2018 Over the Counter (OTC) Benefits

As a member of EmblemHealth's VIP Dual (HMO SNP), you will get an OTC Medicare debit card with a monthly benefit $100 or $1200 yearly in 2018 when you enroll in the plan. You can use this debit card to buy covered items from any OTC pharmacy we contract with. Please review list of covered items below.

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 an EmblemHealth VIP Dual (HMO SNP) member, call 1-877-344-7364 (TTY: 711) 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 VIP Dual (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 controllers, liquids and tablets
  • Adult aspirin, and pain relief
  • Allergy, sinus and combination liquids and tablets
  • Cough, cold and flu liquids and tablets
  • Denture/dental care (floss, toothbrush, toothpaste, and denture care)
  • Ear drops and eye wash
  • Foot care (corn/callus/bunion pads and removers, anti-fungal powders/creams/liquids/sprays)
  • Incontinence
  • Laxatives (stool softeners and fiber acid)
  • Vitamins and minerals

Our plan does not cover OTC drugs in these categories:

Non-Covered Items

  • CoenzymeQ10 (COQ10) - herbals and botanicals - (example echinacea- ginsenge-ginko giloba)
  • Digestive aids (probiotics and prebiotics)
  • Foot care (foot grooming, foot moisturizers, exfoliators & cleansers, odor and wetness treatment insoles/inserts)
  • Heart health and essential fatty acids (fish oil, flax, Gamma Linolenic Acid (GLA), etc.)
  • Liquids and powders and bars
  • Meal replacement shakes/nutrition drinks (Ensure, Boost and Glucerna)
  • Oral care (mouthwash and breath remedies)
  • Sport/energy liquids
  • Weight management foods

How to get reimbursed:

If you forget to bring your debit card with you to the store or pharmacy, you may also ask for a refund using a paper claim form.

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 refund you for the covered OTC item(s) and take off that amount from your current debit card balance.

If you have any questions, please call Customer Service at 1-877-344-7364 (TTY: 711), 8 am to 8 pm,  seven days a week. Customer Service has free language translator services available for non-English speakers.

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