 42 ct20 mg
1970 $2600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Nasacortreg
- 60 spray1881 $2200
Nasal Rinse Kit Saline - Compare to NeilMed Sinus Rinsereg
- 1 kit
1931 $1800
Personal Steam Inhaler - Compare to Vicks Personal Steam Inhalerreg
- 1 ct
1792 $5000
Sore Throat Spray Cherry - Compare to Chlorasepticreg
- 6 oz
1904 $800
Vapor Rub - Compare to Vicks VapoRubreg
- 35 oz47 1
1164 $750
Antacids and Acid Reducers
Antacid Chewables - Compare to Tumsreg
- 150 ct500 mg
1346 $600
Esomeprazole Magnesium 24-hr Delayed Release Acid Reducer
- Compare to Nexiumreg
- 42 ct20 mg
1949 $2300
- Compare to Zantacreg
- 30 ct75 mg
1900 $800
- Compare to Monistat 7reg
- 45 gm1
1115 $800
- Compare to Monistat 1reg
- 1 ct65
1119 $2000
- Compare to Pepto-Bismol Chewablereg
- 30 ct262 mg
1045 $600
- Compare to Colacereg
- 100 ct100 mg
1126 $600
- Compare to Lactaidreg
- 60 ct9000 FCC units
1067 $1000
- Compare to Citrucelreg - 16 oz
1354 $1200
- Compare to Metamucilreg - 13 oz
1340 $1000
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Category Description Item Price Antacids and Acid Reducers (Continued)
Omeprazole Acid Reducer Delayed Release Dissolvable - Compare to Prilosecreg
- 42 ct20 mg
1966 $2600
Simethicone Anti-Gas Chewables - Compare to Gas-X Chewablesreg
- 100 ct80 mg
1800 $1000
Anticandidal (yeast)
Miconazole 3-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 3reg
- 1 kit2
1117 $1400
Bisacodyl Enteric Coated Laxative- Compare to Dulcolaxreg
- 100 ct5 mg
1128 $600
ClearLax Unflavored Powder - Compare to MiraLAXreg
- 83 oz17 g
1969 $1350
Glycerin Suppository - Compare to Fleetreg
- 25 ct2 gm
1125 $500
Milk of Magnesia- Compare to Phillipsreg
- 12 oz400 mg
1011 $600
Natural Vegetable Laxative
7
Natural Vegetable Laxative - Compare to Metamucilreg - 13 oz
1340 $1000
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Loperamide HCL Anti-Diarrheal - Compare to Imodium A-Dreg
- 12 ct2 mg
1133 $500
Methylcellulose Fiber Therapy - Compare to Citrucelreg - 16 oz
1354 $1200
Lactase Capsules - Compare to Lactaidreg
- 60 ct9000 FCC units
1067 $1000
Docusate Sodium Stool Softener - Compare to Colacereg
- 100 ct100 mg
1126 $600
Bismatrol Chewable Tablets - Compare to Pepto-Bismol Chewablereg
- 30 ct262 mg
1045 $600
Tioconazole 1-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 1reg
- 1 ct65
1119 $2000
Anti-diarrheal Laxatives and Digestive Health
Clotrimazole 7-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 7reg
- 45 gm1
1115 $800
Ranitidine Acid Reducer - Compare to Zantacreg
- 30 ct75 mg
1900 $800
- Compare to Metamucilreg
- 304 oz
1967 $1600
- Compare to Pepto-Bismolreg - 8 oz525 mg 30 ml
1318 $600
- Compare to Senokot-Sreg
- 60 ct86 mg 50 mg
1130 $600
- Compare to Lotrimin AFreg
- 15 oz1
1047 $600
- Compare to Cortaidreg
- 1 oz1
1074 $600
- Compare to Micatinreg
- 1 oz2
1135 $800
- Compare to Tinactinreg
- 125 oz1
1064 $500
- 1 ct1728 $6500
- 1 ct1459 $1700
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item Price Anti-diarrheal Laxatives and Digestive Health (Continued)
Natural Vegetable Laxative Sugar free - Compare to Metamucil Sugar Freereg
- 15 oz
1968 $1300
Polycarbophil Fiber Tablets - Compare to FiberConreg
- 90 ct625 mg
1012 $1000
Caldyphen Clear Lotionreg Local Analgesic - 6 oz1
1144 $900
Diphenhydramine HCLZinc Acetate Anti-Itch Cream - Compare to Benadryl Creamreg
- 1 oz
1140 $500
Medicated Antifungal Foot Powder Spray - Compare to Lotrimin AFreg
- 46 oz
1874 $1000
Terbinafine HCL Antifungal Cream - Compare to Lamisil ATreg
- 5 oz1
1046 $1200
Adjustable Transfer Bench- 1 ct
1764 $8000
Bath Bench without Back - 1 ct
1727 $5500
Bath Mat Non-Skid
8
Bath Mat Non-Skid - 1 ct
1459 $1700
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Natural Vegetable Laxative - Compare to Metamucilreg - 304 oz
1967 $1600
Pink Bismuth - Compare to Pepto-Bismolreg - 8 oz525 mg 30 ml
1318 $600
1130 $600
Anti-fungal and Anti-itch
Senna Plus Stool Softener Plus Laxative - Compare to Senokot-Sreg
- 60 ct86 m
Clotrimazole Antifungal Athletersquos Foot Cream - Compare to Lotrimin AFreg
- 15 oz1
1047 $600
Hydrocortisone 1 Cream - Compare to Cortaidreg
- 1 oz1
1074 $600
Bath Bench with Back - 1 ct
1728 $6500
Tolnaftate Antifungal Cream - Compare to Tinactinreg
- 125 oz1
1064 $500
Bathroom Safety
Miconazole Nitrate 2 Antifungal Cream - Compare to Micatinreg
- 1 oz2
1135 $800
9
Category Description Item PriceBathroom Safety (Continued)
Bath Tub Safety Rail - 1 ct
1730 $3700
Raised Toilet Seat - 1 ct
1729 $3500
Raised Toilet Seat with Arms - 1 ct
1950 $6500
Shower Mat Non-Skid - 1 ct
1460 $1400
Toilet Safety Rails - 1 set
1779 $5000
Cold Sore and Medicated Lip Products
Abrevareg
- 2 gm101152 $2600
Carmexreg
- 75 gm1255 $400
Herpecin-Lreg Lip Balm - 1 oz1
1153 $800
Releevreg Cold Sore Treatment - 6 ml013
1359 $2500
Dental and Denture Care Biotenereg Dry Mouth Oral Rinse - 16 oz
1817 $1400
Denture Brush - Compare to G-U-Mreg
- 1 ct
1747 $650
Denture Cleaning Tablets - Compare to Polidentreg
- 40 ct
1032 $700
Efferdent Plusreg Mint Tablets - 36 ct
1653 $800
Effergripreg Denture Cream Adhesive - 25 oz
1843 $900
Fixodentreg
- 75 oz1187 $700
Interdental Flossups - Compare to G-U-Mreg
- 90 ct
1751 $700
Orajelreg Pain Relief - 7 gm20
1454 $1100
Oral Pain Relief - Compare to Orajelreg - 5 oz20
1286 $600
Polidentreg Denture Cream - 39 oz
1324 $800
Polidentreg Overnight - 84 ct
1892 $1250
Reachreg Waxed Dental Floss - Mint - 55 yd
1455 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
10
Category Description Item PriceDental and Denture Care (Continued)
ToothbrushColgatereg Adult Soft
- 1 ctRechargeable
- 1 ctSoft 2-pack
- 2-packTek Pro Angled Soft
- 1 ct
1413
1450
1948
1412
$300
$4000
$600
$300
Toothpaste Crest Sensi-Reliefreg
- 41 oz1838 $950
Toothpaste Pepsodentreg
- 55 oz1414 $500
Water Jet - 1 ct
1744 $3900
Water Jet Replacement Tips - 5 ct
1743 $1800
Diabetic Foot Care Diabetic SocksBlack Medium 3-packBlack Large 3-packBlack X-Large 3-pack
195619571958
$900 $900 $900
Diabetic Socks White Medium 3-packWhite Large 3-packWhite X-Large 3-pack
195319541955
$900 $900 $900
Ultra Soft Padded Diabetic SockBlack Medium 2-packBlack Large 2-packBlack X-Large 2-pack
195919601961
$1100 $1100 $1100
Ultra Soft Padded Diabetic SockWhite Medium 2-packWhite Large 2-packWhite X-Large 2-pack
196219631964
$1100 $1100 $1100
Ear Care Cotton Tipped Swabs - 300 ct
1742 $600
Ear Pain Relief Ear Drops - Compare to Hylandrsquos Ear Reliefreg
- 10 ml
1841 $1300
Ear Wax Removal Drops - Compare to Debroxreg
- 15 ml65
1190 $500
Ear Wax Removal System with Rubber Bulb - Compare to Debroxreg
- 15 ml65
1363 $700
Eye Care Artificial Tears Drops - Compare to Visine Tearsreg
- 5 oz
1192 $600
Artificial Tears Ointment - Compare to Refresh PMreg
- 35 gm
1194 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
11
Category Description Item PriceEye Care(Continued)
Eye Wash Solution - Compare to Bausch and Lombreg
- 4 oz
1196 $800
Multi-Purpose Contact Lens Solution - Compare to Renu Multipurpose Solutionreg
- 4 oz
1468 $600
Redness Relief Eye Drops - Compare to Visine Original Redness Reliefreg
- 15 ml005
1061 $500
First Aid and Medical Supplies
Adhesive Bandages - Compare to Band-Aid Plastic Stripsreg
- 60 ct
1344 $600
After Bite Reliefreg
- 5 oz1803 $900
Alcohol Pads - 100 ct70
1200 $600
Antiseptic Towelettes - 100 ct
1201 $700
Bacitracin Ointment - 1 oz500 Ugm
1020 $600
Cotton Balls - 200 ct
1763 $600
CPAP Pillow Fiber Filled - 1 ct
1836 $6000
CPAP Pillow Memory Foam - 1 ct
1837 $10000
Elastic Bandage (Compare to Acereg)
2rdquo x 45 yd - 1 ct
3rdquo x 5 yd - 1 ct
4rdquo x 5 yd - 1 ct
6rdquo x 5 yd - 1 ct
1207
1209
1211
1213
$400
$400
$500
$500
Fast Freeze Pain Relief Spray - Compare to Biofreeze Pain Relief Sprayreg
- 4 oz
1846 $1400
First Aid Kit 20 Pieces - 1 ct
1947 $700
First Aid Kit 75 Pieces - 1 ct
1215 $1000
First Aid Kit 175 Pieces - 1 ct
1738 $1700
HotCold Pack 1 small and 1 large - 1 ct
1062 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Humidifier Ultra-Sonic Cool Mist - Compare to Vicks Ultrasonic Humidifierreg
- 1 ct
1795 $6000
Hydrogen Peroxide - 16 oz3
1228 $500
Ice Bag - 1 ct
1761 $900
Insect Repellant Spray - Deet - 4 oz30
1796 $1200
Isopropyl Alcohol Wintergreen - 16 oz70
1229 $600
Liquid Bandage - 45 oz
1872 $850
Neosporin Plusreg
- 5 oz1326 $1100
Nitrile Exam Gloves - 100 ct
1840 $1200
Pill Crusher with Storage - 1 ct
1933 $1000
Pill Cutter with Safety Shield - 1 ct
1932 $1000
Povidone Iodine Solution Antiseptic - 4 oz
1203 $800
Procedural Face Masks with Earloops - 50 ct
1896 $1400
Tape Paper Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1217
1218
$600
$600
Tape Silk Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1219
1220
$600
$700
Tape Transparent Surgical(Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1221
1222
$600
$600
Thermometer Digital 60 seconds - 1 ct
1063 $500
Thermometer Digital Ear - 1 ct
1285 $2400
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
13
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Thermometer Flexible Tip Digital 10 seconds - 1 ct
1697 $1000
Thermometer Talking Ear and Forehead - 1 ct
1925 $4500
Triple Antibiotic Ointment - Compare to Neosporinreg
- 1 oz
1014 $700
Foot Care Callus Remover Pads - Compare to Dr Schollrsquosreg
- 6 ct
1238 $700
Corn Remover Pads - Compare to Dr Schollrsquosreg
- 9 ct
1236 $700
Medicated Foot Powder - 5 oz
1240 $700
Hemorrhoidal Preparations
Hemorrhoidal Ointment - Compare to Preparation Hreg
- 2 oz
1066 $700
Hemorrhoidal Suppository - 12 ct
1247 $700
Pre-moist Hemorrhoid Pads - Compare to Tucksreg
- 100 ct
1364 $800
Preparation Hreg Medicated Wipes - 48 ct
1895 $1300
Hormone Replacement DHEADagger
- 50 ct50 mg1737 $1200
Incontinence Supplies A and D Ointment - Compare to AandD Ointmentreg
- 2 oz
1300 $800
Adult Briefs(Compare to Dependreg)
Medium - 32rdquo to 44rdquo - 12 ct
Large - 45rdquo to 58rdquo - 12 ct
X-Large - 59rdquo to 64rdquo - Compare to Dependreg
- 15 ct
1303
1304
1305
$1000
$1200
$1200
Menrsquos Attends Discreet (Compare to Dependreg)
Guard - 20 ct
Shield - 20 ct
1811
1810
$1600
$1500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Category Description Item PriceIncontinence Supplies (Continued)
Womenrsquos Attends Discreet(Compare to Dependreg)
Moderate Bladder Control Pad - 20 ct
Maximum Bladder Control Pad - 20 ct
Ultimate Bladder Control Pad - 20 ct
Ultrathin Pad - 20 ct
Panty Liner - 28 ct
1813
1812
1814
1816
1815
$1800
$2000
$2000
$1400
$1400
Barrier Cream - Compare to Lantiseptic Barrier Creamreg
- 4 oz
1302 $1000
Bladder Control Shaped Pad(Compare to Dependreg)
Moderate Absorbency - 24 ct
Heavy Absorbency - 24 ct
Maximum Absorbency - 18 ct
1478
1479
1480
$1700
$1900
$1600
Disposable Underwear(Compare to Dependreg)
Medium - 34rdquo to 44rdquo - 20 ct
Large - 44rdquo to 58rdquo - 18 ct
X-Large - 58rdquo to 68rdquo - 14 ct
1021
1026
1027
$1600
$1600
$1600
Flushable Wipes - 24 ct
1928 $750
Underpad Disposable(Compare to Dependreg)
23rdquo x 24rdquo - 50 ct
23rdquo x 36rdquo - 25 ct
30rdquo x 30rdquo - 10 ct
1476
1299
1477
$1500
$1000
$800
Washcloth with Lanolin - 64 ct
1348 $900
In-home Diagnostic Equipment
Bathroom ScaleDaggersect
- 1 ct1935 $3500
Blood Pressure Monitor (1 ct)Desktop AutomaticDagger
Desktop TalkingDagger
Replacement CuffDagger
WristDagger
Wrist TalkingDagger
12531503150415011502
$6000 $7000 $1500 $4000 $5000
your doctor before starting a new product regime
OTC MTalk with
EDICATIONS AND PRODUCTS
15
Category Description Item PriceIn-home Diagnostic Equipment (Continued)
Finger Pulse OximeterDagger
- 1 ct1505 $5200
Heart Rate Monitor WatchDagger
- 1 ct1771 $4000
In-home Diagnostic Tests
EZ Detect Colon Cancer Test KitDagger
- 1 ct1416 $1300
Home Access Cholesterol TestDagger
- 1 kit1251 $3300
Lice Treatment (Pediculicide)
Lice Elimination Kit - Compare to RIDreg
- 1 kit
1929 $2700
Lice Treatment Shampoo - Compare to RIDreg
- 4 oz
1271 $900
Permethrin Lice Treatment - Compare to Nixreg
- 59 ml1
1269 $1400
Mobility Cushion Foam Ring - 1 ct
1732 $2100
Cushion GelFoam Seat - 1 ct
1466 $4200
Cushion Lumbar - 1 ct
1731 $2700
Folding Cane Ergonomic Handle - 1 ct
1726 $2000
Quad Cane (1 ct) Small BaseLarge Base
17771776
$2500 $3000
Motion Sickness Dramamine Chewablesreg Orange - 8 ct50 mg
1264 $700
Driminate Antiemetic - Compare to Dramaminereg
- 12 ct50 mg
1263 $500
Meclizine HCL Antiemetic - 100 ct125 mg
1366 $800
Pain Relievers and Fever Reducers
AcetaminophenCompare to Tylenolreg
- 100 ct325 mg
1001
$600
Compare to Tylenol Extra Strengthreg
- 100 ct500 mg1600 $1000
Arthritis Pain Reliever - Compare to Tylenol Arthritisreg
- 100 ct650 mg
1311 $1200
Aspirin - Compare to Bayerreg
- 100 ct325 mg
1095 $500
Aspirin Enteric Coated - Compare to Bayerreg
- 100 ct325 mg
1096 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
- Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
- Compare to Capzasinreg
- 2 oz0025
1367 $1000
- 1 ct1943 $5500
(Compare to ThermaCarereg)Back and Hip
- 2 ctNeck Shoulder and Wrist
- 3 ct
1859
1860
$1300
$1300
- Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
- Compare to Alevereg
- 100 ct220 mg
1097 $1100
- Compare to Bengayreg
- 2 oz25
1475 $600
Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Pain Relievers and Fever Reducers (Continued)
Category Description Item Price
Aspirin Low Dose Chewables - Compare to Bayer Aspirin Chewable Low Dosereg
- 36 ct81 mg
1802 $500
ColdHot Menthol Medicated Patch- Compare to IcyHotreg
- 5 ct5
1944 $1000
Heating Pad 12rdquo x 15rdquo- 1 ct
1861 $2600
Ibuprofen - Compare to Advilreg
- 100 ct200 mg
1004 $700
Migraine Relief- Compare to Excedrinreg
- 100 ct250 mg 250 mg 65 mg
1365 $700
Pain Reliever PM - Extra Strength - Compare to Tylenol PMreg
- 100 ct
1332 $1000
Salonpas Pain Relief Patchesreg
- 5 ct 1739 $1400
XL Heating Pad 12rdquo x 24rdquo- 1 ct
1942 $3500
16
HeatWraps(Compare to ThermaCarereg)
Back and Hip - 2 ct
Neck Shoulder and Wrist - 3 ct
1859
1860
$1300
$1300
ThermaCarereg Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Naproxen - Compare to Alevereg
- 100 ct220 mg
1097 $1100
Lidocaine Patch - Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
Capsaicin External Analgesic - Compare to Capzasinreg
- 2 oz0025
1367 $1000
Aspirin Enteric Coated Low Dose - Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
Heating Pad Wrap for Shoulder Neck and Back 25rdquo x 26rdquo - 1 ct
1943 $5500
Pain Relieving Muscle Rub - Compare to Bengayreg
- 2 oz25
1475 $600
17
Category Description Item PricePersonal Care Acne Gel 10 Benzoyl Peroxide
- Compare to Persa-Gelreg - 15 oz10
1076 $700
Ammonium Lactate Moisturizing Lotion - Compare to AmLactinreg
- 8 oz12
1368 $900
Hand Sanitizer - Compare to Purellreg - 8 oz
1065 $500
Skin and Sun Care Aloe Vera Cream - 8 oz
1070 $600
Calamine Lotion - 6 oz
1821 $600
Moisturizing Body Lotion with Aloe - 8 oz
1893 $800
Scar Gel - 50 gm
1852 $1200
Sunscreen Lotion SPF 30 - 35 oz
1284 $600
Sleep Aids Nasal Strips (Compare to Breathe Rightreg)
Medium - 30 ct
Large - 30 ct
1724
1725
$1200
$1200
Sleep Tablets - Compare to Sominexreg
- 50 ct25 mg
1276 $600
Smoking Cessation Nicorelief GumDagger
- Compare to Nicorettereg
- 50 ct4 mg
1372 $2500
Nicotine LozengesDagger
- Compare to Nicorettereg
- 72 ct4 mg
1281 $4400
Nicotine PatchStep 1Dagger
- Compare to NicoDerm CQ Step 1reg
- 14 ct21 mg 24 hrStep 2Dagger
- Compare to NicoDerm CQ Step 2reg
- 14 ct14 mg 24 hrStep 3Dagger
- Compare to NicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
1369
1370
1371
$4500
$4500
$4500
Supportive Items Ankle Support - Compare to Acereg
- 1 ct
1225 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
- 60 spray1881 $2200
- Compare to NeilMed Sinus Rinsereg
- 1 kit
1931 $1800
- Compare to Vicks Personal Steam Inhalerreg
- 1 ct
1792 $5000
- Compare to Chlorasepticreg
- 6 oz
1904 $800
- Compare to Vicks VapoRubreg
- 35 oz47 1
1164 $750
- Compare to Tumsreg
- 150 ct500 mg
1346 $600
- Compare to Nexiumreg
- 42 ct20 mg
1949 $2300
- Compare to Prilosecreg
- 42 ct20 mg
1970 $2600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item Price Allergy Cold Flu Decongestant and Sinus (Continued)
Multi-Symptom Cold Formula - Compare to Tylenol Cold Multi-Symptom Daytimereg
- 24 ct10 mg 5 mg 325 mg
1357 $600
Nasal Decongestant Spray 12 Hour - Compare to Afrinreg
- 1 oz005
1091 $500
Nasal Spray Saline - Compare to Ocean Saline Nasal Sprayreg
- 15 oz065
1052 $500
Sore Throat Lozenges Cherry - Compare to Cepacolreg
- 18 ct
1176 $700
Sudogest PE Nasal and Sinus Decongestant - Compare to Sudafed PEreg
- 36 ct10 mg
1352 $500
AntacidAnti-Gas Liquid- Compare to Maaloxreg
- 12 oz
1006 $600
Effervescent Pain Reliever - Compare to Alka-Seltzerreg
- 36 ct
1314 $800
Famotidine Acid Reducer - Compare to Pepcid ACreg
- 30 ct10 mg
1108 $600
Omeprazole Acid Reducer
6
Omeprazole Acid Reducer - Compare to Prilosecreg
- 42 ct20 mg
1970 $2600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Nasacortreg
- 60 spray1881 $2200
Nasal Rinse Kit Saline - Compare to NeilMed Sinus Rinsereg
- 1 kit
1931 $1800
Personal Steam Inhaler - Compare to Vicks Personal Steam Inhalerreg
- 1 ct
1792 $5000
Sore Throat Spray Cherry - Compare to Chlorasepticreg
- 6 oz
1904 $800
Vapor Rub - Compare to Vicks VapoRubreg
- 35 oz47 1
1164 $750
Antacids and Acid Reducers
Antacid Chewables - Compare to Tumsreg
- 150 ct500 mg
1346 $600
Esomeprazole Magnesium 24-hr Delayed Release Acid Reducer
- Compare to Nexiumreg
- 42 ct20 mg
1949 $2300
- Compare to Zantacreg
- 30 ct75 mg
1900 $800
- Compare to Monistat 7reg
- 45 gm1
1115 $800
- Compare to Monistat 1reg
- 1 ct65
1119 $2000
- Compare to Pepto-Bismol Chewablereg
- 30 ct262 mg
1045 $600
- Compare to Colacereg
- 100 ct100 mg
1126 $600
- Compare to Lactaidreg
- 60 ct9000 FCC units
1067 $1000
- Compare to Citrucelreg - 16 oz
1354 $1200
- Compare to Metamucilreg - 13 oz
1340 $1000
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Category Description Item Price Antacids and Acid Reducers (Continued)
Omeprazole Acid Reducer Delayed Release Dissolvable - Compare to Prilosecreg
- 42 ct20 mg
1966 $2600
Simethicone Anti-Gas Chewables - Compare to Gas-X Chewablesreg
- 100 ct80 mg
1800 $1000
Anticandidal (yeast)
Miconazole 3-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 3reg
- 1 kit2
1117 $1400
Bisacodyl Enteric Coated Laxative- Compare to Dulcolaxreg
- 100 ct5 mg
1128 $600
ClearLax Unflavored Powder - Compare to MiraLAXreg
- 83 oz17 g
1969 $1350
Glycerin Suppository - Compare to Fleetreg
- 25 ct2 gm
1125 $500
Milk of Magnesia- Compare to Phillipsreg
- 12 oz400 mg
1011 $600
Natural Vegetable Laxative
7
Natural Vegetable Laxative - Compare to Metamucilreg - 13 oz
1340 $1000
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Loperamide HCL Anti-Diarrheal - Compare to Imodium A-Dreg
- 12 ct2 mg
1133 $500
Methylcellulose Fiber Therapy - Compare to Citrucelreg - 16 oz
1354 $1200
Lactase Capsules - Compare to Lactaidreg
- 60 ct9000 FCC units
1067 $1000
Docusate Sodium Stool Softener - Compare to Colacereg
- 100 ct100 mg
1126 $600
Bismatrol Chewable Tablets - Compare to Pepto-Bismol Chewablereg
- 30 ct262 mg
1045 $600
Tioconazole 1-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 1reg
- 1 ct65
1119 $2000
Anti-diarrheal Laxatives and Digestive Health
Clotrimazole 7-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 7reg
- 45 gm1
1115 $800
Ranitidine Acid Reducer - Compare to Zantacreg
- 30 ct75 mg
1900 $800
- Compare to Metamucilreg
- 304 oz
1967 $1600
- Compare to Pepto-Bismolreg - 8 oz525 mg 30 ml
1318 $600
- Compare to Senokot-Sreg
- 60 ct86 mg 50 mg
1130 $600
- Compare to Lotrimin AFreg
- 15 oz1
1047 $600
- Compare to Cortaidreg
- 1 oz1
1074 $600
- Compare to Micatinreg
- 1 oz2
1135 $800
- Compare to Tinactinreg
- 125 oz1
1064 $500
- 1 ct1728 $6500
- 1 ct1459 $1700
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item Price Anti-diarrheal Laxatives and Digestive Health (Continued)
Natural Vegetable Laxative Sugar free - Compare to Metamucil Sugar Freereg
- 15 oz
1968 $1300
Polycarbophil Fiber Tablets - Compare to FiberConreg
- 90 ct625 mg
1012 $1000
Caldyphen Clear Lotionreg Local Analgesic - 6 oz1
1144 $900
Diphenhydramine HCLZinc Acetate Anti-Itch Cream - Compare to Benadryl Creamreg
- 1 oz
1140 $500
Medicated Antifungal Foot Powder Spray - Compare to Lotrimin AFreg
- 46 oz
1874 $1000
Terbinafine HCL Antifungal Cream - Compare to Lamisil ATreg
- 5 oz1
1046 $1200
Adjustable Transfer Bench- 1 ct
1764 $8000
Bath Bench without Back - 1 ct
1727 $5500
Bath Mat Non-Skid
8
Bath Mat Non-Skid - 1 ct
1459 $1700
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Natural Vegetable Laxative - Compare to Metamucilreg - 304 oz
1967 $1600
Pink Bismuth - Compare to Pepto-Bismolreg - 8 oz525 mg 30 ml
1318 $600
1130 $600
Anti-fungal and Anti-itch
Senna Plus Stool Softener Plus Laxative - Compare to Senokot-Sreg
- 60 ct86 m
Clotrimazole Antifungal Athletersquos Foot Cream - Compare to Lotrimin AFreg
- 15 oz1
1047 $600
Hydrocortisone 1 Cream - Compare to Cortaidreg
- 1 oz1
1074 $600
Bath Bench with Back - 1 ct
1728 $6500
Tolnaftate Antifungal Cream - Compare to Tinactinreg
- 125 oz1
1064 $500
Bathroom Safety
Miconazole Nitrate 2 Antifungal Cream - Compare to Micatinreg
- 1 oz2
1135 $800
9
Category Description Item PriceBathroom Safety (Continued)
Bath Tub Safety Rail - 1 ct
1730 $3700
Raised Toilet Seat - 1 ct
1729 $3500
Raised Toilet Seat with Arms - 1 ct
1950 $6500
Shower Mat Non-Skid - 1 ct
1460 $1400
Toilet Safety Rails - 1 set
1779 $5000
Cold Sore and Medicated Lip Products
Abrevareg
- 2 gm101152 $2600
Carmexreg
- 75 gm1255 $400
Herpecin-Lreg Lip Balm - 1 oz1
1153 $800
Releevreg Cold Sore Treatment - 6 ml013
1359 $2500
Dental and Denture Care Biotenereg Dry Mouth Oral Rinse - 16 oz
1817 $1400
Denture Brush - Compare to G-U-Mreg
- 1 ct
1747 $650
Denture Cleaning Tablets - Compare to Polidentreg
- 40 ct
1032 $700
Efferdent Plusreg Mint Tablets - 36 ct
1653 $800
Effergripreg Denture Cream Adhesive - 25 oz
1843 $900
Fixodentreg
- 75 oz1187 $700
Interdental Flossups - Compare to G-U-Mreg
- 90 ct
1751 $700
Orajelreg Pain Relief - 7 gm20
1454 $1100
Oral Pain Relief - Compare to Orajelreg - 5 oz20
1286 $600
Polidentreg Denture Cream - 39 oz
1324 $800
Polidentreg Overnight - 84 ct
1892 $1250
Reachreg Waxed Dental Floss - Mint - 55 yd
1455 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
10
Category Description Item PriceDental and Denture Care (Continued)
ToothbrushColgatereg Adult Soft
- 1 ctRechargeable
- 1 ctSoft 2-pack
- 2-packTek Pro Angled Soft
- 1 ct
1413
1450
1948
1412
$300
$4000
$600
$300
Toothpaste Crest Sensi-Reliefreg
- 41 oz1838 $950
Toothpaste Pepsodentreg
- 55 oz1414 $500
Water Jet - 1 ct
1744 $3900
Water Jet Replacement Tips - 5 ct
1743 $1800
Diabetic Foot Care Diabetic SocksBlack Medium 3-packBlack Large 3-packBlack X-Large 3-pack
195619571958
$900 $900 $900
Diabetic Socks White Medium 3-packWhite Large 3-packWhite X-Large 3-pack
195319541955
$900 $900 $900
Ultra Soft Padded Diabetic SockBlack Medium 2-packBlack Large 2-packBlack X-Large 2-pack
195919601961
$1100 $1100 $1100
Ultra Soft Padded Diabetic SockWhite Medium 2-packWhite Large 2-packWhite X-Large 2-pack
196219631964
$1100 $1100 $1100
Ear Care Cotton Tipped Swabs - 300 ct
1742 $600
Ear Pain Relief Ear Drops - Compare to Hylandrsquos Ear Reliefreg
- 10 ml
1841 $1300
Ear Wax Removal Drops - Compare to Debroxreg
- 15 ml65
1190 $500
Ear Wax Removal System with Rubber Bulb - Compare to Debroxreg
- 15 ml65
1363 $700
Eye Care Artificial Tears Drops - Compare to Visine Tearsreg
- 5 oz
1192 $600
Artificial Tears Ointment - Compare to Refresh PMreg
- 35 gm
1194 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
11
Category Description Item PriceEye Care(Continued)
Eye Wash Solution - Compare to Bausch and Lombreg
- 4 oz
1196 $800
Multi-Purpose Contact Lens Solution - Compare to Renu Multipurpose Solutionreg
- 4 oz
1468 $600
Redness Relief Eye Drops - Compare to Visine Original Redness Reliefreg
- 15 ml005
1061 $500
First Aid and Medical Supplies
Adhesive Bandages - Compare to Band-Aid Plastic Stripsreg
- 60 ct
1344 $600
After Bite Reliefreg
- 5 oz1803 $900
Alcohol Pads - 100 ct70
1200 $600
Antiseptic Towelettes - 100 ct
1201 $700
Bacitracin Ointment - 1 oz500 Ugm
1020 $600
Cotton Balls - 200 ct
1763 $600
CPAP Pillow Fiber Filled - 1 ct
1836 $6000
CPAP Pillow Memory Foam - 1 ct
1837 $10000
Elastic Bandage (Compare to Acereg)
2rdquo x 45 yd - 1 ct
3rdquo x 5 yd - 1 ct
4rdquo x 5 yd - 1 ct
6rdquo x 5 yd - 1 ct
1207
1209
1211
1213
$400
$400
$500
$500
Fast Freeze Pain Relief Spray - Compare to Biofreeze Pain Relief Sprayreg
- 4 oz
1846 $1400
First Aid Kit 20 Pieces - 1 ct
1947 $700
First Aid Kit 75 Pieces - 1 ct
1215 $1000
First Aid Kit 175 Pieces - 1 ct
1738 $1700
HotCold Pack 1 small and 1 large - 1 ct
1062 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Humidifier Ultra-Sonic Cool Mist - Compare to Vicks Ultrasonic Humidifierreg
- 1 ct
1795 $6000
Hydrogen Peroxide - 16 oz3
1228 $500
Ice Bag - 1 ct
1761 $900
Insect Repellant Spray - Deet - 4 oz30
1796 $1200
Isopropyl Alcohol Wintergreen - 16 oz70
1229 $600
Liquid Bandage - 45 oz
1872 $850
Neosporin Plusreg
- 5 oz1326 $1100
Nitrile Exam Gloves - 100 ct
1840 $1200
Pill Crusher with Storage - 1 ct
1933 $1000
Pill Cutter with Safety Shield - 1 ct
1932 $1000
Povidone Iodine Solution Antiseptic - 4 oz
1203 $800
Procedural Face Masks with Earloops - 50 ct
1896 $1400
Tape Paper Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1217
1218
$600
$600
Tape Silk Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1219
1220
$600
$700
Tape Transparent Surgical(Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1221
1222
$600
$600
Thermometer Digital 60 seconds - 1 ct
1063 $500
Thermometer Digital Ear - 1 ct
1285 $2400
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
13
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Thermometer Flexible Tip Digital 10 seconds - 1 ct
1697 $1000
Thermometer Talking Ear and Forehead - 1 ct
1925 $4500
Triple Antibiotic Ointment - Compare to Neosporinreg
- 1 oz
1014 $700
Foot Care Callus Remover Pads - Compare to Dr Schollrsquosreg
- 6 ct
1238 $700
Corn Remover Pads - Compare to Dr Schollrsquosreg
- 9 ct
1236 $700
Medicated Foot Powder - 5 oz
1240 $700
Hemorrhoidal Preparations
Hemorrhoidal Ointment - Compare to Preparation Hreg
- 2 oz
1066 $700
Hemorrhoidal Suppository - 12 ct
1247 $700
Pre-moist Hemorrhoid Pads - Compare to Tucksreg
- 100 ct
1364 $800
Preparation Hreg Medicated Wipes - 48 ct
1895 $1300
Hormone Replacement DHEADagger
- 50 ct50 mg1737 $1200
Incontinence Supplies A and D Ointment - Compare to AandD Ointmentreg
- 2 oz
1300 $800
Adult Briefs(Compare to Dependreg)
Medium - 32rdquo to 44rdquo - 12 ct
Large - 45rdquo to 58rdquo - 12 ct
X-Large - 59rdquo to 64rdquo - Compare to Dependreg
- 15 ct
1303
1304
1305
$1000
$1200
$1200
Menrsquos Attends Discreet (Compare to Dependreg)
Guard - 20 ct
Shield - 20 ct
1811
1810
$1600
$1500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Category Description Item PriceIncontinence Supplies (Continued)
Womenrsquos Attends Discreet(Compare to Dependreg)
Moderate Bladder Control Pad - 20 ct
Maximum Bladder Control Pad - 20 ct
Ultimate Bladder Control Pad - 20 ct
Ultrathin Pad - 20 ct
Panty Liner - 28 ct
1813
1812
1814
1816
1815
$1800
$2000
$2000
$1400
$1400
Barrier Cream - Compare to Lantiseptic Barrier Creamreg
- 4 oz
1302 $1000
Bladder Control Shaped Pad(Compare to Dependreg)
Moderate Absorbency - 24 ct
Heavy Absorbency - 24 ct
Maximum Absorbency - 18 ct
1478
1479
1480
$1700
$1900
$1600
Disposable Underwear(Compare to Dependreg)
Medium - 34rdquo to 44rdquo - 20 ct
Large - 44rdquo to 58rdquo - 18 ct
X-Large - 58rdquo to 68rdquo - 14 ct
1021
1026
1027
$1600
$1600
$1600
Flushable Wipes - 24 ct
1928 $750
Underpad Disposable(Compare to Dependreg)
23rdquo x 24rdquo - 50 ct
23rdquo x 36rdquo - 25 ct
30rdquo x 30rdquo - 10 ct
1476
1299
1477
$1500
$1000
$800
Washcloth with Lanolin - 64 ct
1348 $900
In-home Diagnostic Equipment
Bathroom ScaleDaggersect
- 1 ct1935 $3500
Blood Pressure Monitor (1 ct)Desktop AutomaticDagger
Desktop TalkingDagger
Replacement CuffDagger
WristDagger
Wrist TalkingDagger
12531503150415011502
$6000 $7000 $1500 $4000 $5000
your doctor before starting a new product regime
OTC MTalk with
EDICATIONS AND PRODUCTS
15
Category Description Item PriceIn-home Diagnostic Equipment (Continued)
Finger Pulse OximeterDagger
- 1 ct1505 $5200
Heart Rate Monitor WatchDagger
- 1 ct1771 $4000
In-home Diagnostic Tests
EZ Detect Colon Cancer Test KitDagger
- 1 ct1416 $1300
Home Access Cholesterol TestDagger
- 1 kit1251 $3300
Lice Treatment (Pediculicide)
Lice Elimination Kit - Compare to RIDreg
- 1 kit
1929 $2700
Lice Treatment Shampoo - Compare to RIDreg
- 4 oz
1271 $900
Permethrin Lice Treatment - Compare to Nixreg
- 59 ml1
1269 $1400
Mobility Cushion Foam Ring - 1 ct
1732 $2100
Cushion GelFoam Seat - 1 ct
1466 $4200
Cushion Lumbar - 1 ct
1731 $2700
Folding Cane Ergonomic Handle - 1 ct
1726 $2000
Quad Cane (1 ct) Small BaseLarge Base
17771776
$2500 $3000
Motion Sickness Dramamine Chewablesreg Orange - 8 ct50 mg
1264 $700
Driminate Antiemetic - Compare to Dramaminereg
- 12 ct50 mg
1263 $500
Meclizine HCL Antiemetic - 100 ct125 mg
1366 $800
Pain Relievers and Fever Reducers
AcetaminophenCompare to Tylenolreg
- 100 ct325 mg
1001
$600
Compare to Tylenol Extra Strengthreg
- 100 ct500 mg1600 $1000
Arthritis Pain Reliever - Compare to Tylenol Arthritisreg
- 100 ct650 mg
1311 $1200
Aspirin - Compare to Bayerreg
- 100 ct325 mg
1095 $500
Aspirin Enteric Coated - Compare to Bayerreg
- 100 ct325 mg
1096 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
- Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
- Compare to Capzasinreg
- 2 oz0025
1367 $1000
- 1 ct1943 $5500
(Compare to ThermaCarereg)Back and Hip
- 2 ctNeck Shoulder and Wrist
- 3 ct
1859
1860
$1300
$1300
- Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
- Compare to Alevereg
- 100 ct220 mg
1097 $1100
- Compare to Bengayreg
- 2 oz25
1475 $600
Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Pain Relievers and Fever Reducers (Continued)
Category Description Item Price
Aspirin Low Dose Chewables - Compare to Bayer Aspirin Chewable Low Dosereg
- 36 ct81 mg
1802 $500
ColdHot Menthol Medicated Patch- Compare to IcyHotreg
- 5 ct5
1944 $1000
Heating Pad 12rdquo x 15rdquo- 1 ct
1861 $2600
Ibuprofen - Compare to Advilreg
- 100 ct200 mg
1004 $700
Migraine Relief- Compare to Excedrinreg
- 100 ct250 mg 250 mg 65 mg
1365 $700
Pain Reliever PM - Extra Strength - Compare to Tylenol PMreg
- 100 ct
1332 $1000
Salonpas Pain Relief Patchesreg
- 5 ct 1739 $1400
XL Heating Pad 12rdquo x 24rdquo- 1 ct
1942 $3500
16
HeatWraps(Compare to ThermaCarereg)
Back and Hip - 2 ct
Neck Shoulder and Wrist - 3 ct
1859
1860
$1300
$1300
ThermaCarereg Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Naproxen - Compare to Alevereg
- 100 ct220 mg
1097 $1100
Lidocaine Patch - Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
Capsaicin External Analgesic - Compare to Capzasinreg
- 2 oz0025
1367 $1000
Aspirin Enteric Coated Low Dose - Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
Heating Pad Wrap for Shoulder Neck and Back 25rdquo x 26rdquo - 1 ct
1943 $5500
Pain Relieving Muscle Rub - Compare to Bengayreg
- 2 oz25
1475 $600
17
Category Description Item PricePersonal Care Acne Gel 10 Benzoyl Peroxide
- Compare to Persa-Gelreg - 15 oz10
1076 $700
Ammonium Lactate Moisturizing Lotion - Compare to AmLactinreg
- 8 oz12
1368 $900
Hand Sanitizer - Compare to Purellreg - 8 oz
1065 $500
Skin and Sun Care Aloe Vera Cream - 8 oz
1070 $600
Calamine Lotion - 6 oz
1821 $600
Moisturizing Body Lotion with Aloe - 8 oz
1893 $800
Scar Gel - 50 gm
1852 $1200
Sunscreen Lotion SPF 30 - 35 oz
1284 $600
Sleep Aids Nasal Strips (Compare to Breathe Rightreg)
Medium - 30 ct
Large - 30 ct
1724
1725
$1200
$1200
Sleep Tablets - Compare to Sominexreg
- 50 ct25 mg
1276 $600
Smoking Cessation Nicorelief GumDagger
- Compare to Nicorettereg
- 50 ct4 mg
1372 $2500
Nicotine LozengesDagger
- Compare to Nicorettereg
- 72 ct4 mg
1281 $4400
Nicotine PatchStep 1Dagger
- Compare to NicoDerm CQ Step 1reg
- 14 ct21 mg 24 hrStep 2Dagger
- Compare to NicoDerm CQ Step 2reg
- 14 ct14 mg 24 hrStep 3Dagger
- Compare to NicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
1369
1370
1371
$4500
$4500
$4500
Supportive Items Ankle Support - Compare to Acereg
- 1 ct
1225 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
- Compare to Zantacreg
- 30 ct75 mg
1900 $800
- Compare to Monistat 7reg
- 45 gm1
1115 $800
- Compare to Monistat 1reg
- 1 ct65
1119 $2000
- Compare to Pepto-Bismol Chewablereg
- 30 ct262 mg
1045 $600
- Compare to Colacereg
- 100 ct100 mg
1126 $600
- Compare to Lactaidreg
- 60 ct9000 FCC units
1067 $1000
- Compare to Citrucelreg - 16 oz
1354 $1200
- Compare to Metamucilreg - 13 oz
1340 $1000
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Category Description Item Price Antacids and Acid Reducers (Continued)
Omeprazole Acid Reducer Delayed Release Dissolvable - Compare to Prilosecreg
- 42 ct20 mg
1966 $2600
Simethicone Anti-Gas Chewables - Compare to Gas-X Chewablesreg
- 100 ct80 mg
1800 $1000
Anticandidal (yeast)
Miconazole 3-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 3reg
- 1 kit2
1117 $1400
Bisacodyl Enteric Coated Laxative- Compare to Dulcolaxreg
- 100 ct5 mg
1128 $600
ClearLax Unflavored Powder - Compare to MiraLAXreg
- 83 oz17 g
1969 $1350
Glycerin Suppository - Compare to Fleetreg
- 25 ct2 gm
1125 $500
Milk of Magnesia- Compare to Phillipsreg
- 12 oz400 mg
1011 $600
Natural Vegetable Laxative
7
Natural Vegetable Laxative - Compare to Metamucilreg - 13 oz
1340 $1000
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Loperamide HCL Anti-Diarrheal - Compare to Imodium A-Dreg
- 12 ct2 mg
1133 $500
Methylcellulose Fiber Therapy - Compare to Citrucelreg - 16 oz
1354 $1200
Lactase Capsules - Compare to Lactaidreg
- 60 ct9000 FCC units
1067 $1000
Docusate Sodium Stool Softener - Compare to Colacereg
- 100 ct100 mg
1126 $600
Bismatrol Chewable Tablets - Compare to Pepto-Bismol Chewablereg
- 30 ct262 mg
1045 $600
Tioconazole 1-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 1reg
- 1 ct65
1119 $2000
Anti-diarrheal Laxatives and Digestive Health
Clotrimazole 7-Day Treatment Vaginal Cream (with applicator) - Compare to Monistat 7reg
- 45 gm1
1115 $800
Ranitidine Acid Reducer - Compare to Zantacreg
- 30 ct75 mg
1900 $800
- Compare to Metamucilreg
- 304 oz
1967 $1600
- Compare to Pepto-Bismolreg - 8 oz525 mg 30 ml
1318 $600
- Compare to Senokot-Sreg
- 60 ct86 mg 50 mg
1130 $600
- Compare to Lotrimin AFreg
- 15 oz1
1047 $600
- Compare to Cortaidreg
- 1 oz1
1074 $600
- Compare to Micatinreg
- 1 oz2
1135 $800
- Compare to Tinactinreg
- 125 oz1
1064 $500
- 1 ct1728 $6500
- 1 ct1459 $1700
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item Price Anti-diarrheal Laxatives and Digestive Health (Continued)
Natural Vegetable Laxative Sugar free - Compare to Metamucil Sugar Freereg
- 15 oz
1968 $1300
Polycarbophil Fiber Tablets - Compare to FiberConreg
- 90 ct625 mg
1012 $1000
Caldyphen Clear Lotionreg Local Analgesic - 6 oz1
1144 $900
Diphenhydramine HCLZinc Acetate Anti-Itch Cream - Compare to Benadryl Creamreg
- 1 oz
1140 $500
Medicated Antifungal Foot Powder Spray - Compare to Lotrimin AFreg
- 46 oz
1874 $1000
Terbinafine HCL Antifungal Cream - Compare to Lamisil ATreg
- 5 oz1
1046 $1200
Adjustable Transfer Bench- 1 ct
1764 $8000
Bath Bench without Back - 1 ct
1727 $5500
Bath Mat Non-Skid
8
Bath Mat Non-Skid - 1 ct
1459 $1700
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Natural Vegetable Laxative - Compare to Metamucilreg - 304 oz
1967 $1600
Pink Bismuth - Compare to Pepto-Bismolreg - 8 oz525 mg 30 ml
1318 $600
1130 $600
Anti-fungal and Anti-itch
Senna Plus Stool Softener Plus Laxative - Compare to Senokot-Sreg
- 60 ct86 m
Clotrimazole Antifungal Athletersquos Foot Cream - Compare to Lotrimin AFreg
- 15 oz1
1047 $600
Hydrocortisone 1 Cream - Compare to Cortaidreg
- 1 oz1
1074 $600
Bath Bench with Back - 1 ct
1728 $6500
Tolnaftate Antifungal Cream - Compare to Tinactinreg
- 125 oz1
1064 $500
Bathroom Safety
Miconazole Nitrate 2 Antifungal Cream - Compare to Micatinreg
- 1 oz2
1135 $800
9
Category Description Item PriceBathroom Safety (Continued)
Bath Tub Safety Rail - 1 ct
1730 $3700
Raised Toilet Seat - 1 ct
1729 $3500
Raised Toilet Seat with Arms - 1 ct
1950 $6500
Shower Mat Non-Skid - 1 ct
1460 $1400
Toilet Safety Rails - 1 set
1779 $5000
Cold Sore and Medicated Lip Products
Abrevareg
- 2 gm101152 $2600
Carmexreg
- 75 gm1255 $400
Herpecin-Lreg Lip Balm - 1 oz1
1153 $800
Releevreg Cold Sore Treatment - 6 ml013
1359 $2500
Dental and Denture Care Biotenereg Dry Mouth Oral Rinse - 16 oz
1817 $1400
Denture Brush - Compare to G-U-Mreg
- 1 ct
1747 $650
Denture Cleaning Tablets - Compare to Polidentreg
- 40 ct
1032 $700
Efferdent Plusreg Mint Tablets - 36 ct
1653 $800
Effergripreg Denture Cream Adhesive - 25 oz
1843 $900
Fixodentreg
- 75 oz1187 $700
Interdental Flossups - Compare to G-U-Mreg
- 90 ct
1751 $700
Orajelreg Pain Relief - 7 gm20
1454 $1100
Oral Pain Relief - Compare to Orajelreg - 5 oz20
1286 $600
Polidentreg Denture Cream - 39 oz
1324 $800
Polidentreg Overnight - 84 ct
1892 $1250
Reachreg Waxed Dental Floss - Mint - 55 yd
1455 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
10
Category Description Item PriceDental and Denture Care (Continued)
ToothbrushColgatereg Adult Soft
- 1 ctRechargeable
- 1 ctSoft 2-pack
- 2-packTek Pro Angled Soft
- 1 ct
1413
1450
1948
1412
$300
$4000
$600
$300
Toothpaste Crest Sensi-Reliefreg
- 41 oz1838 $950
Toothpaste Pepsodentreg
- 55 oz1414 $500
Water Jet - 1 ct
1744 $3900
Water Jet Replacement Tips - 5 ct
1743 $1800
Diabetic Foot Care Diabetic SocksBlack Medium 3-packBlack Large 3-packBlack X-Large 3-pack
195619571958
$900 $900 $900
Diabetic Socks White Medium 3-packWhite Large 3-packWhite X-Large 3-pack
195319541955
$900 $900 $900
Ultra Soft Padded Diabetic SockBlack Medium 2-packBlack Large 2-packBlack X-Large 2-pack
195919601961
$1100 $1100 $1100
Ultra Soft Padded Diabetic SockWhite Medium 2-packWhite Large 2-packWhite X-Large 2-pack
196219631964
$1100 $1100 $1100
Ear Care Cotton Tipped Swabs - 300 ct
1742 $600
Ear Pain Relief Ear Drops - Compare to Hylandrsquos Ear Reliefreg
- 10 ml
1841 $1300
Ear Wax Removal Drops - Compare to Debroxreg
- 15 ml65
1190 $500
Ear Wax Removal System with Rubber Bulb - Compare to Debroxreg
- 15 ml65
1363 $700
Eye Care Artificial Tears Drops - Compare to Visine Tearsreg
- 5 oz
1192 $600
Artificial Tears Ointment - Compare to Refresh PMreg
- 35 gm
1194 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
11
Category Description Item PriceEye Care(Continued)
Eye Wash Solution - Compare to Bausch and Lombreg
- 4 oz
1196 $800
Multi-Purpose Contact Lens Solution - Compare to Renu Multipurpose Solutionreg
- 4 oz
1468 $600
Redness Relief Eye Drops - Compare to Visine Original Redness Reliefreg
- 15 ml005
1061 $500
First Aid and Medical Supplies
Adhesive Bandages - Compare to Band-Aid Plastic Stripsreg
- 60 ct
1344 $600
After Bite Reliefreg
- 5 oz1803 $900
Alcohol Pads - 100 ct70
1200 $600
Antiseptic Towelettes - 100 ct
1201 $700
Bacitracin Ointment - 1 oz500 Ugm
1020 $600
Cotton Balls - 200 ct
1763 $600
CPAP Pillow Fiber Filled - 1 ct
1836 $6000
CPAP Pillow Memory Foam - 1 ct
1837 $10000
Elastic Bandage (Compare to Acereg)
2rdquo x 45 yd - 1 ct
3rdquo x 5 yd - 1 ct
4rdquo x 5 yd - 1 ct
6rdquo x 5 yd - 1 ct
1207
1209
1211
1213
$400
$400
$500
$500
Fast Freeze Pain Relief Spray - Compare to Biofreeze Pain Relief Sprayreg
- 4 oz
1846 $1400
First Aid Kit 20 Pieces - 1 ct
1947 $700
First Aid Kit 75 Pieces - 1 ct
1215 $1000
First Aid Kit 175 Pieces - 1 ct
1738 $1700
HotCold Pack 1 small and 1 large - 1 ct
1062 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Humidifier Ultra-Sonic Cool Mist - Compare to Vicks Ultrasonic Humidifierreg
- 1 ct
1795 $6000
Hydrogen Peroxide - 16 oz3
1228 $500
Ice Bag - 1 ct
1761 $900
Insect Repellant Spray - Deet - 4 oz30
1796 $1200
Isopropyl Alcohol Wintergreen - 16 oz70
1229 $600
Liquid Bandage - 45 oz
1872 $850
Neosporin Plusreg
- 5 oz1326 $1100
Nitrile Exam Gloves - 100 ct
1840 $1200
Pill Crusher with Storage - 1 ct
1933 $1000
Pill Cutter with Safety Shield - 1 ct
1932 $1000
Povidone Iodine Solution Antiseptic - 4 oz
1203 $800
Procedural Face Masks with Earloops - 50 ct
1896 $1400
Tape Paper Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1217
1218
$600
$600
Tape Silk Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1219
1220
$600
$700
Tape Transparent Surgical(Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1221
1222
$600
$600
Thermometer Digital 60 seconds - 1 ct
1063 $500
Thermometer Digital Ear - 1 ct
1285 $2400
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
13
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Thermometer Flexible Tip Digital 10 seconds - 1 ct
1697 $1000
Thermometer Talking Ear and Forehead - 1 ct
1925 $4500
Triple Antibiotic Ointment - Compare to Neosporinreg
- 1 oz
1014 $700
Foot Care Callus Remover Pads - Compare to Dr Schollrsquosreg
- 6 ct
1238 $700
Corn Remover Pads - Compare to Dr Schollrsquosreg
- 9 ct
1236 $700
Medicated Foot Powder - 5 oz
1240 $700
Hemorrhoidal Preparations
Hemorrhoidal Ointment - Compare to Preparation Hreg
- 2 oz
1066 $700
Hemorrhoidal Suppository - 12 ct
1247 $700
Pre-moist Hemorrhoid Pads - Compare to Tucksreg
- 100 ct
1364 $800
Preparation Hreg Medicated Wipes - 48 ct
1895 $1300
Hormone Replacement DHEADagger
- 50 ct50 mg1737 $1200
Incontinence Supplies A and D Ointment - Compare to AandD Ointmentreg
- 2 oz
1300 $800
Adult Briefs(Compare to Dependreg)
Medium - 32rdquo to 44rdquo - 12 ct
Large - 45rdquo to 58rdquo - 12 ct
X-Large - 59rdquo to 64rdquo - Compare to Dependreg
- 15 ct
1303
1304
1305
$1000
$1200
$1200
Menrsquos Attends Discreet (Compare to Dependreg)
Guard - 20 ct
Shield - 20 ct
1811
1810
$1600
$1500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Category Description Item PriceIncontinence Supplies (Continued)
Womenrsquos Attends Discreet(Compare to Dependreg)
Moderate Bladder Control Pad - 20 ct
Maximum Bladder Control Pad - 20 ct
Ultimate Bladder Control Pad - 20 ct
Ultrathin Pad - 20 ct
Panty Liner - 28 ct
1813
1812
1814
1816
1815
$1800
$2000
$2000
$1400
$1400
Barrier Cream - Compare to Lantiseptic Barrier Creamreg
- 4 oz
1302 $1000
Bladder Control Shaped Pad(Compare to Dependreg)
Moderate Absorbency - 24 ct
Heavy Absorbency - 24 ct
Maximum Absorbency - 18 ct
1478
1479
1480
$1700
$1900
$1600
Disposable Underwear(Compare to Dependreg)
Medium - 34rdquo to 44rdquo - 20 ct
Large - 44rdquo to 58rdquo - 18 ct
X-Large - 58rdquo to 68rdquo - 14 ct
1021
1026
1027
$1600
$1600
$1600
Flushable Wipes - 24 ct
1928 $750
Underpad Disposable(Compare to Dependreg)
23rdquo x 24rdquo - 50 ct
23rdquo x 36rdquo - 25 ct
30rdquo x 30rdquo - 10 ct
1476
1299
1477
$1500
$1000
$800
Washcloth with Lanolin - 64 ct
1348 $900
In-home Diagnostic Equipment
Bathroom ScaleDaggersect
- 1 ct1935 $3500
Blood Pressure Monitor (1 ct)Desktop AutomaticDagger
Desktop TalkingDagger
Replacement CuffDagger
WristDagger
Wrist TalkingDagger
12531503150415011502
$6000 $7000 $1500 $4000 $5000
your doctor before starting a new product regime
OTC MTalk with
EDICATIONS AND PRODUCTS
15
Category Description Item PriceIn-home Diagnostic Equipment (Continued)
Finger Pulse OximeterDagger
- 1 ct1505 $5200
Heart Rate Monitor WatchDagger
- 1 ct1771 $4000
In-home Diagnostic Tests
EZ Detect Colon Cancer Test KitDagger
- 1 ct1416 $1300
Home Access Cholesterol TestDagger
- 1 kit1251 $3300
Lice Treatment (Pediculicide)
Lice Elimination Kit - Compare to RIDreg
- 1 kit
1929 $2700
Lice Treatment Shampoo - Compare to RIDreg
- 4 oz
1271 $900
Permethrin Lice Treatment - Compare to Nixreg
- 59 ml1
1269 $1400
Mobility Cushion Foam Ring - 1 ct
1732 $2100
Cushion GelFoam Seat - 1 ct
1466 $4200
Cushion Lumbar - 1 ct
1731 $2700
Folding Cane Ergonomic Handle - 1 ct
1726 $2000
Quad Cane (1 ct) Small BaseLarge Base
17771776
$2500 $3000
Motion Sickness Dramamine Chewablesreg Orange - 8 ct50 mg
1264 $700
Driminate Antiemetic - Compare to Dramaminereg
- 12 ct50 mg
1263 $500
Meclizine HCL Antiemetic - 100 ct125 mg
1366 $800
Pain Relievers and Fever Reducers
AcetaminophenCompare to Tylenolreg
- 100 ct325 mg
1001
$600
Compare to Tylenol Extra Strengthreg
- 100 ct500 mg1600 $1000
Arthritis Pain Reliever - Compare to Tylenol Arthritisreg
- 100 ct650 mg
1311 $1200
Aspirin - Compare to Bayerreg
- 100 ct325 mg
1095 $500
Aspirin Enteric Coated - Compare to Bayerreg
- 100 ct325 mg
1096 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
- Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
- Compare to Capzasinreg
- 2 oz0025
1367 $1000
- 1 ct1943 $5500
(Compare to ThermaCarereg)Back and Hip
- 2 ctNeck Shoulder and Wrist
- 3 ct
1859
1860
$1300
$1300
- Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
- Compare to Alevereg
- 100 ct220 mg
1097 $1100
- Compare to Bengayreg
- 2 oz25
1475 $600
Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Pain Relievers and Fever Reducers (Continued)
Category Description Item Price
Aspirin Low Dose Chewables - Compare to Bayer Aspirin Chewable Low Dosereg
- 36 ct81 mg
1802 $500
ColdHot Menthol Medicated Patch- Compare to IcyHotreg
- 5 ct5
1944 $1000
Heating Pad 12rdquo x 15rdquo- 1 ct
1861 $2600
Ibuprofen - Compare to Advilreg
- 100 ct200 mg
1004 $700
Migraine Relief- Compare to Excedrinreg
- 100 ct250 mg 250 mg 65 mg
1365 $700
Pain Reliever PM - Extra Strength - Compare to Tylenol PMreg
- 100 ct
1332 $1000
Salonpas Pain Relief Patchesreg
- 5 ct 1739 $1400
XL Heating Pad 12rdquo x 24rdquo- 1 ct
1942 $3500
16
HeatWraps(Compare to ThermaCarereg)
Back and Hip - 2 ct
Neck Shoulder and Wrist - 3 ct
1859
1860
$1300
$1300
ThermaCarereg Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Naproxen - Compare to Alevereg
- 100 ct220 mg
1097 $1100
Lidocaine Patch - Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
Capsaicin External Analgesic - Compare to Capzasinreg
- 2 oz0025
1367 $1000
Aspirin Enteric Coated Low Dose - Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
Heating Pad Wrap for Shoulder Neck and Back 25rdquo x 26rdquo - 1 ct
1943 $5500
Pain Relieving Muscle Rub - Compare to Bengayreg
- 2 oz25
1475 $600
17
Category Description Item PricePersonal Care Acne Gel 10 Benzoyl Peroxide
- Compare to Persa-Gelreg - 15 oz10
1076 $700
Ammonium Lactate Moisturizing Lotion - Compare to AmLactinreg
- 8 oz12
1368 $900
Hand Sanitizer - Compare to Purellreg - 8 oz
1065 $500
Skin and Sun Care Aloe Vera Cream - 8 oz
1070 $600
Calamine Lotion - 6 oz
1821 $600
Moisturizing Body Lotion with Aloe - 8 oz
1893 $800
Scar Gel - 50 gm
1852 $1200
Sunscreen Lotion SPF 30 - 35 oz
1284 $600
Sleep Aids Nasal Strips (Compare to Breathe Rightreg)
Medium - 30 ct
Large - 30 ct
1724
1725
$1200
$1200
Sleep Tablets - Compare to Sominexreg
- 50 ct25 mg
1276 $600
Smoking Cessation Nicorelief GumDagger
- Compare to Nicorettereg
- 50 ct4 mg
1372 $2500
Nicotine LozengesDagger
- Compare to Nicorettereg
- 72 ct4 mg
1281 $4400
Nicotine PatchStep 1Dagger
- Compare to NicoDerm CQ Step 1reg
- 14 ct21 mg 24 hrStep 2Dagger
- Compare to NicoDerm CQ Step 2reg
- 14 ct14 mg 24 hrStep 3Dagger
- Compare to NicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
1369
1370
1371
$4500
$4500
$4500
Supportive Items Ankle Support - Compare to Acereg
- 1 ct
1225 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
- Compare to Metamucilreg
- 304 oz
1967 $1600
- Compare to Pepto-Bismolreg - 8 oz525 mg 30 ml
1318 $600
- Compare to Senokot-Sreg
- 60 ct86 mg 50 mg
1130 $600
- Compare to Lotrimin AFreg
- 15 oz1
1047 $600
- Compare to Cortaidreg
- 1 oz1
1074 $600
- Compare to Micatinreg
- 1 oz2
1135 $800
- Compare to Tinactinreg
- 125 oz1
1064 $500
- 1 ct1728 $6500
- 1 ct1459 $1700
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Category Description Item Price Anti-diarrheal Laxatives and Digestive Health (Continued)
Natural Vegetable Laxative Sugar free - Compare to Metamucil Sugar Freereg
- 15 oz
1968 $1300
Polycarbophil Fiber Tablets - Compare to FiberConreg
- 90 ct625 mg
1012 $1000
Caldyphen Clear Lotionreg Local Analgesic - 6 oz1
1144 $900
Diphenhydramine HCLZinc Acetate Anti-Itch Cream - Compare to Benadryl Creamreg
- 1 oz
1140 $500
Medicated Antifungal Foot Powder Spray - Compare to Lotrimin AFreg
- 46 oz
1874 $1000
Terbinafine HCL Antifungal Cream - Compare to Lamisil ATreg
- 5 oz1
1046 $1200
Adjustable Transfer Bench- 1 ct
1764 $8000
Bath Bench without Back - 1 ct
1727 $5500
Bath Mat Non-Skid
8
Bath Mat Non-Skid - 1 ct
1459 $1700
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Natural Vegetable Laxative - Compare to Metamucilreg - 304 oz
1967 $1600
Pink Bismuth - Compare to Pepto-Bismolreg - 8 oz525 mg 30 ml
1318 $600
1130 $600
Anti-fungal and Anti-itch
Senna Plus Stool Softener Plus Laxative - Compare to Senokot-Sreg
- 60 ct86 m
Clotrimazole Antifungal Athletersquos Foot Cream - Compare to Lotrimin AFreg
- 15 oz1
1047 $600
Hydrocortisone 1 Cream - Compare to Cortaidreg
- 1 oz1
1074 $600
Bath Bench with Back - 1 ct
1728 $6500
Tolnaftate Antifungal Cream - Compare to Tinactinreg
- 125 oz1
1064 $500
Bathroom Safety
Miconazole Nitrate 2 Antifungal Cream - Compare to Micatinreg
- 1 oz2
1135 $800
9
Category Description Item PriceBathroom Safety (Continued)
Bath Tub Safety Rail - 1 ct
1730 $3700
Raised Toilet Seat - 1 ct
1729 $3500
Raised Toilet Seat with Arms - 1 ct
1950 $6500
Shower Mat Non-Skid - 1 ct
1460 $1400
Toilet Safety Rails - 1 set
1779 $5000
Cold Sore and Medicated Lip Products
Abrevareg
- 2 gm101152 $2600
Carmexreg
- 75 gm1255 $400
Herpecin-Lreg Lip Balm - 1 oz1
1153 $800
Releevreg Cold Sore Treatment - 6 ml013
1359 $2500
Dental and Denture Care Biotenereg Dry Mouth Oral Rinse - 16 oz
1817 $1400
Denture Brush - Compare to G-U-Mreg
- 1 ct
1747 $650
Denture Cleaning Tablets - Compare to Polidentreg
- 40 ct
1032 $700
Efferdent Plusreg Mint Tablets - 36 ct
1653 $800
Effergripreg Denture Cream Adhesive - 25 oz
1843 $900
Fixodentreg
- 75 oz1187 $700
Interdental Flossups - Compare to G-U-Mreg
- 90 ct
1751 $700
Orajelreg Pain Relief - 7 gm20
1454 $1100
Oral Pain Relief - Compare to Orajelreg - 5 oz20
1286 $600
Polidentreg Denture Cream - 39 oz
1324 $800
Polidentreg Overnight - 84 ct
1892 $1250
Reachreg Waxed Dental Floss - Mint - 55 yd
1455 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
10
Category Description Item PriceDental and Denture Care (Continued)
ToothbrushColgatereg Adult Soft
- 1 ctRechargeable
- 1 ctSoft 2-pack
- 2-packTek Pro Angled Soft
- 1 ct
1413
1450
1948
1412
$300
$4000
$600
$300
Toothpaste Crest Sensi-Reliefreg
- 41 oz1838 $950
Toothpaste Pepsodentreg
- 55 oz1414 $500
Water Jet - 1 ct
1744 $3900
Water Jet Replacement Tips - 5 ct
1743 $1800
Diabetic Foot Care Diabetic SocksBlack Medium 3-packBlack Large 3-packBlack X-Large 3-pack
195619571958
$900 $900 $900
Diabetic Socks White Medium 3-packWhite Large 3-packWhite X-Large 3-pack
195319541955
$900 $900 $900
Ultra Soft Padded Diabetic SockBlack Medium 2-packBlack Large 2-packBlack X-Large 2-pack
195919601961
$1100 $1100 $1100
Ultra Soft Padded Diabetic SockWhite Medium 2-packWhite Large 2-packWhite X-Large 2-pack
196219631964
$1100 $1100 $1100
Ear Care Cotton Tipped Swabs - 300 ct
1742 $600
Ear Pain Relief Ear Drops - Compare to Hylandrsquos Ear Reliefreg
- 10 ml
1841 $1300
Ear Wax Removal Drops - Compare to Debroxreg
- 15 ml65
1190 $500
Ear Wax Removal System with Rubber Bulb - Compare to Debroxreg
- 15 ml65
1363 $700
Eye Care Artificial Tears Drops - Compare to Visine Tearsreg
- 5 oz
1192 $600
Artificial Tears Ointment - Compare to Refresh PMreg
- 35 gm
1194 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
11
Category Description Item PriceEye Care(Continued)
Eye Wash Solution - Compare to Bausch and Lombreg
- 4 oz
1196 $800
Multi-Purpose Contact Lens Solution - Compare to Renu Multipurpose Solutionreg
- 4 oz
1468 $600
Redness Relief Eye Drops - Compare to Visine Original Redness Reliefreg
- 15 ml005
1061 $500
First Aid and Medical Supplies
Adhesive Bandages - Compare to Band-Aid Plastic Stripsreg
- 60 ct
1344 $600
After Bite Reliefreg
- 5 oz1803 $900
Alcohol Pads - 100 ct70
1200 $600
Antiseptic Towelettes - 100 ct
1201 $700
Bacitracin Ointment - 1 oz500 Ugm
1020 $600
Cotton Balls - 200 ct
1763 $600
CPAP Pillow Fiber Filled - 1 ct
1836 $6000
CPAP Pillow Memory Foam - 1 ct
1837 $10000
Elastic Bandage (Compare to Acereg)
2rdquo x 45 yd - 1 ct
3rdquo x 5 yd - 1 ct
4rdquo x 5 yd - 1 ct
6rdquo x 5 yd - 1 ct
1207
1209
1211
1213
$400
$400
$500
$500
Fast Freeze Pain Relief Spray - Compare to Biofreeze Pain Relief Sprayreg
- 4 oz
1846 $1400
First Aid Kit 20 Pieces - 1 ct
1947 $700
First Aid Kit 75 Pieces - 1 ct
1215 $1000
First Aid Kit 175 Pieces - 1 ct
1738 $1700
HotCold Pack 1 small and 1 large - 1 ct
1062 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Humidifier Ultra-Sonic Cool Mist - Compare to Vicks Ultrasonic Humidifierreg
- 1 ct
1795 $6000
Hydrogen Peroxide - 16 oz3
1228 $500
Ice Bag - 1 ct
1761 $900
Insect Repellant Spray - Deet - 4 oz30
1796 $1200
Isopropyl Alcohol Wintergreen - 16 oz70
1229 $600
Liquid Bandage - 45 oz
1872 $850
Neosporin Plusreg
- 5 oz1326 $1100
Nitrile Exam Gloves - 100 ct
1840 $1200
Pill Crusher with Storage - 1 ct
1933 $1000
Pill Cutter with Safety Shield - 1 ct
1932 $1000
Povidone Iodine Solution Antiseptic - 4 oz
1203 $800
Procedural Face Masks with Earloops - 50 ct
1896 $1400
Tape Paper Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1217
1218
$600
$600
Tape Silk Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1219
1220
$600
$700
Tape Transparent Surgical(Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1221
1222
$600
$600
Thermometer Digital 60 seconds - 1 ct
1063 $500
Thermometer Digital Ear - 1 ct
1285 $2400
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
13
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Thermometer Flexible Tip Digital 10 seconds - 1 ct
1697 $1000
Thermometer Talking Ear and Forehead - 1 ct
1925 $4500
Triple Antibiotic Ointment - Compare to Neosporinreg
- 1 oz
1014 $700
Foot Care Callus Remover Pads - Compare to Dr Schollrsquosreg
- 6 ct
1238 $700
Corn Remover Pads - Compare to Dr Schollrsquosreg
- 9 ct
1236 $700
Medicated Foot Powder - 5 oz
1240 $700
Hemorrhoidal Preparations
Hemorrhoidal Ointment - Compare to Preparation Hreg
- 2 oz
1066 $700
Hemorrhoidal Suppository - 12 ct
1247 $700
Pre-moist Hemorrhoid Pads - Compare to Tucksreg
- 100 ct
1364 $800
Preparation Hreg Medicated Wipes - 48 ct
1895 $1300
Hormone Replacement DHEADagger
- 50 ct50 mg1737 $1200
Incontinence Supplies A and D Ointment - Compare to AandD Ointmentreg
- 2 oz
1300 $800
Adult Briefs(Compare to Dependreg)
Medium - 32rdquo to 44rdquo - 12 ct
Large - 45rdquo to 58rdquo - 12 ct
X-Large - 59rdquo to 64rdquo - Compare to Dependreg
- 15 ct
1303
1304
1305
$1000
$1200
$1200
Menrsquos Attends Discreet (Compare to Dependreg)
Guard - 20 ct
Shield - 20 ct
1811
1810
$1600
$1500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Category Description Item PriceIncontinence Supplies (Continued)
Womenrsquos Attends Discreet(Compare to Dependreg)
Moderate Bladder Control Pad - 20 ct
Maximum Bladder Control Pad - 20 ct
Ultimate Bladder Control Pad - 20 ct
Ultrathin Pad - 20 ct
Panty Liner - 28 ct
1813
1812
1814
1816
1815
$1800
$2000
$2000
$1400
$1400
Barrier Cream - Compare to Lantiseptic Barrier Creamreg
- 4 oz
1302 $1000
Bladder Control Shaped Pad(Compare to Dependreg)
Moderate Absorbency - 24 ct
Heavy Absorbency - 24 ct
Maximum Absorbency - 18 ct
1478
1479
1480
$1700
$1900
$1600
Disposable Underwear(Compare to Dependreg)
Medium - 34rdquo to 44rdquo - 20 ct
Large - 44rdquo to 58rdquo - 18 ct
X-Large - 58rdquo to 68rdquo - 14 ct
1021
1026
1027
$1600
$1600
$1600
Flushable Wipes - 24 ct
1928 $750
Underpad Disposable(Compare to Dependreg)
23rdquo x 24rdquo - 50 ct
23rdquo x 36rdquo - 25 ct
30rdquo x 30rdquo - 10 ct
1476
1299
1477
$1500
$1000
$800
Washcloth with Lanolin - 64 ct
1348 $900
In-home Diagnostic Equipment
Bathroom ScaleDaggersect
- 1 ct1935 $3500
Blood Pressure Monitor (1 ct)Desktop AutomaticDagger
Desktop TalkingDagger
Replacement CuffDagger
WristDagger
Wrist TalkingDagger
12531503150415011502
$6000 $7000 $1500 $4000 $5000
your doctor before starting a new product regime
OTC MTalk with
EDICATIONS AND PRODUCTS
15
Category Description Item PriceIn-home Diagnostic Equipment (Continued)
Finger Pulse OximeterDagger
- 1 ct1505 $5200
Heart Rate Monitor WatchDagger
- 1 ct1771 $4000
In-home Diagnostic Tests
EZ Detect Colon Cancer Test KitDagger
- 1 ct1416 $1300
Home Access Cholesterol TestDagger
- 1 kit1251 $3300
Lice Treatment (Pediculicide)
Lice Elimination Kit - Compare to RIDreg
- 1 kit
1929 $2700
Lice Treatment Shampoo - Compare to RIDreg
- 4 oz
1271 $900
Permethrin Lice Treatment - Compare to Nixreg
- 59 ml1
1269 $1400
Mobility Cushion Foam Ring - 1 ct
1732 $2100
Cushion GelFoam Seat - 1 ct
1466 $4200
Cushion Lumbar - 1 ct
1731 $2700
Folding Cane Ergonomic Handle - 1 ct
1726 $2000
Quad Cane (1 ct) Small BaseLarge Base
17771776
$2500 $3000
Motion Sickness Dramamine Chewablesreg Orange - 8 ct50 mg
1264 $700
Driminate Antiemetic - Compare to Dramaminereg
- 12 ct50 mg
1263 $500
Meclizine HCL Antiemetic - 100 ct125 mg
1366 $800
Pain Relievers and Fever Reducers
AcetaminophenCompare to Tylenolreg
- 100 ct325 mg
1001
$600
Compare to Tylenol Extra Strengthreg
- 100 ct500 mg1600 $1000
Arthritis Pain Reliever - Compare to Tylenol Arthritisreg
- 100 ct650 mg
1311 $1200
Aspirin - Compare to Bayerreg
- 100 ct325 mg
1095 $500
Aspirin Enteric Coated - Compare to Bayerreg
- 100 ct325 mg
1096 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
- Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
- Compare to Capzasinreg
- 2 oz0025
1367 $1000
- 1 ct1943 $5500
(Compare to ThermaCarereg)Back and Hip
- 2 ctNeck Shoulder and Wrist
- 3 ct
1859
1860
$1300
$1300
- Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
- Compare to Alevereg
- 100 ct220 mg
1097 $1100
- Compare to Bengayreg
- 2 oz25
1475 $600
Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Pain Relievers and Fever Reducers (Continued)
Category Description Item Price
Aspirin Low Dose Chewables - Compare to Bayer Aspirin Chewable Low Dosereg
- 36 ct81 mg
1802 $500
ColdHot Menthol Medicated Patch- Compare to IcyHotreg
- 5 ct5
1944 $1000
Heating Pad 12rdquo x 15rdquo- 1 ct
1861 $2600
Ibuprofen - Compare to Advilreg
- 100 ct200 mg
1004 $700
Migraine Relief- Compare to Excedrinreg
- 100 ct250 mg 250 mg 65 mg
1365 $700
Pain Reliever PM - Extra Strength - Compare to Tylenol PMreg
- 100 ct
1332 $1000
Salonpas Pain Relief Patchesreg
- 5 ct 1739 $1400
XL Heating Pad 12rdquo x 24rdquo- 1 ct
1942 $3500
16
HeatWraps(Compare to ThermaCarereg)
Back and Hip - 2 ct
Neck Shoulder and Wrist - 3 ct
1859
1860
$1300
$1300
ThermaCarereg Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Naproxen - Compare to Alevereg
- 100 ct220 mg
1097 $1100
Lidocaine Patch - Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
Capsaicin External Analgesic - Compare to Capzasinreg
- 2 oz0025
1367 $1000
Aspirin Enteric Coated Low Dose - Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
Heating Pad Wrap for Shoulder Neck and Back 25rdquo x 26rdquo - 1 ct
1943 $5500
Pain Relieving Muscle Rub - Compare to Bengayreg
- 2 oz25
1475 $600
17
Category Description Item PricePersonal Care Acne Gel 10 Benzoyl Peroxide
- Compare to Persa-Gelreg - 15 oz10
1076 $700
Ammonium Lactate Moisturizing Lotion - Compare to AmLactinreg
- 8 oz12
1368 $900
Hand Sanitizer - Compare to Purellreg - 8 oz
1065 $500
Skin and Sun Care Aloe Vera Cream - 8 oz
1070 $600
Calamine Lotion - 6 oz
1821 $600
Moisturizing Body Lotion with Aloe - 8 oz
1893 $800
Scar Gel - 50 gm
1852 $1200
Sunscreen Lotion SPF 30 - 35 oz
1284 $600
Sleep Aids Nasal Strips (Compare to Breathe Rightreg)
Medium - 30 ct
Large - 30 ct
1724
1725
$1200
$1200
Sleep Tablets - Compare to Sominexreg
- 50 ct25 mg
1276 $600
Smoking Cessation Nicorelief GumDagger
- Compare to Nicorettereg
- 50 ct4 mg
1372 $2500
Nicotine LozengesDagger
- Compare to Nicorettereg
- 72 ct4 mg
1281 $4400
Nicotine PatchStep 1Dagger
- Compare to NicoDerm CQ Step 1reg
- 14 ct21 mg 24 hrStep 2Dagger
- Compare to NicoDerm CQ Step 2reg
- 14 ct14 mg 24 hrStep 3Dagger
- Compare to NicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
1369
1370
1371
$4500
$4500
$4500
Supportive Items Ankle Support - Compare to Acereg
- 1 ct
1225 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
9
Category Description Item PriceBathroom Safety (Continued)
Bath Tub Safety Rail - 1 ct
1730 $3700
Raised Toilet Seat - 1 ct
1729 $3500
Raised Toilet Seat with Arms - 1 ct
1950 $6500
Shower Mat Non-Skid - 1 ct
1460 $1400
Toilet Safety Rails - 1 set
1779 $5000
Cold Sore and Medicated Lip Products
Abrevareg
- 2 gm101152 $2600
Carmexreg
- 75 gm1255 $400
Herpecin-Lreg Lip Balm - 1 oz1
1153 $800
Releevreg Cold Sore Treatment - 6 ml013
1359 $2500
Dental and Denture Care Biotenereg Dry Mouth Oral Rinse - 16 oz
1817 $1400
Denture Brush - Compare to G-U-Mreg
- 1 ct
1747 $650
Denture Cleaning Tablets - Compare to Polidentreg
- 40 ct
1032 $700
Efferdent Plusreg Mint Tablets - 36 ct
1653 $800
Effergripreg Denture Cream Adhesive - 25 oz
1843 $900
Fixodentreg
- 75 oz1187 $700
Interdental Flossups - Compare to G-U-Mreg
- 90 ct
1751 $700
Orajelreg Pain Relief - 7 gm20
1454 $1100
Oral Pain Relief - Compare to Orajelreg - 5 oz20
1286 $600
Polidentreg Denture Cream - 39 oz
1324 $800
Polidentreg Overnight - 84 ct
1892 $1250
Reachreg Waxed Dental Floss - Mint - 55 yd
1455 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
10
Category Description Item PriceDental and Denture Care (Continued)
ToothbrushColgatereg Adult Soft
- 1 ctRechargeable
- 1 ctSoft 2-pack
- 2-packTek Pro Angled Soft
- 1 ct
1413
1450
1948
1412
$300
$4000
$600
$300
Toothpaste Crest Sensi-Reliefreg
- 41 oz1838 $950
Toothpaste Pepsodentreg
- 55 oz1414 $500
Water Jet - 1 ct
1744 $3900
Water Jet Replacement Tips - 5 ct
1743 $1800
Diabetic Foot Care Diabetic SocksBlack Medium 3-packBlack Large 3-packBlack X-Large 3-pack
195619571958
$900 $900 $900
Diabetic Socks White Medium 3-packWhite Large 3-packWhite X-Large 3-pack
195319541955
$900 $900 $900
Ultra Soft Padded Diabetic SockBlack Medium 2-packBlack Large 2-packBlack X-Large 2-pack
195919601961
$1100 $1100 $1100
Ultra Soft Padded Diabetic SockWhite Medium 2-packWhite Large 2-packWhite X-Large 2-pack
196219631964
$1100 $1100 $1100
Ear Care Cotton Tipped Swabs - 300 ct
1742 $600
Ear Pain Relief Ear Drops - Compare to Hylandrsquos Ear Reliefreg
- 10 ml
1841 $1300
Ear Wax Removal Drops - Compare to Debroxreg
- 15 ml65
1190 $500
Ear Wax Removal System with Rubber Bulb - Compare to Debroxreg
- 15 ml65
1363 $700
Eye Care Artificial Tears Drops - Compare to Visine Tearsreg
- 5 oz
1192 $600
Artificial Tears Ointment - Compare to Refresh PMreg
- 35 gm
1194 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
11
Category Description Item PriceEye Care(Continued)
Eye Wash Solution - Compare to Bausch and Lombreg
- 4 oz
1196 $800
Multi-Purpose Contact Lens Solution - Compare to Renu Multipurpose Solutionreg
- 4 oz
1468 $600
Redness Relief Eye Drops - Compare to Visine Original Redness Reliefreg
- 15 ml005
1061 $500
First Aid and Medical Supplies
Adhesive Bandages - Compare to Band-Aid Plastic Stripsreg
- 60 ct
1344 $600
After Bite Reliefreg
- 5 oz1803 $900
Alcohol Pads - 100 ct70
1200 $600
Antiseptic Towelettes - 100 ct
1201 $700
Bacitracin Ointment - 1 oz500 Ugm
1020 $600
Cotton Balls - 200 ct
1763 $600
CPAP Pillow Fiber Filled - 1 ct
1836 $6000
CPAP Pillow Memory Foam - 1 ct
1837 $10000
Elastic Bandage (Compare to Acereg)
2rdquo x 45 yd - 1 ct
3rdquo x 5 yd - 1 ct
4rdquo x 5 yd - 1 ct
6rdquo x 5 yd - 1 ct
1207
1209
1211
1213
$400
$400
$500
$500
Fast Freeze Pain Relief Spray - Compare to Biofreeze Pain Relief Sprayreg
- 4 oz
1846 $1400
First Aid Kit 20 Pieces - 1 ct
1947 $700
First Aid Kit 75 Pieces - 1 ct
1215 $1000
First Aid Kit 175 Pieces - 1 ct
1738 $1700
HotCold Pack 1 small and 1 large - 1 ct
1062 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Humidifier Ultra-Sonic Cool Mist - Compare to Vicks Ultrasonic Humidifierreg
- 1 ct
1795 $6000
Hydrogen Peroxide - 16 oz3
1228 $500
Ice Bag - 1 ct
1761 $900
Insect Repellant Spray - Deet - 4 oz30
1796 $1200
Isopropyl Alcohol Wintergreen - 16 oz70
1229 $600
Liquid Bandage - 45 oz
1872 $850
Neosporin Plusreg
- 5 oz1326 $1100
Nitrile Exam Gloves - 100 ct
1840 $1200
Pill Crusher with Storage - 1 ct
1933 $1000
Pill Cutter with Safety Shield - 1 ct
1932 $1000
Povidone Iodine Solution Antiseptic - 4 oz
1203 $800
Procedural Face Masks with Earloops - 50 ct
1896 $1400
Tape Paper Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1217
1218
$600
$600
Tape Silk Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1219
1220
$600
$700
Tape Transparent Surgical(Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1221
1222
$600
$600
Thermometer Digital 60 seconds - 1 ct
1063 $500
Thermometer Digital Ear - 1 ct
1285 $2400
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
13
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Thermometer Flexible Tip Digital 10 seconds - 1 ct
1697 $1000
Thermometer Talking Ear and Forehead - 1 ct
1925 $4500
Triple Antibiotic Ointment - Compare to Neosporinreg
- 1 oz
1014 $700
Foot Care Callus Remover Pads - Compare to Dr Schollrsquosreg
- 6 ct
1238 $700
Corn Remover Pads - Compare to Dr Schollrsquosreg
- 9 ct
1236 $700
Medicated Foot Powder - 5 oz
1240 $700
Hemorrhoidal Preparations
Hemorrhoidal Ointment - Compare to Preparation Hreg
- 2 oz
1066 $700
Hemorrhoidal Suppository - 12 ct
1247 $700
Pre-moist Hemorrhoid Pads - Compare to Tucksreg
- 100 ct
1364 $800
Preparation Hreg Medicated Wipes - 48 ct
1895 $1300
Hormone Replacement DHEADagger
- 50 ct50 mg1737 $1200
Incontinence Supplies A and D Ointment - Compare to AandD Ointmentreg
- 2 oz
1300 $800
Adult Briefs(Compare to Dependreg)
Medium - 32rdquo to 44rdquo - 12 ct
Large - 45rdquo to 58rdquo - 12 ct
X-Large - 59rdquo to 64rdquo - Compare to Dependreg
- 15 ct
1303
1304
1305
$1000
$1200
$1200
Menrsquos Attends Discreet (Compare to Dependreg)
Guard - 20 ct
Shield - 20 ct
1811
1810
$1600
$1500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Category Description Item PriceIncontinence Supplies (Continued)
Womenrsquos Attends Discreet(Compare to Dependreg)
Moderate Bladder Control Pad - 20 ct
Maximum Bladder Control Pad - 20 ct
Ultimate Bladder Control Pad - 20 ct
Ultrathin Pad - 20 ct
Panty Liner - 28 ct
1813
1812
1814
1816
1815
$1800
$2000
$2000
$1400
$1400
Barrier Cream - Compare to Lantiseptic Barrier Creamreg
- 4 oz
1302 $1000
Bladder Control Shaped Pad(Compare to Dependreg)
Moderate Absorbency - 24 ct
Heavy Absorbency - 24 ct
Maximum Absorbency - 18 ct
1478
1479
1480
$1700
$1900
$1600
Disposable Underwear(Compare to Dependreg)
Medium - 34rdquo to 44rdquo - 20 ct
Large - 44rdquo to 58rdquo - 18 ct
X-Large - 58rdquo to 68rdquo - 14 ct
1021
1026
1027
$1600
$1600
$1600
Flushable Wipes - 24 ct
1928 $750
Underpad Disposable(Compare to Dependreg)
23rdquo x 24rdquo - 50 ct
23rdquo x 36rdquo - 25 ct
30rdquo x 30rdquo - 10 ct
1476
1299
1477
$1500
$1000
$800
Washcloth with Lanolin - 64 ct
1348 $900
In-home Diagnostic Equipment
Bathroom ScaleDaggersect
- 1 ct1935 $3500
Blood Pressure Monitor (1 ct)Desktop AutomaticDagger
Desktop TalkingDagger
Replacement CuffDagger
WristDagger
Wrist TalkingDagger
12531503150415011502
$6000 $7000 $1500 $4000 $5000
your doctor before starting a new product regime
OTC MTalk with
EDICATIONS AND PRODUCTS
15
Category Description Item PriceIn-home Diagnostic Equipment (Continued)
Finger Pulse OximeterDagger
- 1 ct1505 $5200
Heart Rate Monitor WatchDagger
- 1 ct1771 $4000
In-home Diagnostic Tests
EZ Detect Colon Cancer Test KitDagger
- 1 ct1416 $1300
Home Access Cholesterol TestDagger
- 1 kit1251 $3300
Lice Treatment (Pediculicide)
Lice Elimination Kit - Compare to RIDreg
- 1 kit
1929 $2700
Lice Treatment Shampoo - Compare to RIDreg
- 4 oz
1271 $900
Permethrin Lice Treatment - Compare to Nixreg
- 59 ml1
1269 $1400
Mobility Cushion Foam Ring - 1 ct
1732 $2100
Cushion GelFoam Seat - 1 ct
1466 $4200
Cushion Lumbar - 1 ct
1731 $2700
Folding Cane Ergonomic Handle - 1 ct
1726 $2000
Quad Cane (1 ct) Small BaseLarge Base
17771776
$2500 $3000
Motion Sickness Dramamine Chewablesreg Orange - 8 ct50 mg
1264 $700
Driminate Antiemetic - Compare to Dramaminereg
- 12 ct50 mg
1263 $500
Meclizine HCL Antiemetic - 100 ct125 mg
1366 $800
Pain Relievers and Fever Reducers
AcetaminophenCompare to Tylenolreg
- 100 ct325 mg
1001
$600
Compare to Tylenol Extra Strengthreg
- 100 ct500 mg1600 $1000
Arthritis Pain Reliever - Compare to Tylenol Arthritisreg
- 100 ct650 mg
1311 $1200
Aspirin - Compare to Bayerreg
- 100 ct325 mg
1095 $500
Aspirin Enteric Coated - Compare to Bayerreg
- 100 ct325 mg
1096 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
- Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
- Compare to Capzasinreg
- 2 oz0025
1367 $1000
- 1 ct1943 $5500
(Compare to ThermaCarereg)Back and Hip
- 2 ctNeck Shoulder and Wrist
- 3 ct
1859
1860
$1300
$1300
- Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
- Compare to Alevereg
- 100 ct220 mg
1097 $1100
- Compare to Bengayreg
- 2 oz25
1475 $600
Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Pain Relievers and Fever Reducers (Continued)
Category Description Item Price
Aspirin Low Dose Chewables - Compare to Bayer Aspirin Chewable Low Dosereg
- 36 ct81 mg
1802 $500
ColdHot Menthol Medicated Patch- Compare to IcyHotreg
- 5 ct5
1944 $1000
Heating Pad 12rdquo x 15rdquo- 1 ct
1861 $2600
Ibuprofen - Compare to Advilreg
- 100 ct200 mg
1004 $700
Migraine Relief- Compare to Excedrinreg
- 100 ct250 mg 250 mg 65 mg
1365 $700
Pain Reliever PM - Extra Strength - Compare to Tylenol PMreg
- 100 ct
1332 $1000
Salonpas Pain Relief Patchesreg
- 5 ct 1739 $1400
XL Heating Pad 12rdquo x 24rdquo- 1 ct
1942 $3500
16
HeatWraps(Compare to ThermaCarereg)
Back and Hip - 2 ct
Neck Shoulder and Wrist - 3 ct
1859
1860
$1300
$1300
ThermaCarereg Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Naproxen - Compare to Alevereg
- 100 ct220 mg
1097 $1100
Lidocaine Patch - Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
Capsaicin External Analgesic - Compare to Capzasinreg
- 2 oz0025
1367 $1000
Aspirin Enteric Coated Low Dose - Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
Heating Pad Wrap for Shoulder Neck and Back 25rdquo x 26rdquo - 1 ct
1943 $5500
Pain Relieving Muscle Rub - Compare to Bengayreg
- 2 oz25
1475 $600
17
Category Description Item PricePersonal Care Acne Gel 10 Benzoyl Peroxide
- Compare to Persa-Gelreg - 15 oz10
1076 $700
Ammonium Lactate Moisturizing Lotion - Compare to AmLactinreg
- 8 oz12
1368 $900
Hand Sanitizer - Compare to Purellreg - 8 oz
1065 $500
Skin and Sun Care Aloe Vera Cream - 8 oz
1070 $600
Calamine Lotion - 6 oz
1821 $600
Moisturizing Body Lotion with Aloe - 8 oz
1893 $800
Scar Gel - 50 gm
1852 $1200
Sunscreen Lotion SPF 30 - 35 oz
1284 $600
Sleep Aids Nasal Strips (Compare to Breathe Rightreg)
Medium - 30 ct
Large - 30 ct
1724
1725
$1200
$1200
Sleep Tablets - Compare to Sominexreg
- 50 ct25 mg
1276 $600
Smoking Cessation Nicorelief GumDagger
- Compare to Nicorettereg
- 50 ct4 mg
1372 $2500
Nicotine LozengesDagger
- Compare to Nicorettereg
- 72 ct4 mg
1281 $4400
Nicotine PatchStep 1Dagger
- Compare to NicoDerm CQ Step 1reg
- 14 ct21 mg 24 hrStep 2Dagger
- Compare to NicoDerm CQ Step 2reg
- 14 ct14 mg 24 hrStep 3Dagger
- Compare to NicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
1369
1370
1371
$4500
$4500
$4500
Supportive Items Ankle Support - Compare to Acereg
- 1 ct
1225 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
10
Category Description Item PriceDental and Denture Care (Continued)
ToothbrushColgatereg Adult Soft
- 1 ctRechargeable
- 1 ctSoft 2-pack
- 2-packTek Pro Angled Soft
- 1 ct
1413
1450
1948
1412
$300
$4000
$600
$300
Toothpaste Crest Sensi-Reliefreg
- 41 oz1838 $950
Toothpaste Pepsodentreg
- 55 oz1414 $500
Water Jet - 1 ct
1744 $3900
Water Jet Replacement Tips - 5 ct
1743 $1800
Diabetic Foot Care Diabetic SocksBlack Medium 3-packBlack Large 3-packBlack X-Large 3-pack
195619571958
$900 $900 $900
Diabetic Socks White Medium 3-packWhite Large 3-packWhite X-Large 3-pack
195319541955
$900 $900 $900
Ultra Soft Padded Diabetic SockBlack Medium 2-packBlack Large 2-packBlack X-Large 2-pack
195919601961
$1100 $1100 $1100
Ultra Soft Padded Diabetic SockWhite Medium 2-packWhite Large 2-packWhite X-Large 2-pack
196219631964
$1100 $1100 $1100
Ear Care Cotton Tipped Swabs - 300 ct
1742 $600
Ear Pain Relief Ear Drops - Compare to Hylandrsquos Ear Reliefreg
- 10 ml
1841 $1300
Ear Wax Removal Drops - Compare to Debroxreg
- 15 ml65
1190 $500
Ear Wax Removal System with Rubber Bulb - Compare to Debroxreg
- 15 ml65
1363 $700
Eye Care Artificial Tears Drops - Compare to Visine Tearsreg
- 5 oz
1192 $600
Artificial Tears Ointment - Compare to Refresh PMreg
- 35 gm
1194 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
11
Category Description Item PriceEye Care(Continued)
Eye Wash Solution - Compare to Bausch and Lombreg
- 4 oz
1196 $800
Multi-Purpose Contact Lens Solution - Compare to Renu Multipurpose Solutionreg
- 4 oz
1468 $600
Redness Relief Eye Drops - Compare to Visine Original Redness Reliefreg
- 15 ml005
1061 $500
First Aid and Medical Supplies
Adhesive Bandages - Compare to Band-Aid Plastic Stripsreg
- 60 ct
1344 $600
After Bite Reliefreg
- 5 oz1803 $900
Alcohol Pads - 100 ct70
1200 $600
Antiseptic Towelettes - 100 ct
1201 $700
Bacitracin Ointment - 1 oz500 Ugm
1020 $600
Cotton Balls - 200 ct
1763 $600
CPAP Pillow Fiber Filled - 1 ct
1836 $6000
CPAP Pillow Memory Foam - 1 ct
1837 $10000
Elastic Bandage (Compare to Acereg)
2rdquo x 45 yd - 1 ct
3rdquo x 5 yd - 1 ct
4rdquo x 5 yd - 1 ct
6rdquo x 5 yd - 1 ct
1207
1209
1211
1213
$400
$400
$500
$500
Fast Freeze Pain Relief Spray - Compare to Biofreeze Pain Relief Sprayreg
- 4 oz
1846 $1400
First Aid Kit 20 Pieces - 1 ct
1947 $700
First Aid Kit 75 Pieces - 1 ct
1215 $1000
First Aid Kit 175 Pieces - 1 ct
1738 $1700
HotCold Pack 1 small and 1 large - 1 ct
1062 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Humidifier Ultra-Sonic Cool Mist - Compare to Vicks Ultrasonic Humidifierreg
- 1 ct
1795 $6000
Hydrogen Peroxide - 16 oz3
1228 $500
Ice Bag - 1 ct
1761 $900
Insect Repellant Spray - Deet - 4 oz30
1796 $1200
Isopropyl Alcohol Wintergreen - 16 oz70
1229 $600
Liquid Bandage - 45 oz
1872 $850
Neosporin Plusreg
- 5 oz1326 $1100
Nitrile Exam Gloves - 100 ct
1840 $1200
Pill Crusher with Storage - 1 ct
1933 $1000
Pill Cutter with Safety Shield - 1 ct
1932 $1000
Povidone Iodine Solution Antiseptic - 4 oz
1203 $800
Procedural Face Masks with Earloops - 50 ct
1896 $1400
Tape Paper Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1217
1218
$600
$600
Tape Silk Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1219
1220
$600
$700
Tape Transparent Surgical(Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1221
1222
$600
$600
Thermometer Digital 60 seconds - 1 ct
1063 $500
Thermometer Digital Ear - 1 ct
1285 $2400
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
13
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Thermometer Flexible Tip Digital 10 seconds - 1 ct
1697 $1000
Thermometer Talking Ear and Forehead - 1 ct
1925 $4500
Triple Antibiotic Ointment - Compare to Neosporinreg
- 1 oz
1014 $700
Foot Care Callus Remover Pads - Compare to Dr Schollrsquosreg
- 6 ct
1238 $700
Corn Remover Pads - Compare to Dr Schollrsquosreg
- 9 ct
1236 $700
Medicated Foot Powder - 5 oz
1240 $700
Hemorrhoidal Preparations
Hemorrhoidal Ointment - Compare to Preparation Hreg
- 2 oz
1066 $700
Hemorrhoidal Suppository - 12 ct
1247 $700
Pre-moist Hemorrhoid Pads - Compare to Tucksreg
- 100 ct
1364 $800
Preparation Hreg Medicated Wipes - 48 ct
1895 $1300
Hormone Replacement DHEADagger
- 50 ct50 mg1737 $1200
Incontinence Supplies A and D Ointment - Compare to AandD Ointmentreg
- 2 oz
1300 $800
Adult Briefs(Compare to Dependreg)
Medium - 32rdquo to 44rdquo - 12 ct
Large - 45rdquo to 58rdquo - 12 ct
X-Large - 59rdquo to 64rdquo - Compare to Dependreg
- 15 ct
1303
1304
1305
$1000
$1200
$1200
Menrsquos Attends Discreet (Compare to Dependreg)
Guard - 20 ct
Shield - 20 ct
1811
1810
$1600
$1500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Category Description Item PriceIncontinence Supplies (Continued)
Womenrsquos Attends Discreet(Compare to Dependreg)
Moderate Bladder Control Pad - 20 ct
Maximum Bladder Control Pad - 20 ct
Ultimate Bladder Control Pad - 20 ct
Ultrathin Pad - 20 ct
Panty Liner - 28 ct
1813
1812
1814
1816
1815
$1800
$2000
$2000
$1400
$1400
Barrier Cream - Compare to Lantiseptic Barrier Creamreg
- 4 oz
1302 $1000
Bladder Control Shaped Pad(Compare to Dependreg)
Moderate Absorbency - 24 ct
Heavy Absorbency - 24 ct
Maximum Absorbency - 18 ct
1478
1479
1480
$1700
$1900
$1600
Disposable Underwear(Compare to Dependreg)
Medium - 34rdquo to 44rdquo - 20 ct
Large - 44rdquo to 58rdquo - 18 ct
X-Large - 58rdquo to 68rdquo - 14 ct
1021
1026
1027
$1600
$1600
$1600
Flushable Wipes - 24 ct
1928 $750
Underpad Disposable(Compare to Dependreg)
23rdquo x 24rdquo - 50 ct
23rdquo x 36rdquo - 25 ct
30rdquo x 30rdquo - 10 ct
1476
1299
1477
$1500
$1000
$800
Washcloth with Lanolin - 64 ct
1348 $900
In-home Diagnostic Equipment
Bathroom ScaleDaggersect
- 1 ct1935 $3500
Blood Pressure Monitor (1 ct)Desktop AutomaticDagger
Desktop TalkingDagger
Replacement CuffDagger
WristDagger
Wrist TalkingDagger
12531503150415011502
$6000 $7000 $1500 $4000 $5000
your doctor before starting a new product regime
OTC MTalk with
EDICATIONS AND PRODUCTS
15
Category Description Item PriceIn-home Diagnostic Equipment (Continued)
Finger Pulse OximeterDagger
- 1 ct1505 $5200
Heart Rate Monitor WatchDagger
- 1 ct1771 $4000
In-home Diagnostic Tests
EZ Detect Colon Cancer Test KitDagger
- 1 ct1416 $1300
Home Access Cholesterol TestDagger
- 1 kit1251 $3300
Lice Treatment (Pediculicide)
Lice Elimination Kit - Compare to RIDreg
- 1 kit
1929 $2700
Lice Treatment Shampoo - Compare to RIDreg
- 4 oz
1271 $900
Permethrin Lice Treatment - Compare to Nixreg
- 59 ml1
1269 $1400
Mobility Cushion Foam Ring - 1 ct
1732 $2100
Cushion GelFoam Seat - 1 ct
1466 $4200
Cushion Lumbar - 1 ct
1731 $2700
Folding Cane Ergonomic Handle - 1 ct
1726 $2000
Quad Cane (1 ct) Small BaseLarge Base
17771776
$2500 $3000
Motion Sickness Dramamine Chewablesreg Orange - 8 ct50 mg
1264 $700
Driminate Antiemetic - Compare to Dramaminereg
- 12 ct50 mg
1263 $500
Meclizine HCL Antiemetic - 100 ct125 mg
1366 $800
Pain Relievers and Fever Reducers
AcetaminophenCompare to Tylenolreg
- 100 ct325 mg
1001
$600
Compare to Tylenol Extra Strengthreg
- 100 ct500 mg1600 $1000
Arthritis Pain Reliever - Compare to Tylenol Arthritisreg
- 100 ct650 mg
1311 $1200
Aspirin - Compare to Bayerreg
- 100 ct325 mg
1095 $500
Aspirin Enteric Coated - Compare to Bayerreg
- 100 ct325 mg
1096 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
- Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
- Compare to Capzasinreg
- 2 oz0025
1367 $1000
- 1 ct1943 $5500
(Compare to ThermaCarereg)Back and Hip
- 2 ctNeck Shoulder and Wrist
- 3 ct
1859
1860
$1300
$1300
- Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
- Compare to Alevereg
- 100 ct220 mg
1097 $1100
- Compare to Bengayreg
- 2 oz25
1475 $600
Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Pain Relievers and Fever Reducers (Continued)
Category Description Item Price
Aspirin Low Dose Chewables - Compare to Bayer Aspirin Chewable Low Dosereg
- 36 ct81 mg
1802 $500
ColdHot Menthol Medicated Patch- Compare to IcyHotreg
- 5 ct5
1944 $1000
Heating Pad 12rdquo x 15rdquo- 1 ct
1861 $2600
Ibuprofen - Compare to Advilreg
- 100 ct200 mg
1004 $700
Migraine Relief- Compare to Excedrinreg
- 100 ct250 mg 250 mg 65 mg
1365 $700
Pain Reliever PM - Extra Strength - Compare to Tylenol PMreg
- 100 ct
1332 $1000
Salonpas Pain Relief Patchesreg
- 5 ct 1739 $1400
XL Heating Pad 12rdquo x 24rdquo- 1 ct
1942 $3500
16
HeatWraps(Compare to ThermaCarereg)
Back and Hip - 2 ct
Neck Shoulder and Wrist - 3 ct
1859
1860
$1300
$1300
ThermaCarereg Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Naproxen - Compare to Alevereg
- 100 ct220 mg
1097 $1100
Lidocaine Patch - Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
Capsaicin External Analgesic - Compare to Capzasinreg
- 2 oz0025
1367 $1000
Aspirin Enteric Coated Low Dose - Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
Heating Pad Wrap for Shoulder Neck and Back 25rdquo x 26rdquo - 1 ct
1943 $5500
Pain Relieving Muscle Rub - Compare to Bengayreg
- 2 oz25
1475 $600
17
Category Description Item PricePersonal Care Acne Gel 10 Benzoyl Peroxide
- Compare to Persa-Gelreg - 15 oz10
1076 $700
Ammonium Lactate Moisturizing Lotion - Compare to AmLactinreg
- 8 oz12
1368 $900
Hand Sanitizer - Compare to Purellreg - 8 oz
1065 $500
Skin and Sun Care Aloe Vera Cream - 8 oz
1070 $600
Calamine Lotion - 6 oz
1821 $600
Moisturizing Body Lotion with Aloe - 8 oz
1893 $800
Scar Gel - 50 gm
1852 $1200
Sunscreen Lotion SPF 30 - 35 oz
1284 $600
Sleep Aids Nasal Strips (Compare to Breathe Rightreg)
Medium - 30 ct
Large - 30 ct
1724
1725
$1200
$1200
Sleep Tablets - Compare to Sominexreg
- 50 ct25 mg
1276 $600
Smoking Cessation Nicorelief GumDagger
- Compare to Nicorettereg
- 50 ct4 mg
1372 $2500
Nicotine LozengesDagger
- Compare to Nicorettereg
- 72 ct4 mg
1281 $4400
Nicotine PatchStep 1Dagger
- Compare to NicoDerm CQ Step 1reg
- 14 ct21 mg 24 hrStep 2Dagger
- Compare to NicoDerm CQ Step 2reg
- 14 ct14 mg 24 hrStep 3Dagger
- Compare to NicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
1369
1370
1371
$4500
$4500
$4500
Supportive Items Ankle Support - Compare to Acereg
- 1 ct
1225 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
11
Category Description Item PriceEye Care(Continued)
Eye Wash Solution - Compare to Bausch and Lombreg
- 4 oz
1196 $800
Multi-Purpose Contact Lens Solution - Compare to Renu Multipurpose Solutionreg
- 4 oz
1468 $600
Redness Relief Eye Drops - Compare to Visine Original Redness Reliefreg
- 15 ml005
1061 $500
First Aid and Medical Supplies
Adhesive Bandages - Compare to Band-Aid Plastic Stripsreg
- 60 ct
1344 $600
After Bite Reliefreg
- 5 oz1803 $900
Alcohol Pads - 100 ct70
1200 $600
Antiseptic Towelettes - 100 ct
1201 $700
Bacitracin Ointment - 1 oz500 Ugm
1020 $600
Cotton Balls - 200 ct
1763 $600
CPAP Pillow Fiber Filled - 1 ct
1836 $6000
CPAP Pillow Memory Foam - 1 ct
1837 $10000
Elastic Bandage (Compare to Acereg)
2rdquo x 45 yd - 1 ct
3rdquo x 5 yd - 1 ct
4rdquo x 5 yd - 1 ct
6rdquo x 5 yd - 1 ct
1207
1209
1211
1213
$400
$400
$500
$500
Fast Freeze Pain Relief Spray - Compare to Biofreeze Pain Relief Sprayreg
- 4 oz
1846 $1400
First Aid Kit 20 Pieces - 1 ct
1947 $700
First Aid Kit 75 Pieces - 1 ct
1215 $1000
First Aid Kit 175 Pieces - 1 ct
1738 $1700
HotCold Pack 1 small and 1 large - 1 ct
1062 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
12
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Humidifier Ultra-Sonic Cool Mist - Compare to Vicks Ultrasonic Humidifierreg
- 1 ct
1795 $6000
Hydrogen Peroxide - 16 oz3
1228 $500
Ice Bag - 1 ct
1761 $900
Insect Repellant Spray - Deet - 4 oz30
1796 $1200
Isopropyl Alcohol Wintergreen - 16 oz70
1229 $600
Liquid Bandage - 45 oz
1872 $850
Neosporin Plusreg
- 5 oz1326 $1100
Nitrile Exam Gloves - 100 ct
1840 $1200
Pill Crusher with Storage - 1 ct
1933 $1000
Pill Cutter with Safety Shield - 1 ct
1932 $1000
Povidone Iodine Solution Antiseptic - 4 oz
1203 $800
Procedural Face Masks with Earloops - 50 ct
1896 $1400
Tape Paper Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1217
1218
$600
$600
Tape Silk Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1219
1220
$600
$700
Tape Transparent Surgical(Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1221
1222
$600
$600
Thermometer Digital 60 seconds - 1 ct
1063 $500
Thermometer Digital Ear - 1 ct
1285 $2400
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
13
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Thermometer Flexible Tip Digital 10 seconds - 1 ct
1697 $1000
Thermometer Talking Ear and Forehead - 1 ct
1925 $4500
Triple Antibiotic Ointment - Compare to Neosporinreg
- 1 oz
1014 $700
Foot Care Callus Remover Pads - Compare to Dr Schollrsquosreg
- 6 ct
1238 $700
Corn Remover Pads - Compare to Dr Schollrsquosreg
- 9 ct
1236 $700
Medicated Foot Powder - 5 oz
1240 $700
Hemorrhoidal Preparations
Hemorrhoidal Ointment - Compare to Preparation Hreg
- 2 oz
1066 $700
Hemorrhoidal Suppository - 12 ct
1247 $700
Pre-moist Hemorrhoid Pads - Compare to Tucksreg
- 100 ct
1364 $800
Preparation Hreg Medicated Wipes - 48 ct
1895 $1300
Hormone Replacement DHEADagger
- 50 ct50 mg1737 $1200
Incontinence Supplies A and D Ointment - Compare to AandD Ointmentreg
- 2 oz
1300 $800
Adult Briefs(Compare to Dependreg)
Medium - 32rdquo to 44rdquo - 12 ct
Large - 45rdquo to 58rdquo - 12 ct
X-Large - 59rdquo to 64rdquo - Compare to Dependreg
- 15 ct
1303
1304
1305
$1000
$1200
$1200
Menrsquos Attends Discreet (Compare to Dependreg)
Guard - 20 ct
Shield - 20 ct
1811
1810
$1600
$1500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Category Description Item PriceIncontinence Supplies (Continued)
Womenrsquos Attends Discreet(Compare to Dependreg)
Moderate Bladder Control Pad - 20 ct
Maximum Bladder Control Pad - 20 ct
Ultimate Bladder Control Pad - 20 ct
Ultrathin Pad - 20 ct
Panty Liner - 28 ct
1813
1812
1814
1816
1815
$1800
$2000
$2000
$1400
$1400
Barrier Cream - Compare to Lantiseptic Barrier Creamreg
- 4 oz
1302 $1000
Bladder Control Shaped Pad(Compare to Dependreg)
Moderate Absorbency - 24 ct
Heavy Absorbency - 24 ct
Maximum Absorbency - 18 ct
1478
1479
1480
$1700
$1900
$1600
Disposable Underwear(Compare to Dependreg)
Medium - 34rdquo to 44rdquo - 20 ct
Large - 44rdquo to 58rdquo - 18 ct
X-Large - 58rdquo to 68rdquo - 14 ct
1021
1026
1027
$1600
$1600
$1600
Flushable Wipes - 24 ct
1928 $750
Underpad Disposable(Compare to Dependreg)
23rdquo x 24rdquo - 50 ct
23rdquo x 36rdquo - 25 ct
30rdquo x 30rdquo - 10 ct
1476
1299
1477
$1500
$1000
$800
Washcloth with Lanolin - 64 ct
1348 $900
In-home Diagnostic Equipment
Bathroom ScaleDaggersect
- 1 ct1935 $3500
Blood Pressure Monitor (1 ct)Desktop AutomaticDagger
Desktop TalkingDagger
Replacement CuffDagger
WristDagger
Wrist TalkingDagger
12531503150415011502
$6000 $7000 $1500 $4000 $5000
your doctor before starting a new product regime
OTC MTalk with
EDICATIONS AND PRODUCTS
15
Category Description Item PriceIn-home Diagnostic Equipment (Continued)
Finger Pulse OximeterDagger
- 1 ct1505 $5200
Heart Rate Monitor WatchDagger
- 1 ct1771 $4000
In-home Diagnostic Tests
EZ Detect Colon Cancer Test KitDagger
- 1 ct1416 $1300
Home Access Cholesterol TestDagger
- 1 kit1251 $3300
Lice Treatment (Pediculicide)
Lice Elimination Kit - Compare to RIDreg
- 1 kit
1929 $2700
Lice Treatment Shampoo - Compare to RIDreg
- 4 oz
1271 $900
Permethrin Lice Treatment - Compare to Nixreg
- 59 ml1
1269 $1400
Mobility Cushion Foam Ring - 1 ct
1732 $2100
Cushion GelFoam Seat - 1 ct
1466 $4200
Cushion Lumbar - 1 ct
1731 $2700
Folding Cane Ergonomic Handle - 1 ct
1726 $2000
Quad Cane (1 ct) Small BaseLarge Base
17771776
$2500 $3000
Motion Sickness Dramamine Chewablesreg Orange - 8 ct50 mg
1264 $700
Driminate Antiemetic - Compare to Dramaminereg
- 12 ct50 mg
1263 $500
Meclizine HCL Antiemetic - 100 ct125 mg
1366 $800
Pain Relievers and Fever Reducers
AcetaminophenCompare to Tylenolreg
- 100 ct325 mg
1001
$600
Compare to Tylenol Extra Strengthreg
- 100 ct500 mg1600 $1000
Arthritis Pain Reliever - Compare to Tylenol Arthritisreg
- 100 ct650 mg
1311 $1200
Aspirin - Compare to Bayerreg
- 100 ct325 mg
1095 $500
Aspirin Enteric Coated - Compare to Bayerreg
- 100 ct325 mg
1096 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
- Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
- Compare to Capzasinreg
- 2 oz0025
1367 $1000
- 1 ct1943 $5500
(Compare to ThermaCarereg)Back and Hip
- 2 ctNeck Shoulder and Wrist
- 3 ct
1859
1860
$1300
$1300
- Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
- Compare to Alevereg
- 100 ct220 mg
1097 $1100
- Compare to Bengayreg
- 2 oz25
1475 $600
Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Pain Relievers and Fever Reducers (Continued)
Category Description Item Price
Aspirin Low Dose Chewables - Compare to Bayer Aspirin Chewable Low Dosereg
- 36 ct81 mg
1802 $500
ColdHot Menthol Medicated Patch- Compare to IcyHotreg
- 5 ct5
1944 $1000
Heating Pad 12rdquo x 15rdquo- 1 ct
1861 $2600
Ibuprofen - Compare to Advilreg
- 100 ct200 mg
1004 $700
Migraine Relief- Compare to Excedrinreg
- 100 ct250 mg 250 mg 65 mg
1365 $700
Pain Reliever PM - Extra Strength - Compare to Tylenol PMreg
- 100 ct
1332 $1000
Salonpas Pain Relief Patchesreg
- 5 ct 1739 $1400
XL Heating Pad 12rdquo x 24rdquo- 1 ct
1942 $3500
16
HeatWraps(Compare to ThermaCarereg)
Back and Hip - 2 ct
Neck Shoulder and Wrist - 3 ct
1859
1860
$1300
$1300
ThermaCarereg Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Naproxen - Compare to Alevereg
- 100 ct220 mg
1097 $1100
Lidocaine Patch - Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
Capsaicin External Analgesic - Compare to Capzasinreg
- 2 oz0025
1367 $1000
Aspirin Enteric Coated Low Dose - Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
Heating Pad Wrap for Shoulder Neck and Back 25rdquo x 26rdquo - 1 ct
1943 $5500
Pain Relieving Muscle Rub - Compare to Bengayreg
- 2 oz25
1475 $600
17
Category Description Item PricePersonal Care Acne Gel 10 Benzoyl Peroxide
- Compare to Persa-Gelreg - 15 oz10
1076 $700
Ammonium Lactate Moisturizing Lotion - Compare to AmLactinreg
- 8 oz12
1368 $900
Hand Sanitizer - Compare to Purellreg - 8 oz
1065 $500
Skin and Sun Care Aloe Vera Cream - 8 oz
1070 $600
Calamine Lotion - 6 oz
1821 $600
Moisturizing Body Lotion with Aloe - 8 oz
1893 $800
Scar Gel - 50 gm
1852 $1200
Sunscreen Lotion SPF 30 - 35 oz
1284 $600
Sleep Aids Nasal Strips (Compare to Breathe Rightreg)
Medium - 30 ct
Large - 30 ct
1724
1725
$1200
$1200
Sleep Tablets - Compare to Sominexreg
- 50 ct25 mg
1276 $600
Smoking Cessation Nicorelief GumDagger
- Compare to Nicorettereg
- 50 ct4 mg
1372 $2500
Nicotine LozengesDagger
- Compare to Nicorettereg
- 72 ct4 mg
1281 $4400
Nicotine PatchStep 1Dagger
- Compare to NicoDerm CQ Step 1reg
- 14 ct21 mg 24 hrStep 2Dagger
- Compare to NicoDerm CQ Step 2reg
- 14 ct14 mg 24 hrStep 3Dagger
- Compare to NicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
1369
1370
1371
$4500
$4500
$4500
Supportive Items Ankle Support - Compare to Acereg
- 1 ct
1225 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
12
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Humidifier Ultra-Sonic Cool Mist - Compare to Vicks Ultrasonic Humidifierreg
- 1 ct
1795 $6000
Hydrogen Peroxide - 16 oz3
1228 $500
Ice Bag - 1 ct
1761 $900
Insect Repellant Spray - Deet - 4 oz30
1796 $1200
Isopropyl Alcohol Wintergreen - 16 oz70
1229 $600
Liquid Bandage - 45 oz
1872 $850
Neosporin Plusreg
- 5 oz1326 $1100
Nitrile Exam Gloves - 100 ct
1840 $1200
Pill Crusher with Storage - 1 ct
1933 $1000
Pill Cutter with Safety Shield - 1 ct
1932 $1000
Povidone Iodine Solution Antiseptic - 4 oz
1203 $800
Procedural Face Masks with Earloops - 50 ct
1896 $1400
Tape Paper Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1217
1218
$600
$600
Tape Silk Surgical (Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1219
1220
$600
$700
Tape Transparent Surgical(Compare to 3M Tapereg)
1rdquo x 10 yd - 1 ct
2rdquo x 10 yd - 1 ct
1221
1222
$600
$600
Thermometer Digital 60 seconds - 1 ct
1063 $500
Thermometer Digital Ear - 1 ct
1285 $2400
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
13
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Thermometer Flexible Tip Digital 10 seconds - 1 ct
1697 $1000
Thermometer Talking Ear and Forehead - 1 ct
1925 $4500
Triple Antibiotic Ointment - Compare to Neosporinreg
- 1 oz
1014 $700
Foot Care Callus Remover Pads - Compare to Dr Schollrsquosreg
- 6 ct
1238 $700
Corn Remover Pads - Compare to Dr Schollrsquosreg
- 9 ct
1236 $700
Medicated Foot Powder - 5 oz
1240 $700
Hemorrhoidal Preparations
Hemorrhoidal Ointment - Compare to Preparation Hreg
- 2 oz
1066 $700
Hemorrhoidal Suppository - 12 ct
1247 $700
Pre-moist Hemorrhoid Pads - Compare to Tucksreg
- 100 ct
1364 $800
Preparation Hreg Medicated Wipes - 48 ct
1895 $1300
Hormone Replacement DHEADagger
- 50 ct50 mg1737 $1200
Incontinence Supplies A and D Ointment - Compare to AandD Ointmentreg
- 2 oz
1300 $800
Adult Briefs(Compare to Dependreg)
Medium - 32rdquo to 44rdquo - 12 ct
Large - 45rdquo to 58rdquo - 12 ct
X-Large - 59rdquo to 64rdquo - Compare to Dependreg
- 15 ct
1303
1304
1305
$1000
$1200
$1200
Menrsquos Attends Discreet (Compare to Dependreg)
Guard - 20 ct
Shield - 20 ct
1811
1810
$1600
$1500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Category Description Item PriceIncontinence Supplies (Continued)
Womenrsquos Attends Discreet(Compare to Dependreg)
Moderate Bladder Control Pad - 20 ct
Maximum Bladder Control Pad - 20 ct
Ultimate Bladder Control Pad - 20 ct
Ultrathin Pad - 20 ct
Panty Liner - 28 ct
1813
1812
1814
1816
1815
$1800
$2000
$2000
$1400
$1400
Barrier Cream - Compare to Lantiseptic Barrier Creamreg
- 4 oz
1302 $1000
Bladder Control Shaped Pad(Compare to Dependreg)
Moderate Absorbency - 24 ct
Heavy Absorbency - 24 ct
Maximum Absorbency - 18 ct
1478
1479
1480
$1700
$1900
$1600
Disposable Underwear(Compare to Dependreg)
Medium - 34rdquo to 44rdquo - 20 ct
Large - 44rdquo to 58rdquo - 18 ct
X-Large - 58rdquo to 68rdquo - 14 ct
1021
1026
1027
$1600
$1600
$1600
Flushable Wipes - 24 ct
1928 $750
Underpad Disposable(Compare to Dependreg)
23rdquo x 24rdquo - 50 ct
23rdquo x 36rdquo - 25 ct
30rdquo x 30rdquo - 10 ct
1476
1299
1477
$1500
$1000
$800
Washcloth with Lanolin - 64 ct
1348 $900
In-home Diagnostic Equipment
Bathroom ScaleDaggersect
- 1 ct1935 $3500
Blood Pressure Monitor (1 ct)Desktop AutomaticDagger
Desktop TalkingDagger
Replacement CuffDagger
WristDagger
Wrist TalkingDagger
12531503150415011502
$6000 $7000 $1500 $4000 $5000
your doctor before starting a new product regime
OTC MTalk with
EDICATIONS AND PRODUCTS
15
Category Description Item PriceIn-home Diagnostic Equipment (Continued)
Finger Pulse OximeterDagger
- 1 ct1505 $5200
Heart Rate Monitor WatchDagger
- 1 ct1771 $4000
In-home Diagnostic Tests
EZ Detect Colon Cancer Test KitDagger
- 1 ct1416 $1300
Home Access Cholesterol TestDagger
- 1 kit1251 $3300
Lice Treatment (Pediculicide)
Lice Elimination Kit - Compare to RIDreg
- 1 kit
1929 $2700
Lice Treatment Shampoo - Compare to RIDreg
- 4 oz
1271 $900
Permethrin Lice Treatment - Compare to Nixreg
- 59 ml1
1269 $1400
Mobility Cushion Foam Ring - 1 ct
1732 $2100
Cushion GelFoam Seat - 1 ct
1466 $4200
Cushion Lumbar - 1 ct
1731 $2700
Folding Cane Ergonomic Handle - 1 ct
1726 $2000
Quad Cane (1 ct) Small BaseLarge Base
17771776
$2500 $3000
Motion Sickness Dramamine Chewablesreg Orange - 8 ct50 mg
1264 $700
Driminate Antiemetic - Compare to Dramaminereg
- 12 ct50 mg
1263 $500
Meclizine HCL Antiemetic - 100 ct125 mg
1366 $800
Pain Relievers and Fever Reducers
AcetaminophenCompare to Tylenolreg
- 100 ct325 mg
1001
$600
Compare to Tylenol Extra Strengthreg
- 100 ct500 mg1600 $1000
Arthritis Pain Reliever - Compare to Tylenol Arthritisreg
- 100 ct650 mg
1311 $1200
Aspirin - Compare to Bayerreg
- 100 ct325 mg
1095 $500
Aspirin Enteric Coated - Compare to Bayerreg
- 100 ct325 mg
1096 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
- Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
- Compare to Capzasinreg
- 2 oz0025
1367 $1000
- 1 ct1943 $5500
(Compare to ThermaCarereg)Back and Hip
- 2 ctNeck Shoulder and Wrist
- 3 ct
1859
1860
$1300
$1300
- Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
- Compare to Alevereg
- 100 ct220 mg
1097 $1100
- Compare to Bengayreg
- 2 oz25
1475 $600
Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Pain Relievers and Fever Reducers (Continued)
Category Description Item Price
Aspirin Low Dose Chewables - Compare to Bayer Aspirin Chewable Low Dosereg
- 36 ct81 mg
1802 $500
ColdHot Menthol Medicated Patch- Compare to IcyHotreg
- 5 ct5
1944 $1000
Heating Pad 12rdquo x 15rdquo- 1 ct
1861 $2600
Ibuprofen - Compare to Advilreg
- 100 ct200 mg
1004 $700
Migraine Relief- Compare to Excedrinreg
- 100 ct250 mg 250 mg 65 mg
1365 $700
Pain Reliever PM - Extra Strength - Compare to Tylenol PMreg
- 100 ct
1332 $1000
Salonpas Pain Relief Patchesreg
- 5 ct 1739 $1400
XL Heating Pad 12rdquo x 24rdquo- 1 ct
1942 $3500
16
HeatWraps(Compare to ThermaCarereg)
Back and Hip - 2 ct
Neck Shoulder and Wrist - 3 ct
1859
1860
$1300
$1300
ThermaCarereg Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Naproxen - Compare to Alevereg
- 100 ct220 mg
1097 $1100
Lidocaine Patch - Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
Capsaicin External Analgesic - Compare to Capzasinreg
- 2 oz0025
1367 $1000
Aspirin Enteric Coated Low Dose - Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
Heating Pad Wrap for Shoulder Neck and Back 25rdquo x 26rdquo - 1 ct
1943 $5500
Pain Relieving Muscle Rub - Compare to Bengayreg
- 2 oz25
1475 $600
17
Category Description Item PricePersonal Care Acne Gel 10 Benzoyl Peroxide
- Compare to Persa-Gelreg - 15 oz10
1076 $700
Ammonium Lactate Moisturizing Lotion - Compare to AmLactinreg
- 8 oz12
1368 $900
Hand Sanitizer - Compare to Purellreg - 8 oz
1065 $500
Skin and Sun Care Aloe Vera Cream - 8 oz
1070 $600
Calamine Lotion - 6 oz
1821 $600
Moisturizing Body Lotion with Aloe - 8 oz
1893 $800
Scar Gel - 50 gm
1852 $1200
Sunscreen Lotion SPF 30 - 35 oz
1284 $600
Sleep Aids Nasal Strips (Compare to Breathe Rightreg)
Medium - 30 ct
Large - 30 ct
1724
1725
$1200
$1200
Sleep Tablets - Compare to Sominexreg
- 50 ct25 mg
1276 $600
Smoking Cessation Nicorelief GumDagger
- Compare to Nicorettereg
- 50 ct4 mg
1372 $2500
Nicotine LozengesDagger
- Compare to Nicorettereg
- 72 ct4 mg
1281 $4400
Nicotine PatchStep 1Dagger
- Compare to NicoDerm CQ Step 1reg
- 14 ct21 mg 24 hrStep 2Dagger
- Compare to NicoDerm CQ Step 2reg
- 14 ct14 mg 24 hrStep 3Dagger
- Compare to NicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
1369
1370
1371
$4500
$4500
$4500
Supportive Items Ankle Support - Compare to Acereg
- 1 ct
1225 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
13
Category Description Item PriceFirst Aid and Medical Supplies (Continued)
Thermometer Flexible Tip Digital 10 seconds - 1 ct
1697 $1000
Thermometer Talking Ear and Forehead - 1 ct
1925 $4500
Triple Antibiotic Ointment - Compare to Neosporinreg
- 1 oz
1014 $700
Foot Care Callus Remover Pads - Compare to Dr Schollrsquosreg
- 6 ct
1238 $700
Corn Remover Pads - Compare to Dr Schollrsquosreg
- 9 ct
1236 $700
Medicated Foot Powder - 5 oz
1240 $700
Hemorrhoidal Preparations
Hemorrhoidal Ointment - Compare to Preparation Hreg
- 2 oz
1066 $700
Hemorrhoidal Suppository - 12 ct
1247 $700
Pre-moist Hemorrhoid Pads - Compare to Tucksreg
- 100 ct
1364 $800
Preparation Hreg Medicated Wipes - 48 ct
1895 $1300
Hormone Replacement DHEADagger
- 50 ct50 mg1737 $1200
Incontinence Supplies A and D Ointment - Compare to AandD Ointmentreg
- 2 oz
1300 $800
Adult Briefs(Compare to Dependreg)
Medium - 32rdquo to 44rdquo - 12 ct
Large - 45rdquo to 58rdquo - 12 ct
X-Large - 59rdquo to 64rdquo - Compare to Dependreg
- 15 ct
1303
1304
1305
$1000
$1200
$1200
Menrsquos Attends Discreet (Compare to Dependreg)
Guard - 20 ct
Shield - 20 ct
1811
1810
$1600
$1500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
14
Category Description Item PriceIncontinence Supplies (Continued)
Womenrsquos Attends Discreet(Compare to Dependreg)
Moderate Bladder Control Pad - 20 ct
Maximum Bladder Control Pad - 20 ct
Ultimate Bladder Control Pad - 20 ct
Ultrathin Pad - 20 ct
Panty Liner - 28 ct
1813
1812
1814
1816
1815
$1800
$2000
$2000
$1400
$1400
Barrier Cream - Compare to Lantiseptic Barrier Creamreg
- 4 oz
1302 $1000
Bladder Control Shaped Pad(Compare to Dependreg)
Moderate Absorbency - 24 ct
Heavy Absorbency - 24 ct
Maximum Absorbency - 18 ct
1478
1479
1480
$1700
$1900
$1600
Disposable Underwear(Compare to Dependreg)
Medium - 34rdquo to 44rdquo - 20 ct
Large - 44rdquo to 58rdquo - 18 ct
X-Large - 58rdquo to 68rdquo - 14 ct
1021
1026
1027
$1600
$1600
$1600
Flushable Wipes - 24 ct
1928 $750
Underpad Disposable(Compare to Dependreg)
23rdquo x 24rdquo - 50 ct
23rdquo x 36rdquo - 25 ct
30rdquo x 30rdquo - 10 ct
1476
1299
1477
$1500
$1000
$800
Washcloth with Lanolin - 64 ct
1348 $900
In-home Diagnostic Equipment
Bathroom ScaleDaggersect
- 1 ct1935 $3500
Blood Pressure Monitor (1 ct)Desktop AutomaticDagger
Desktop TalkingDagger
Replacement CuffDagger
WristDagger
Wrist TalkingDagger
12531503150415011502
$6000 $7000 $1500 $4000 $5000
your doctor before starting a new product regime
OTC MTalk with
EDICATIONS AND PRODUCTS
15
Category Description Item PriceIn-home Diagnostic Equipment (Continued)
Finger Pulse OximeterDagger
- 1 ct1505 $5200
Heart Rate Monitor WatchDagger
- 1 ct1771 $4000
In-home Diagnostic Tests
EZ Detect Colon Cancer Test KitDagger
- 1 ct1416 $1300
Home Access Cholesterol TestDagger
- 1 kit1251 $3300
Lice Treatment (Pediculicide)
Lice Elimination Kit - Compare to RIDreg
- 1 kit
1929 $2700
Lice Treatment Shampoo - Compare to RIDreg
- 4 oz
1271 $900
Permethrin Lice Treatment - Compare to Nixreg
- 59 ml1
1269 $1400
Mobility Cushion Foam Ring - 1 ct
1732 $2100
Cushion GelFoam Seat - 1 ct
1466 $4200
Cushion Lumbar - 1 ct
1731 $2700
Folding Cane Ergonomic Handle - 1 ct
1726 $2000
Quad Cane (1 ct) Small BaseLarge Base
17771776
$2500 $3000
Motion Sickness Dramamine Chewablesreg Orange - 8 ct50 mg
1264 $700
Driminate Antiemetic - Compare to Dramaminereg
- 12 ct50 mg
1263 $500
Meclizine HCL Antiemetic - 100 ct125 mg
1366 $800
Pain Relievers and Fever Reducers
AcetaminophenCompare to Tylenolreg
- 100 ct325 mg
1001
$600
Compare to Tylenol Extra Strengthreg
- 100 ct500 mg1600 $1000
Arthritis Pain Reliever - Compare to Tylenol Arthritisreg
- 100 ct650 mg
1311 $1200
Aspirin - Compare to Bayerreg
- 100 ct325 mg
1095 $500
Aspirin Enteric Coated - Compare to Bayerreg
- 100 ct325 mg
1096 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
- Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
- Compare to Capzasinreg
- 2 oz0025
1367 $1000
- 1 ct1943 $5500
(Compare to ThermaCarereg)Back and Hip
- 2 ctNeck Shoulder and Wrist
- 3 ct
1859
1860
$1300
$1300
- Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
- Compare to Alevereg
- 100 ct220 mg
1097 $1100
- Compare to Bengayreg
- 2 oz25
1475 $600
Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Pain Relievers and Fever Reducers (Continued)
Category Description Item Price
Aspirin Low Dose Chewables - Compare to Bayer Aspirin Chewable Low Dosereg
- 36 ct81 mg
1802 $500
ColdHot Menthol Medicated Patch- Compare to IcyHotreg
- 5 ct5
1944 $1000
Heating Pad 12rdquo x 15rdquo- 1 ct
1861 $2600
Ibuprofen - Compare to Advilreg
- 100 ct200 mg
1004 $700
Migraine Relief- Compare to Excedrinreg
- 100 ct250 mg 250 mg 65 mg
1365 $700
Pain Reliever PM - Extra Strength - Compare to Tylenol PMreg
- 100 ct
1332 $1000
Salonpas Pain Relief Patchesreg
- 5 ct 1739 $1400
XL Heating Pad 12rdquo x 24rdquo- 1 ct
1942 $3500
16
HeatWraps(Compare to ThermaCarereg)
Back and Hip - 2 ct
Neck Shoulder and Wrist - 3 ct
1859
1860
$1300
$1300
ThermaCarereg Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Naproxen - Compare to Alevereg
- 100 ct220 mg
1097 $1100
Lidocaine Patch - Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
Capsaicin External Analgesic - Compare to Capzasinreg
- 2 oz0025
1367 $1000
Aspirin Enteric Coated Low Dose - Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
Heating Pad Wrap for Shoulder Neck and Back 25rdquo x 26rdquo - 1 ct
1943 $5500
Pain Relieving Muscle Rub - Compare to Bengayreg
- 2 oz25
1475 $600
17
Category Description Item PricePersonal Care Acne Gel 10 Benzoyl Peroxide
- Compare to Persa-Gelreg - 15 oz10
1076 $700
Ammonium Lactate Moisturizing Lotion - Compare to AmLactinreg
- 8 oz12
1368 $900
Hand Sanitizer - Compare to Purellreg - 8 oz
1065 $500
Skin and Sun Care Aloe Vera Cream - 8 oz
1070 $600
Calamine Lotion - 6 oz
1821 $600
Moisturizing Body Lotion with Aloe - 8 oz
1893 $800
Scar Gel - 50 gm
1852 $1200
Sunscreen Lotion SPF 30 - 35 oz
1284 $600
Sleep Aids Nasal Strips (Compare to Breathe Rightreg)
Medium - 30 ct
Large - 30 ct
1724
1725
$1200
$1200
Sleep Tablets - Compare to Sominexreg
- 50 ct25 mg
1276 $600
Smoking Cessation Nicorelief GumDagger
- Compare to Nicorettereg
- 50 ct4 mg
1372 $2500
Nicotine LozengesDagger
- Compare to Nicorettereg
- 72 ct4 mg
1281 $4400
Nicotine PatchStep 1Dagger
- Compare to NicoDerm CQ Step 1reg
- 14 ct21 mg 24 hrStep 2Dagger
- Compare to NicoDerm CQ Step 2reg
- 14 ct14 mg 24 hrStep 3Dagger
- Compare to NicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
1369
1370
1371
$4500
$4500
$4500
Supportive Items Ankle Support - Compare to Acereg
- 1 ct
1225 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
14
Category Description Item PriceIncontinence Supplies (Continued)
Womenrsquos Attends Discreet(Compare to Dependreg)
Moderate Bladder Control Pad - 20 ct
Maximum Bladder Control Pad - 20 ct
Ultimate Bladder Control Pad - 20 ct
Ultrathin Pad - 20 ct
Panty Liner - 28 ct
1813
1812
1814
1816
1815
$1800
$2000
$2000
$1400
$1400
Barrier Cream - Compare to Lantiseptic Barrier Creamreg
- 4 oz
1302 $1000
Bladder Control Shaped Pad(Compare to Dependreg)
Moderate Absorbency - 24 ct
Heavy Absorbency - 24 ct
Maximum Absorbency - 18 ct
1478
1479
1480
$1700
$1900
$1600
Disposable Underwear(Compare to Dependreg)
Medium - 34rdquo to 44rdquo - 20 ct
Large - 44rdquo to 58rdquo - 18 ct
X-Large - 58rdquo to 68rdquo - 14 ct
1021
1026
1027
$1600
$1600
$1600
Flushable Wipes - 24 ct
1928 $750
Underpad Disposable(Compare to Dependreg)
23rdquo x 24rdquo - 50 ct
23rdquo x 36rdquo - 25 ct
30rdquo x 30rdquo - 10 ct
1476
1299
1477
$1500
$1000
$800
Washcloth with Lanolin - 64 ct
1348 $900
In-home Diagnostic Equipment
Bathroom ScaleDaggersect
- 1 ct1935 $3500
Blood Pressure Monitor (1 ct)Desktop AutomaticDagger
Desktop TalkingDagger
Replacement CuffDagger
WristDagger
Wrist TalkingDagger
12531503150415011502
$6000 $7000 $1500 $4000 $5000
your doctor before starting a new product regime
OTC MTalk with
EDICATIONS AND PRODUCTS
15
Category Description Item PriceIn-home Diagnostic Equipment (Continued)
Finger Pulse OximeterDagger
- 1 ct1505 $5200
Heart Rate Monitor WatchDagger
- 1 ct1771 $4000
In-home Diagnostic Tests
EZ Detect Colon Cancer Test KitDagger
- 1 ct1416 $1300
Home Access Cholesterol TestDagger
- 1 kit1251 $3300
Lice Treatment (Pediculicide)
Lice Elimination Kit - Compare to RIDreg
- 1 kit
1929 $2700
Lice Treatment Shampoo - Compare to RIDreg
- 4 oz
1271 $900
Permethrin Lice Treatment - Compare to Nixreg
- 59 ml1
1269 $1400
Mobility Cushion Foam Ring - 1 ct
1732 $2100
Cushion GelFoam Seat - 1 ct
1466 $4200
Cushion Lumbar - 1 ct
1731 $2700
Folding Cane Ergonomic Handle - 1 ct
1726 $2000
Quad Cane (1 ct) Small BaseLarge Base
17771776
$2500 $3000
Motion Sickness Dramamine Chewablesreg Orange - 8 ct50 mg
1264 $700
Driminate Antiemetic - Compare to Dramaminereg
- 12 ct50 mg
1263 $500
Meclizine HCL Antiemetic - 100 ct125 mg
1366 $800
Pain Relievers and Fever Reducers
AcetaminophenCompare to Tylenolreg
- 100 ct325 mg
1001
$600
Compare to Tylenol Extra Strengthreg
- 100 ct500 mg1600 $1000
Arthritis Pain Reliever - Compare to Tylenol Arthritisreg
- 100 ct650 mg
1311 $1200
Aspirin - Compare to Bayerreg
- 100 ct325 mg
1095 $500
Aspirin Enteric Coated - Compare to Bayerreg
- 100 ct325 mg
1096 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
- Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
- Compare to Capzasinreg
- 2 oz0025
1367 $1000
- 1 ct1943 $5500
(Compare to ThermaCarereg)Back and Hip
- 2 ctNeck Shoulder and Wrist
- 3 ct
1859
1860
$1300
$1300
- Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
- Compare to Alevereg
- 100 ct220 mg
1097 $1100
- Compare to Bengayreg
- 2 oz25
1475 $600
Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Pain Relievers and Fever Reducers (Continued)
Category Description Item Price
Aspirin Low Dose Chewables - Compare to Bayer Aspirin Chewable Low Dosereg
- 36 ct81 mg
1802 $500
ColdHot Menthol Medicated Patch- Compare to IcyHotreg
- 5 ct5
1944 $1000
Heating Pad 12rdquo x 15rdquo- 1 ct
1861 $2600
Ibuprofen - Compare to Advilreg
- 100 ct200 mg
1004 $700
Migraine Relief- Compare to Excedrinreg
- 100 ct250 mg 250 mg 65 mg
1365 $700
Pain Reliever PM - Extra Strength - Compare to Tylenol PMreg
- 100 ct
1332 $1000
Salonpas Pain Relief Patchesreg
- 5 ct 1739 $1400
XL Heating Pad 12rdquo x 24rdquo- 1 ct
1942 $3500
16
HeatWraps(Compare to ThermaCarereg)
Back and Hip - 2 ct
Neck Shoulder and Wrist - 3 ct
1859
1860
$1300
$1300
ThermaCarereg Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Naproxen - Compare to Alevereg
- 100 ct220 mg
1097 $1100
Lidocaine Patch - Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
Capsaicin External Analgesic - Compare to Capzasinreg
- 2 oz0025
1367 $1000
Aspirin Enteric Coated Low Dose - Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
Heating Pad Wrap for Shoulder Neck and Back 25rdquo x 26rdquo - 1 ct
1943 $5500
Pain Relieving Muscle Rub - Compare to Bengayreg
- 2 oz25
1475 $600
17
Category Description Item PricePersonal Care Acne Gel 10 Benzoyl Peroxide
- Compare to Persa-Gelreg - 15 oz10
1076 $700
Ammonium Lactate Moisturizing Lotion - Compare to AmLactinreg
- 8 oz12
1368 $900
Hand Sanitizer - Compare to Purellreg - 8 oz
1065 $500
Skin and Sun Care Aloe Vera Cream - 8 oz
1070 $600
Calamine Lotion - 6 oz
1821 $600
Moisturizing Body Lotion with Aloe - 8 oz
1893 $800
Scar Gel - 50 gm
1852 $1200
Sunscreen Lotion SPF 30 - 35 oz
1284 $600
Sleep Aids Nasal Strips (Compare to Breathe Rightreg)
Medium - 30 ct
Large - 30 ct
1724
1725
$1200
$1200
Sleep Tablets - Compare to Sominexreg
- 50 ct25 mg
1276 $600
Smoking Cessation Nicorelief GumDagger
- Compare to Nicorettereg
- 50 ct4 mg
1372 $2500
Nicotine LozengesDagger
- Compare to Nicorettereg
- 72 ct4 mg
1281 $4400
Nicotine PatchStep 1Dagger
- Compare to NicoDerm CQ Step 1reg
- 14 ct21 mg 24 hrStep 2Dagger
- Compare to NicoDerm CQ Step 2reg
- 14 ct14 mg 24 hrStep 3Dagger
- Compare to NicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
1369
1370
1371
$4500
$4500
$4500
Supportive Items Ankle Support - Compare to Acereg
- 1 ct
1225 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
15
Category Description Item PriceIn-home Diagnostic Equipment (Continued)
Finger Pulse OximeterDagger
- 1 ct1505 $5200
Heart Rate Monitor WatchDagger
- 1 ct1771 $4000
In-home Diagnostic Tests
EZ Detect Colon Cancer Test KitDagger
- 1 ct1416 $1300
Home Access Cholesterol TestDagger
- 1 kit1251 $3300
Lice Treatment (Pediculicide)
Lice Elimination Kit - Compare to RIDreg
- 1 kit
1929 $2700
Lice Treatment Shampoo - Compare to RIDreg
- 4 oz
1271 $900
Permethrin Lice Treatment - Compare to Nixreg
- 59 ml1
1269 $1400
Mobility Cushion Foam Ring - 1 ct
1732 $2100
Cushion GelFoam Seat - 1 ct
1466 $4200
Cushion Lumbar - 1 ct
1731 $2700
Folding Cane Ergonomic Handle - 1 ct
1726 $2000
Quad Cane (1 ct) Small BaseLarge Base
17771776
$2500 $3000
Motion Sickness Dramamine Chewablesreg Orange - 8 ct50 mg
1264 $700
Driminate Antiemetic - Compare to Dramaminereg
- 12 ct50 mg
1263 $500
Meclizine HCL Antiemetic - 100 ct125 mg
1366 $800
Pain Relievers and Fever Reducers
AcetaminophenCompare to Tylenolreg
- 100 ct325 mg
1001
$600
Compare to Tylenol Extra Strengthreg
- 100 ct500 mg1600 $1000
Arthritis Pain Reliever - Compare to Tylenol Arthritisreg
- 100 ct650 mg
1311 $1200
Aspirin - Compare to Bayerreg
- 100 ct325 mg
1095 $500
Aspirin Enteric Coated - Compare to Bayerreg
- 100 ct325 mg
1096 $500
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
- Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
- Compare to Capzasinreg
- 2 oz0025
1367 $1000
- 1 ct1943 $5500
(Compare to ThermaCarereg)Back and Hip
- 2 ctNeck Shoulder and Wrist
- 3 ct
1859
1860
$1300
$1300
- Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
- Compare to Alevereg
- 100 ct220 mg
1097 $1100
- Compare to Bengayreg
- 2 oz25
1475 $600
Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Pain Relievers and Fever Reducers (Continued)
Category Description Item Price
Aspirin Low Dose Chewables - Compare to Bayer Aspirin Chewable Low Dosereg
- 36 ct81 mg
1802 $500
ColdHot Menthol Medicated Patch- Compare to IcyHotreg
- 5 ct5
1944 $1000
Heating Pad 12rdquo x 15rdquo- 1 ct
1861 $2600
Ibuprofen - Compare to Advilreg
- 100 ct200 mg
1004 $700
Migraine Relief- Compare to Excedrinreg
- 100 ct250 mg 250 mg 65 mg
1365 $700
Pain Reliever PM - Extra Strength - Compare to Tylenol PMreg
- 100 ct
1332 $1000
Salonpas Pain Relief Patchesreg
- 5 ct 1739 $1400
XL Heating Pad 12rdquo x 24rdquo- 1 ct
1942 $3500
16
HeatWraps(Compare to ThermaCarereg)
Back and Hip - 2 ct
Neck Shoulder and Wrist - 3 ct
1859
1860
$1300
$1300
ThermaCarereg Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Naproxen - Compare to Alevereg
- 100 ct220 mg
1097 $1100
Lidocaine Patch - Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
Capsaicin External Analgesic - Compare to Capzasinreg
- 2 oz0025
1367 $1000
Aspirin Enteric Coated Low Dose - Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
Heating Pad Wrap for Shoulder Neck and Back 25rdquo x 26rdquo - 1 ct
1943 $5500
Pain Relieving Muscle Rub - Compare to Bengayreg
- 2 oz25
1475 $600
17
Category Description Item PricePersonal Care Acne Gel 10 Benzoyl Peroxide
- Compare to Persa-Gelreg - 15 oz10
1076 $700
Ammonium Lactate Moisturizing Lotion - Compare to AmLactinreg
- 8 oz12
1368 $900
Hand Sanitizer - Compare to Purellreg - 8 oz
1065 $500
Skin and Sun Care Aloe Vera Cream - 8 oz
1070 $600
Calamine Lotion - 6 oz
1821 $600
Moisturizing Body Lotion with Aloe - 8 oz
1893 $800
Scar Gel - 50 gm
1852 $1200
Sunscreen Lotion SPF 30 - 35 oz
1284 $600
Sleep Aids Nasal Strips (Compare to Breathe Rightreg)
Medium - 30 ct
Large - 30 ct
1724
1725
$1200
$1200
Sleep Tablets - Compare to Sominexreg
- 50 ct25 mg
1276 $600
Smoking Cessation Nicorelief GumDagger
- Compare to Nicorettereg
- 50 ct4 mg
1372 $2500
Nicotine LozengesDagger
- Compare to Nicorettereg
- 72 ct4 mg
1281 $4400
Nicotine PatchStep 1Dagger
- Compare to NicoDerm CQ Step 1reg
- 14 ct21 mg 24 hrStep 2Dagger
- Compare to NicoDerm CQ Step 2reg
- 14 ct14 mg 24 hrStep 3Dagger
- Compare to NicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
1369
1370
1371
$4500
$4500
$4500
Supportive Items Ankle Support - Compare to Acereg
- 1 ct
1225 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
- Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
- Compare to Capzasinreg
- 2 oz0025
1367 $1000
- 1 ct1943 $5500
(Compare to ThermaCarereg)Back and Hip
- 2 ctNeck Shoulder and Wrist
- 3 ct
1859
1860
$1300
$1300
- Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
- Compare to Alevereg
- 100 ct220 mg
1097 $1100
- Compare to Bengayreg
- 2 oz25
1475 $600
Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
Pain Relievers and Fever Reducers (Continued)
Category Description Item Price
Aspirin Low Dose Chewables - Compare to Bayer Aspirin Chewable Low Dosereg
- 36 ct81 mg
1802 $500
ColdHot Menthol Medicated Patch- Compare to IcyHotreg
- 5 ct5
1944 $1000
Heating Pad 12rdquo x 15rdquo- 1 ct
1861 $2600
Ibuprofen - Compare to Advilreg
- 100 ct200 mg
1004 $700
Migraine Relief- Compare to Excedrinreg
- 100 ct250 mg 250 mg 65 mg
1365 $700
Pain Reliever PM - Extra Strength - Compare to Tylenol PMreg
- 100 ct
1332 $1000
Salonpas Pain Relief Patchesreg
- 5 ct 1739 $1400
XL Heating Pad 12rdquo x 24rdquo- 1 ct
1942 $3500
16
HeatWraps(Compare to ThermaCarereg)
Back and Hip - 2 ct
Neck Shoulder and Wrist - 3 ct
1859
1860
$1300
$1300
ThermaCarereg Lower Back and Hip
- 2 ctMenstrual Relief
- 3 ct
1912
1913
$1500
$1500
Naproxen - Compare to Alevereg
- 100 ct220 mg
1097 $1100
Lidocaine Patch - Compare to Aspercreme Lidocaine Patchreg
- 5 ct4
1871 $1500
Capsaicin External Analgesic - Compare to Capzasinreg
- 2 oz0025
1367 $1000
Aspirin Enteric Coated Low Dose - Compare to Bayer Low Dosereg
- 120 ct81 mg
1002 $600
Heating Pad Wrap for Shoulder Neck and Back 25rdquo x 26rdquo - 1 ct
1943 $5500
Pain Relieving Muscle Rub - Compare to Bengayreg
- 2 oz25
1475 $600
17
Category Description Item PricePersonal Care Acne Gel 10 Benzoyl Peroxide
- Compare to Persa-Gelreg - 15 oz10
1076 $700
Ammonium Lactate Moisturizing Lotion - Compare to AmLactinreg
- 8 oz12
1368 $900
Hand Sanitizer - Compare to Purellreg - 8 oz
1065 $500
Skin and Sun Care Aloe Vera Cream - 8 oz
1070 $600
Calamine Lotion - 6 oz
1821 $600
Moisturizing Body Lotion with Aloe - 8 oz
1893 $800
Scar Gel - 50 gm
1852 $1200
Sunscreen Lotion SPF 30 - 35 oz
1284 $600
Sleep Aids Nasal Strips (Compare to Breathe Rightreg)
Medium - 30 ct
Large - 30 ct
1724
1725
$1200
$1200
Sleep Tablets - Compare to Sominexreg
- 50 ct25 mg
1276 $600
Smoking Cessation Nicorelief GumDagger
- Compare to Nicorettereg
- 50 ct4 mg
1372 $2500
Nicotine LozengesDagger
- Compare to Nicorettereg
- 72 ct4 mg
1281 $4400
Nicotine PatchStep 1Dagger
- Compare to NicoDerm CQ Step 1reg
- 14 ct21 mg 24 hrStep 2Dagger
- Compare to NicoDerm CQ Step 2reg
- 14 ct14 mg 24 hrStep 3Dagger
- Compare to NicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
1369
1370
1371
$4500
$4500
$4500
Supportive Items Ankle Support - Compare to Acereg
- 1 ct
1225 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
17
Category Description Item PricePersonal Care Acne Gel 10 Benzoyl Peroxide
- Compare to Persa-Gelreg - 15 oz10
1076 $700
Ammonium Lactate Moisturizing Lotion - Compare to AmLactinreg
- 8 oz12
1368 $900
Hand Sanitizer - Compare to Purellreg - 8 oz
1065 $500
Skin and Sun Care Aloe Vera Cream - 8 oz
1070 $600
Calamine Lotion - 6 oz
1821 $600
Moisturizing Body Lotion with Aloe - 8 oz
1893 $800
Scar Gel - 50 gm
1852 $1200
Sunscreen Lotion SPF 30 - 35 oz
1284 $600
Sleep Aids Nasal Strips (Compare to Breathe Rightreg)
Medium - 30 ct
Large - 30 ct
1724
1725
$1200
$1200
Sleep Tablets - Compare to Sominexreg
- 50 ct25 mg
1276 $600
Smoking Cessation Nicorelief GumDagger
- Compare to Nicorettereg
- 50 ct4 mg
1372 $2500
Nicotine LozengesDagger
- Compare to Nicorettereg
- 72 ct4 mg
1281 $4400
Nicotine PatchStep 1Dagger
- Compare to NicoDerm CQ Step 1reg
- 14 ct21 mg 24 hrStep 2Dagger
- Compare to NicoDerm CQ Step 2reg
- 14 ct14 mg 24 hrStep 3Dagger
- Compare to NicoDerm CQ Step 3reg
- 14 ct7 mg 24 hr
1369
1370
1371
$4500
$4500
$4500
Supportive Items Ankle Support - Compare to Acereg
- 1 ct
1225 $800
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
18
Category Description Item PriceSupportive Items (Continued)
Arthritis Gloves (1 pair) SmallMediumLarge
176717661765
$2500 $2500 $2500
Back Support Elastic (1 ct)(Compare to Acereg)
24rdquo to 46rdquoWith Lumbar
14871488
$2500 $2900
Carpal Tunnel Brace (1 ct) SmallMediumLarge
177017691768
$2500 $2500 $2500
Menrsquos Black Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger
13981399
$1700 $1700
Menrsquos White Compression Knee High Socks (1 pair15 - 20 mmHg)
Medium (Shoe Size 8 - 10)Dagger
Large (Shoe Size 105 - 12)Dagger14001401
$1700 $1700
Womenrsquos Black Compression Knee High Socks (1 pair8 - 15 mmHg)
Small (Shoe Size 4-5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140914101411
$1500 $1500 $1500
Womenrsquos Nude Compression Knee High Socks(1 pair8 - 15 mmHg)
Small (Shoe Size 4 - 5)Medium (Shoe Size 55 - 75)Large (Shoe Size 8 - 105)
140614071408
$1500 $1500 $1500
Elbow Support - 1 ct
1224 $1500
Hip Protector (1 ct) SmallMediumLargeX-Large
1862186318641865
$4500 $4500 $4500 $4500
Hypoallergenic Pillow - 1 ct
1936 $5500
Elastic Knee Support (1 ct)(Compare to Acereg)
SmallMediumLargeSmall with StaysMedium with StaysLarge with Stays
148114821483148414851486
$1000 $1000 $1000 $1600 $1600 $1600
Night Wrist Support Smart Glove - Compare to Futuro Night Wrist Supportreg
- 1 ct
1463 $2800
T our doctor before starting a new product regime
OTC Malk with y
EDICATIONS AND PRODUCTS
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
19
Category Description Item PriceSupportive Items (Continued)
Rib Belt (1 ct One size fits most)(Compare to Curad Rib Beltreg)
FemaleMale
14571456
$2100 $2100
Wrist Splint - Compare to Futuro Wrist Splintreg
- 1 ct
1230 $1900
Wrist Support - 1 ct
1227 $1200
Vitamins and Minerals Biotin GummyDagger
- Compare to Vitafusionreg
- 60 ct5000 mcg
1820 $1200
Calcium + Vitamin DDagger
- Compare to Caltrate-Dreg
- 60 ct600 mg 400 u
1373 $700
Calcium + Vitamin D GummyDagger
- Compare to Caltrate-D Gummyreg
- 60 ct500 mg 1000 IU
1823 $1400
Calcium Carbonate Supplement TabletsDagger
- Compare to Caltratereg
- 60 ct600 mg
1291 $500
Calcium Chew ChocolateDagger
- Compare to Caltratereg
- 60 ct500 mg 1000 IU
1945 $1100
Coenzyme Q-10Dagger
- 30 ct50 mg1829 $1200
Daily Multiple Vitamin Tablets with MineralsDagger
- Compare to Centrumreg
- 100 ct
1385 $700
Daily Multivitamin GummyDagger
- Compare to Vitafusionreg
- 120 ct
1972 $1250
Ferrous Gluconate Iron SupplementDagger
- Compare to Fergonreg
- 100 ct240 mg
1375 $600
Ferrous Sulfate Iron SupplementDagger
- Compare to Feosolreg - 100 ct325 mg
1376 $500
Fish Oil Soft GelsDagger
- 60 ct1000 mg1741 $1100
Folic AcidDagger
- 100 ct800 mcg1850 $800
GlucosamineChondroitinDagger
- 60 ct250 mg 200 mg1003 $1100
Healthy Eyes with Lutein - Compare to Ocuvitereg
- 60 ct
1975 $850
IronDagger
- 110 ct27 mg1417 $900
Please note that could change thr
the products you receive may look different from the images shown in this brochure The packaging oughout the year Be assured the active ingredients in the products will remain the same
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
20
Category Description Item PriceVitamins and Minerals (Continued)
Leg Cramps Pain Relief CapletsDagger
- 50 ct1869 $1400
MagnesiumDagger
- 110 ct250 mg1418 $800
Magnesium OxideDagger
- 100 ct250 mg1377 $700
MelatoninDagger
- 100 ct5 mg1879 $1200
Melatonin GummyDagger
- Compare to Vitafusionreg
- 120 ct5 mg
1971 $1500
NiacinDagger
- 100 ct100 mg1378 $500
NiacinDagger
- 100 ct500 mg1394 $1000
Niacin No FlushDagger
- 60 ct500 mg1930 $1500
Omega and DHA Gummy - Compare to Vitafusionreg
- 120 ct275 mg 50 mg
1976 $1400
One Daily Menrsquos MultivitaminDagger
- Compare to One-A-Day Menrsquosreg
- 100 ct
1886 $1000
One Daily Womenrsquos MultivitaminDagger
- Compare to One-A-Day Womenrsquosreg
- 100 ct
1887 $1000
Potassium Gluconate - 100 ct595 mg
1977 $600
Senior MultivitaminDagger
- Compare to Centrum Silverreg
- 90 ct
1392 $1000
Stress Formula Tablets with ZincDagger
- 60 ct1734 $1400
Vitamin ADagger
- 100 ct10000 iu1379 $600
Vitamin B-1Dagger
- 100 ct100 mg1016 $600
Vitamin B-12Dagger
- 100 ct1000 mcg1381 $1000
Vitamin B-12 SublingualDagger
- 30 ct5000 mcg1974 $1000
Vitamin B-6Dagger
- 100 ct50 mg1380 $600
Vitamin B-6Dagger
- 100 ct100 mg1388 $800
Vitamin B-ComplexDagger
- 100 ct1382 $600
Talk with your doctor before starting a new product regime
OTC MEDICATIONS AND PRODUCTS
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
21
sect Scales are only available to customers with congestive heart failure or liver disease Please talk with your health care provider before ordering
Dagger Must be recommended by your health care provider for a specific diagnosed condition Please talk with your provider before ordering
Category Description Item PriceVitamins and Minerals (Continued)
Vitamin B-Complex GummyDagger
- Compare to Vitafusionreg
- 70 ct
1915 $1200
Vitamin CDagger
- 100 ct500 mg1017 $600
Vitamin C GummyDagger
- Compare to Vitafusionreg
- 60 ct250 mg
1916 $1100
Vitamin DDagger
- 100 ct400 iu1383 $600
Vitamin DDagger
- 100 ct1000 iu1390 $800
Vitamin DDagger
- 100 ct5000 iu1973 $1000
Vitamin E Soft GelsDagger
- 100 ct400 iu1384 $900
Zinc ChelatedDagger
- 100 ct50 mg1419 $800
Wart Remover Wart Remover Liquid - Compare to Compound Wreg
- 9 ml17
1075 $900
Weight Loss Vitafusionreg Fiber Weight ManagementDagger
- 90 ct1735 $1600
Please note that the products you receive may look different from the images shown in this brochure The packaging could change throughout the year Be assured the active ingredients in the products will remain the same
Date Item
KEEP TRACK OF YOUR ORDERS BELOW
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
22
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
Notice of Nondiscrimination Discrimination is Against the Law
Cigna-HealthSpring complies with applicable Federal civil rights laws and does not discriminate on the basis of race color national origin age disability or sex Cigna-HealthSpring does not exclude people or treat them differently because of race color national origin age disability or sex
Cigna-HealthSpring x 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)
x 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 Customer Service at 1-800-668-3813 8 amndash8 pm 7 days a week
If you believe that Cigna-HealthSpring 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
Cigna-HealthSpring Attn Customer Grievances PO Box 2888 Houston TX 77252-2888 Phone 1-800-668-3813 (TTY 711) Fax 1-888-586-9946
You can file a grievance in writing by mail or fax If you need help filing a grievance Customer Service is available to help you
You can also file a civil rights complaint with the US Department of Health and Human Services Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal available at httpsocrportalhhsgovocrportallobbyjsf or by mail or phone at
US Department of Health and Human Services 200 Independence Avenue SW Room 509F HHH Building Washington DC 20201 1-800-368-1019 800-537-7697 (TDD) Complaint forms are available at httpwwwhhsgovocrofficefileindexhtml
$OOampLJQDSURGXFWVDQGVHUYLFHVDUHSURYLGHGH[FOXVLYHOERUWKURXJKRSHUDWLQJVXEVLGLDULHVRIampLJQDampRUSRUDWLRQ7KH ampLJQDQDPHORJRVDQGRWKHUampLJQDPDUNVDUHRZQHGEampLJQDQWHOOHFWXDO3URSHUWQF$77(1721IRXVSHDN ODQJXDJHVRWKHUWKDQ(QJOLVKODQJXDJHDVVLVWDQFHVHUYLFHVIUHHRIFKDUJHDUHDYDLODEOHWRRXampDOO77ltDPplusmnSPGDVDZHHN$7(1ampIuml1VLXVWHGKDEODXQLGLRPDTXHQRVHDLQJOpVWLHQHDVXGLVSRVLFLyQ VHUYLFLRVJUDWXLWRVGHDVLVWHQFLDOLQJtVWLFDODPHDO77ltDPplusmnSPGtDVGHODVHPDQD ampLJQD+HDOWK6SULQJLVFRQWUDFWHGZLWK0HGLFDUHIRU33SODQV+02DQG332SODQVLQVHOHFWVWDWHVDQGZLWKVHOHFW 6WDWH0HGLFDLGSURJUDPV(QUROOPHQWLQampLJQD+HDOWK6SULQJGHSHQGVRQFRQWUDFWUHQHZDOINT_17_49135 09302016
23
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna
Three ways to order
CALL 1-866-851-1579 (TTY 711) Monday - Friday 8 am - 11 pm EST
COMPLETE the order form enclosed and mail it
NEW CLICK to order at wwwCignaHealthSpringOTCcom
Residents of nursing facilities should check to determine which OTC products may be shipped to their facility before ordering Product ordering policies may vary by facility PLEASE NOTE The items covered by the benefit are limited to items that are consistent with CMS guidance in the most recent version of chapter 4 of the Medicare Managed Care Manual Each item in the following alphabetized list is either a medicine ointment or spray or a condition which is addressed by a medicine ointment or spray acid acne allergy analgesics (which reduce pain inflammation) anti-arthritics antibiotics anti-diarrheals anti-fungals anti-gas antihistamines anti-inflammatory anti-insect anti-itch anti-parasitic antipyretics (fever reducing) antiradicals antiseptics arthritis asthma blood clotting bruises burns calluses colds cold sores corns cough decongestants dermatitis diabetes digestive aids ear drops eczema expectorants (mucus) eye drops flu gastrointestinal hay fever headaches hemorrhoidal incontinence influenza lactose intolerance products laxatives (medicated) lice (medicated) lip products menopausal menstrual motion sickness nasal osteoporosis pain pediculicide psoriasis rash respiratory scars sinus sleep smoking snoring sore throat steroids stomach sunscreen thrush travel sickness wart wormswounds etc The following are not eligible for purchase through the OTC and will not be covered by Cigna-HealthSpring Baby medicines contraceptives dehydration drink dry skin lotions (eg Eucerinreg Aquaphorreg) hair-loss products lactaid milk (because it is a food not a medicine) and shampoos to fight dandruff Certain smoking cessation may be Part B Certain diabetic supplies may be Part B or Part D Please contact Customer Service for more information Antiperspirants lip balm deodorants facial cleansers feminine products grooming devices hair conditioners hair removal hair bleaches moisturizers perfumes shampoos shaving and menrsquos grooming and soaps are also not eligible All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation including CignaHealth and Life Insurance Company Cigna HealthCare of South Carolina Inc Cigna HealthCare of North Carolina Inc CignaHealthCare of Georgia Inc Cigna HealthCare of Arizona Inc Cigna HealthCare of St Louis Inc HealthSpring Life amp Health Insurance Company Inc HealthSpring of Florida Inc Bravo Health Mid-Atlantic Inc and Bravo Health Pennsylvania Inc The Cigna name logos and other Cigna marks are owned by Cigna Intellectual Property Inc The benefit information provided is a brief summary not a complete description of benefits For more information contact the plan Limitations copayments and restrictions may apply Benefits formulary pharmacy network provider network premium andor copaymentscoinsurance may change on January 1 of each year Cigna-HealthSpring is contracted with Medicare for PDP plans HMO and PPO plans in select states and with select State Medicaid programs Enrollment in Cigna-HealthSpring depends on contract renewal copy 2018 Cigna