Medical Support Services Company

EmblemHealth VIP Dual (HMO SNP)

and EmblemHealth Affinity Medicare

Ultimate (HMO SNP)

Over-the-Counter

(OTC) Covered Items

As a member of EmblemHealth VIP

Dual (HMO SNP) and EmblemHealth Affinity

Medicare Ultimate (HMO SNP), you can use

your Over-the-Counter (OTC) debit card to

buy covered items from any participating

OTC pharmacy. For more information about

participating OTC pharmacies, please visit

otcnetwork.com.

Please note you can only use this card to buy

items for yourself.

Over-the-Counter (OTC) Covered Drugs

Abdominal Supports & Rib Belts

Acid Controllers

Allergy

Allergy Liquids, Tabs & Caps

Allergy Nasal Sprays, Drops & Inhalers

Anti-Diarrheals

Anti-Diarrheal Tabs, Liquids & Caps

Antifungal Treatments

Antifungal Powders, Creams, Liquids & Sprays

Nail Fungus Treatments

Anti-Gas

Mixed/Miscellaneous Anti-Gas

Anti-Itch Treatments

Anti-Itch Treatments (Excluding Hydrocortisone),

Jock Itch & Insect Bite Remedies

Hydrocortisone Products

Antiparasitic Treatments

Lice Treatments & Accessories

Braces

Ankle & Foot

Elbow & Arm

Hand & Wrist

Joint Warmers & Arthritis

Knee

Thigh, Calf & Shin

Contact Lens Care

Gas Permeable & Hard Lens Care

Soft Lens Cleaners

Soft Lens Multi-Purpose & Saline Solutions

Soft Lens Rewetting Drops

Cough, Cold, Flu & Sinus

Cold & Flu Preventatives/Symptom Reducers

Cough, Cold, Flu & Sinus Liquids, Tabs & Caps

Cough Drops, Sore Throat Relief

Sore Throat Pain Relief

Throat & Cough Drops

and Items

Denture Care

Alcohol Swabs and Wipes

Denture Adhesives

Denture Repair & Pain Relief

Diabetes Health & Personal Care

Diabetes Cough, Cold & Allergy

Diabetes Skin Care & External Pain Relief

Diabetes Supplements

Digestive Aids

Lactose Intolerance

Prebiotics & Probiotics

Diuretics & Weight Loss Cleansing & Detox

Diuretics

Weight Loss Cleansing & Detox

Ear Care

Ear Drops & Syringes

Hearing Aids

Lipoflavonoids

Elastic Bandages & Athletic Treatments

Athletic Treatments

Elastic Bandages

Protective Guards

Electrical & Audio

Hearing Aid Batteries

(Standard & High Performance)

External Pain Relief

External Muscle/Joint Pain Relief Patches,

Pads, Creams, Ointments, Gels,

Lotions, Liquids, Roll-Ons & Sprays

Eye Care

Magnifying Glasses

Reading Glasses

Eye Preparations (Includes Sleep Masks)

Dry Eye Relief

Eye Relief Products

Eye Wash

Facial & Body Acne Medications

Acne Creams, Gels, Lotions, Patches, Soaps,

Cleansers, Astringents, Toners & Pads

Feminine Antifungal

First Aid Dressings

Adhesive & Liquid Bandages

Finger Cots & Splints

First Aid Kits, Supplies & Tapes

Gauze Pads, Dressings & Rolls

Surgical Bandages & Dressings

First Aid Treatments

Antiseptics & Medicated Products

(Includes Alcohol, Peroxide, Epsom Salt, Etc.)

Skin Protectants (Includes Petroleum Jelly)

Skin Treatments (Includes Burn & Scar)

Topical Antibiotics

Wound Cleansers

Floss & Gum Care

Dental Gum

Floss & Flossers

Gum Care

Foot Cushioning & Treatments

Corn, Callus & Bunion Pads

Corn & Callus Removers

Foot Pain Relief

Athletic Support Socks

General Compression Sleeves & Garments

General Support - Low Compression

(8-15 mmHg) & Medical Support High

Compression (Over 8-15 mmHg)

Lymphedema Treatments (Sleeves,

Socks, Pumps, Etc.)

Medical Compression Sleeves & Garments

Mixed/Miscellaneous General Support

- Low Compression (8-15mmHg)

Medical Support & Accessories

(Knee High, Thigh High & Waist High)

Men’s Support Hose

Women’s High Compression Support

Hose - Full & Maternity

Women’s Support Hose - Knee High,

Thigh High, Full & Maternity

Hemorrhoid Preparations

Hemorrhoid Treatments, Wipes & Washes

Home Diagnostics and Aids for Daily Living

Bathing & Oral Hygiene Aids

Blood Pressure Kits & Accessories

Drug & Alcohol Tests

Electric Heating Pads

Grooming & Dressing Aids

Medical Alert IDs & Devices

Medicine Dosers, Pillboxes,

Organizers & Reminders

Mobility Safety: Stair Rails, Stair Treads,

Temporary Mobility Ramps

Nightlights, Safety Lights, Pill Cutters

Reachers, Grippers & Lifts

Reading, Writing & Telephone Aids

Stethoscopes & Accessories

Thermometers, Fever Strips & Accessories

Home Health Care

Bathtub Safety & Accessories

Bathtub & Toilet Rails & Frames

Elevated Toilet Seats & Accessories

Grab Bars & Handles

Hand Held Showers

Mixed/Miscellaneous Bathroom Safety

Sitz Baths & Bidets

Incontinence Personal Care

Deodorizers

Disposable Underwear, Briefs,

Undergarments, Underpads, Pads,

Shields, Guards & Drip Collectors

Perineal - Only Antifungals

Perineal - Only Cleansers & Washes

Perineal - Only Moisturizers,

Barriers & Protectants

Perineal - Only Wipes & Novelettes

Laxatives

Enemas, Laxative Suppositories, Kits, Etc.

Fiber Products

Laxative Liquids & Combination

Stool-Softener Products

Non-Liquid Laxatives (Non-Fiber) &

Combination Stool-Softener Products

Stool Softeners

Lip Care

Medicated Lip Treatments

Nasal

Decongestant Nasal Sprays, Drops & Inhalers

Nasal Moisturizers, Washes, Strips & Snore Relief

Oral Remedies (Includes Fluoride Treatments)

Dry Mouth

Oral Pain Relief & Mouth Sores

Temporary Dental Repair

Orthopedic & Surgical Support

Arm Slings & Cervical Collars

Hernia Supports & Suspensories

Sacro & Back Braces

Shoulder & Clavicle Braces

Pain Relief

Adult Acetaminophen

Adult Aspirin & Combinations

Adult Ibuprofen & Other Anti-Inflammatories

Adult Nighttime Pain Relief

Adult Specialty Pain Relief

Feminine Pain Relief

Patient Skin Support

Antifungals

Moisturizers, Barriers & Protectants

Physical Fitness & Exercise Equipment

Fitness Trackers & Pedometers

Respiratory Treatments

Asthma Preparations

Humidifiers & Accessories

Repository Treatments

Vapor Products (Includes Waterless Vaporizers)

Reusable Incontinence

Reusable Garments & Underpads

Sleep Aids, Stimulants & Motion Sickness

Motion Sickness & Vertigo

Sleep Aids, Sedatives & Stimulants

Smoking Deterrents

Nicotine Patches, Gums & Lozenges

Over-the-Counter (OTC) Covered Drugs

Specialized Orthopedic Braces/Supports/

Splints

Specialized Ankle & Foot Braces/Supports/Splints

Specialized Elbow & Arm Braces/Supports/Splints

Specialized Hinged Knee Braces/Supports/Splints

Specialized Knee Immobilizer

Braces/Supports/Splints

Specialized Shoulder & Clavicle

Braces/Supports/Splints

Specialized Thigh & Calf Braces/Supports/Splints

Specialized Wrist & Hand Braces/

Supports/Splints

Specialized Wound Care

Alginate Dressings

Collagen Dressings

Foam Dressings

Gauze Dressings, Pads, Sponges & Packing

Hydrocolloid/Hydrogel Dressings

Tapes, Wraps & Compression

Transparent Dressings

Wound Cleansers, Treatments & Accessories

Stomach Remedies

Antacids

Antacid Liquids, Tabs & Caps

Effervescent Antacids & Combinations

Multi-Symptom & Nausea Products

Sun Protection

Sport Sun Protection

Sun Protection (< SPF 50)

Sun Protection (SPF 50+)

Supplements

Enzymes, Amino Acids & Hormones

Eye Health Vitamins

General Health Prebiotics & Probiotics

Menopause Support (Soy)

Weight Management Tabs & Caps

Toothbrushes

Battery & Rechargeable Toothbrushes & Refills

Manual Toothbrushes & Accessories

and Items (Continued)

Toothpastes & Treatments

Regular & Sensitive Toothpastes

Tooth Powders & Treatments

Whitening Toothpastes

Urine Testing

Urine Test Strips & Tabs

Vitamins

Calcium

CoQ10 Only (UBIQUINOL)

Eye Health Vitamins

Heart Health & Essential Fatty Acids

(Fish Oil, Flax, GLA, Etc.)

Iron

Joint Health (Including Glucosamine)

Multi-Minerals

Vitamin B & Vitamin B Complex

Vitamin C

Vitamin D

Vitamin E

Wart Removers

Liquids & Pads

HIP Health Plan of New York (HIP) is an HMO

plan with a Medicare contract. Enrollment in

HIP depends on contract renewal. HIP is an

EmblemHealth company.

Group Health Incorporated (GHI), Health

Insurance Plan of Greater New York (HIP),

HIP Insurance Company of New York and

EmblemHealth Services Company, LLC are

EmblemHealth companies. EmblemHealth

Services Company, LLC provides administrative

services to the EmblemHealth companies.

Y0026_127357_C NS

86-9378 1/19

Contact this candidate