over-the-counter booklet 2019 cigna-healthspring · 2018-12-13 · 2 3 4 save money and time. ......

24
INT_19_65379 _C Approved 08302018 920824 OVER-THE-COUNTER (OTC) MEDICATIONS AND PRODUCTS Your 2019 catalog

Upload: vuongdan

Post on 12-Feb-2019

212 views

Category:

Documents


0 download

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