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2014 Over the Counter (OTC) Benefits

As a member of EmblemHealth's Dual Eligible (HMO SNP), you will get a OTC Medicare debit card with a monthly benefit $45 or $540 annually in 2014 when you enroll in the plan. EmblemHealth's Dual Eligible (PPO SNP), you will get a OTC Medicare debit card with a monthly benefit $25 or $300 annually. You can use this debit card to buy covered items from any OTC network pharmacy. View the list of covered OTC items (Y0026_124245 Accepted 02/10/2014) you can buy with your debit card. Please note that not all OTC items are covered. Your card will only work for covered items.

How to buy your OTC item(s):

To get your OTC item(s), take your debit card and your covered OTC item(s) to the checkout at any store or pharmacy in the OTC network. The amount you spend will be taken out of your monthly benefit. Your left-over balance will show at the bottom of your receipt. Any leftover balance will carry over until your next purchase. You must use the entire balance on the card before the end of each month. On the first day of each month your balance will be reset.

Participating stores:

You can use the debit card to pay for covered OTC items at participating stores, including Duane Reade, CVS, Rite Aid, Walgreens and Family Dollar. Other stores are available in the network.

If you are a EmblemHealth Dual Eligible (PPO SNP) member, call 1-866-557-7300 for help finding a participating store. If you are a EmblemHealth Dual Eligible (HMO SNP) member, call 1-877-344-7364 for help finding a participating store.

For debit card balance:

Please call 1-888-682-2400 and enter your OTC Medicare card number listed on the front of your card and your plan member ID located on the front of your EmblemHealth Dual Eligible (PPO SNP) or EmblemHealth Dual Eligible (HMO SNP) member ID card. You can also check your balance at www.otcmedicare.com.

Our plan covers some OTC drugs in these categories:

Covered items

  • Acid controller
  • Adult acetaminophen
  • Adult aspirin combinations
  • Adult ibuprophen
  • Adult nighttime pain relief
  • Adult topical headache & fever relief
  • Allergy, sinus & combination liquids
  • Allergy, sinus & combination tabs
  • Antacid liquids
  • Antacid tabs & other forms
  • Antacid effervescent
  • Cough, cold & flu liquids
  • Cough, cold & flu tabs
  • Cold & flu preventatives/symptom reducers
  • Feminine pain relief
  • Generic adult pain relief
  • Motion sickness relief
  • Sleep aids & sedatives
  • Sore throat pain relief
  • Throat & cough drops


Our plan does not cover OTC drugs in these categories:

Non-Covered Items

  • Anti-diarrheals
  • Anti-gas
  • Compression hosiery
  • Diabetes care
  • Digestive aids
  • Elastics/athletic treatment
  • Eye/ear care
  • First aid
  • Foot care
  • Hemorrhoidal preparations
  • Home health items
  • Laxatives
  • Lip care
  • Nasal items
  • Oral care
  • Respiratory treatments
  • Skin care
  • Smoking deterrents
  • Sun care
  • Vitamins/dietary supplements
  • Weight control/nutritional food


How to get reimbursed:

If you forget to bring your debit card with you to the store or pharmacy, you may also ask for reimbursement using a paper claim form (Y0026_122256 File and Use 11/08/2010). After you pay for the OTC item(s), simply mail your completed paper claim form to us with a copy of the receipt(s) for the covered item(s) you bought. We will then reimburse you for the covered OTC item(s) and take off that amount from your current debit card balance.

For EmblemHealth PPO SNP: If you have any questions, please call Customer Service at 1-866-557-7300 (TTY/TDD users should call 711), Monday through Sunday, 8 am to 8 pm. Customer Service also has free language translator services available for non-English speakers.

For EmblemHealth HMO SNP: If you have any questions, please call Customer Service at 1-877-344-7364 (TTY/TDD users should call 711), Monday through Sunday, 8 am to 8 pm. Customer Service has free language translator services available for non-English speakers




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Medicare Annual Enrollment
October 15 through December 7. Are you covered?
Last Updated 10/14/14
Y0026_124627 Approved

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