When your EmblemHealth Medicare Advantage plan includes the over-the-counter (OTC) benefit, you can get covered for the OTC items below. Your benefit amount and how you get your OTC items and supplies depends on the plan you join.
When your EmblemHealth Medicare Advantage plan includes the over-the-counter (OTC) benefit, you can get covered for the OTC items below. Your benefit amount and how you get your OTC items and supplies depends on the plan you join.
Our plan covers CMS-approved over-the-counter (OTC) health-related items. Certain brands are included. Eligible health categories include:
Our plan does not cover over-the-counter (OTC) items in these categories (note: non-covered items can change):
Please note the product list is subject to change. Items, quantities, sizes, and brands change depending on availability at the retailer.
Take a look at the chart below to find your plan and information on how to use your OTC benefit:
Plan Name |
Frequency |
OTC items by mail order |
OTC items in retail stores |
OTC items and healthy foods |
OTC card |
---|---|---|---|---|---|
EmblemHealth VIP Dual (HMO D-SNP) |
Monthly |
✓ |
✓ |
✓ |
✓ |
EmblemHealth VIP Dual Reserve (HMO D-SNP) |
Monthly |
✓ |
✓ |
✓ |
✓ |
EmblemHealth VIP Dual Select (HMO D-SNP) |
Monthly |
✓ |
✓ |
|
✓ |
EmblemHealth VIP Reserve (HMO) |
Monthly |
✓ |
|
|
|
EmblemHealth VIP Rx Saver (HMO) |
Monthly |
✓ |
|
|
|
See your Evidence of Coverage or Cost Sharing Guide for the OTC amount you get with your plan or call EmblemHealth Medicare Connect Concierge for help. OTC benefit amount must be used within the benefit month and will not roll over.
You can use your OTC benefit to buy both covered health items and healthy foods* from any participating OTC store or pharmacy we contract with, online, by phone, or through mail- order. The combined over-the-counter (OTC) health and food benefit allows you to also purchase fresh, nutritious, and healthy grocery items.
*EmblemHealth VIP Dual Select members do not have an OTC food option.
Eligible food categories include:
Ways to get healthy food eligible items:
*EmblemHealth VIP Dual Select, EmblemHealth VIP Reserve, and EmblemHealth VIP Rx Saver members do not have an OTC food option.
By mail – just fill out and send the mail-order form below to ConveyBenefits.
List of covered OTC items by mail, phone and online and mail order form
Visit ConveyBenefits.com/emblemhealth to select your covered items and complete the checkout process.
Call ConveyBenefits at 855-858-5940 (TTY: 711),
Monday to Friday, 8 am to 8 pm
EmblemHealth VIP Reserve (HMO) and EmblemHealth VIP Rx Saver (HMO) plan members receive $25 per month and can get covered OTC items by mail order only.
Visit emblemhealth.com/mailOTC to select your covered items and complete the checkout process.
Call NationsOTC at 877-239-2942 (TTY: 711), Monday to Friday, 8 am to 8 pm
Mail-order items should be received in the mail within two to five business days from the time of receipt of your order. If the total amount of your order is more than your OTC balance, you will be asked for an alternate method of payment. You can use a credit card online or over the phone, and a check when using mail order.
We ask that you use your benefit in one of the ways listed above. If you are unable, you can request a refund using the below form. 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 send you a refund check in the mail.
Over-the-counter (OTC) Reimbursement Form:
If you have any questions, please see your Evidence of Coverage or Cost Sharing Guide for the OTC allowance amount you get with your plan or call EmblemHealth Medicare Connect Concierge at 877-344-7364 (TTY: 711), 8 am to 8 pm, seven days a week.
Last Updated 05/26/2022
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