NA9WCMOTC17707K_ROTC_R

Transcription

1 2019 일반의약품 (OTC) 카탈로그 Medicare Advantage 플랜 Y0070_WCM_15199K_FINAL_02 CMS Accepted WellCare 2018 NA9WCMOTC17707K_ROTC

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3 WellCare 가드리는혜택시간과돈을절약하고싶으세요? 일반의약품 OTC 혜택을누리십시오. 이혜택은더욱편리한생활을위해 WellCare 가제공하는추가혜택입니다. 고객이부담해야할비용은전혀없습니다. 붕대, 진통제, 감기약, 치약, 비타민등과같은 OTC 품목 ( 브랜드품목, 복제약품목모두포함 ) 을구매하는빠르고간편한방법입니다. 이카탈로그를살펴본후온라인으로또는전화로주문하세요. 귀하의댁까지주문하신품목을무료로배송해드립니다. 각플랜은서로다른 OTC 혜택금액을제공합니다. 귀하의플랜을통해제공되는구체적금액이궁금하시면보장범위증명서또는혜택요약서를확인해주십시오. 귀하의혜택과품목은오직본인만사용할수있습니다. 혜택을일부사용하지않았더라도걱정하지마십시오. 쓰지않은혜택은다음달 / 분기로이월됩니다. 나의일반의약품 OTC 혜택은어떻게사용하나요? 혜택금액을이용해늘사용하는갖가지품목을넉넉히구매하십시오. 품목을주문하는방법은두가지입니다. 주문방법과관계없이주문하신품목을댁까지배송해드립니다. 아주간단합니다. 주문품목수령까지는영업일로 7-10 일정도를감안해주십시오. 가입자환급에대한정보는고객서비스센터에문의하십시오. 이카탈로그를살펴보신후다음단계를따르십시오. 1 저희에게전화합니다. 거주하는주의고객서비스센터전화번호는이카탈로그뒷면에서확인할수있습니다. 친절한상담원이도움을드리기위해대기하고있습니다. 2 에서온라인으로주문합니다. 사용자이름과암호로로그온합니다. 사용자이름이없으면간단히가입할수있습니다. 안내에따라가입하면됩니다. 총혜택금액을초과하기전까지품목을주문합니다. 일부혜택금액을사용하지않았거나월 / 분기에주문하는것을잊으셨나요? 1 품목주문은반드시매달또는분기마다완료해주십시오. 한달이나분기를건너뛰었더라도혜택이다음달 / 분기로이월되므로걱정하지마십시오. 2 일반의약품 OTC 카탈로그는매년변경될수있습니다. 최신카탈로그로새로운품목과전년대비변경사항을확인하십시오. 최신카탈로그는 에서온라인으로확인할수있습니다. 본카탈로그뒷면에있는거주하는주의고객서비스센터전화번호로전화하여사본을요청할수도있습니다. 요청하시면바로보내드립니다. 즐겁게쇼핑하십시오! NA9WCMOTC17707K_ROTC

4 일반의약품 OTC 목록을읽는방법 품목분류 ID# 복제약명수량 * 비용 ID# 브랜드명 * 수량 * 비용 알레르기예방및치료 1 알레르기완화제 ( 세티리진 ) 10mg 정제 30 $ Zyrtec 14 $17 품목 ID 번호 복제품목명 복제품목수량 복제품목가격 품목 ID 번호 브랜드품목명 브랜드품목수량 브랜드품목가격 품목분류 ID# 복제약명수량 * 비용 ID# 브랜드명 * 수량 * 비용 알레르기예방및치료 26 관절염통증완화제정제 24 $5 해당사항없음 Tylenol 관절염 해당사항없음 해당사항없음 품목 ID 번호 복제품목명 복제품목수량 복제품목가격 이용불가능 동일한성분을포함하는의약품의예 브랜드품목수량 브랜드품목가격 품목, 수량, 크기및가치는재고여부에따라달라질수있습니다. * = 수량및브랜드는재고여부에따라달라질수있습니다. ** = 경우에따라파트 B 또는파트 D에서보장됩니다. 파트 B 또는파트 D에서보장되는품목은 Medicare 보장품목이며추가 OTC 혜택대상품목이아닙니다. = 의약품인동시에건강기능식품인품목 NA = 복제약및 / 또는브랜드품목이용불가능제품비교에표시되는품목은다르거나정확히동일하지않을수있습니다. 품목비용은매년변경될수있습니다. 일부품목은제조업체에따라다를수있습니다 ( 예 : 캐플렛, 알약, 캡슐또는소프트젤이서로바뀔수있음 ).

5 ALLERGY PREVENTION AND TREATMENT 1 2 Allergy Relief Cetirizine 10mg Tablets Allergy Relief Loratadine 10mg Tablets 280 Nasoflow Allergy Relief 30 $ Zyrtec 14 $19 30 $7 502 Claritin 10 $14 60 Sprays $ Flonase 9.9 ml $37 ANALGESICS / ANTIPYRETICS 3 Acetaminophen 325mg Tablets 100 $4 503 Tylenol 325mg Regular Strength Tablets 100 $12 4 Acetaminophen 500mg Tablets 100 $5 504 Tylenol 500mg Extra Strength Tablets 100 $18 5 Aspirin 325mg Tablets 100 $3 505 Bayer Aspirin 325mg 100 $10 6 Aspirin 81mg Chewable 36 $3 Bayer Aspirin 81mg Chewable 7 8 Aspirin Enteric Coated 81mg Tablets Aspirin Enteric Coated 325mg Tablets 120 $5 507 Bayer EC Aspirin 81mg Adult Regimen 32 $6 100 $4 508 Ecotrin Tablets 325mg 459 Menstrual Pain Relief 24 $5 Midol 654 Menthol/Camphor 8G TIGER BALM 8G 8G $12 ANTACIDS AND ACID REDUCERS Acid Reducer Esomeprazole Acid Reducer Famotidine 10mg Tablets Acid Reducer Omeprazole 20mg Acid Reducer Ranitidine 75mg Tablets 686 Nexium 22.3mg 14 $26 30 $6 509 Pepcid AC Tab 10mg 30 $12 14 $ Prilosec OTC 20mg 14 $16 30 $7 511 Zantac OTC 75mg 30 $17 12 Antacid Tablets 150 $5 512 Tums Tablets 150 $10

6 ANTACIDS AND ACID REDUCERS (CONTINUED) 13 Effervescent Tablets 36 $6 513 Alka-Seltzer 24 $9 14 Gas Relief Caplet Extra-Strength 30 $4 514 Gas-X Extra Strength 18 $8 ANTICANDIDAL YEAST 15 Miconazole Vaginal Suppository 3-Day 1 $ Monistat Vaginal Suppository 3-Day 16 Adult Glycerin Suppositories ANTIDIARRHEAL AND LAXATIVES 25 $3 516 Fleet Adult Suppositories 50 $6 17 Anti-Diarrheal Caplets 12 $4 Imodium A-D Caplets 18 Anti-Nausea Liquid 4 oz. $7 518 Emetrol 19 Bisacodyl 5mg Tablets 25 $4 519 Dulcolax Tablets 25 $8 231 Enema Mineral Oil 4.5 oz. $4 Fleet Mineral Oil 279 Enema Saline Laxative 4.5 oz. $2 779 Fleet Enema A24, Saline 4.5 oz. $ Laxative Bisacodyl 10mg Suppositories Stomach Relief Flavored Liquid Stomach Relief Flavored Liquid Stomach Relief Flavored Tablets 12 $5 520 Dulcolax Suppositories 8 oz. $6 790 Pepto-Bismol 8 oz. $9 691 Pepto-Bismol 16 oz. $15 30 $4 521 Pepto-Bismol Tablets 30 $7 22 Stool Softener Softgel 100 $6 522 Colace Softgels 30 $15 ANTI-INFLAMMATORY 23 Ibuprofen 200mg Liquid Gel Caps 20 $5 523 Advil Liqui-Gels Caps 200mg 20 $8 24 Ibuprofen 200mg Tablets 50 $6 524 Advil Tablets 200mg 50 $12

7 ANTI-INFLAMMATORY (CONTINUED) Naproxen Sodium 220mg Caplets Arthritis Pain Relief Tablets 50 $8 525 Aleve Caplets 220mg 24 $9 ARTHRITIS MEDICINE 24 $5 Tylenol Arthritis 27 Hot/Cold Patches 5 $6 527 Icy Hot Patches 5 $9 Hot/Cold Patches 695 Salonpas Patch 5 $15 Pain Relief Roll-On $6 696 Pain Relief Stick, Topical 700 Icy Hot, Pain Relief Roll-on Advocate Pain Relief Stick, Topical 1 $ oz. $14 BLADDER CONTROL ITEMS 170 Adult Bladder Control Pads 28 $9 Depend Adult Bladder Control Pads 167 Adult Protective Disposable Briefs S/M 20 $18 Depend Adult Protective Briefs S/M 168 Adult Protective Disposable Briefs LG 20 $18 Depend Adult Protective Briefs LG 169 Adult Protective Disposable Briefs XL 20 $20 Depend Adult Protective Briefs XL 200 Disposable Bed Underpads 5 $6 Prevail Disposable Bed Underpads COLD/COUGH/FLU REMEDIES 53 APAP Sinus Congestion 24 $4 553 Tylenol Sinus Congestion 24 $9 54 Cough/Throat Drops 30 $3 554 Halls Cough Drops 30 $ Daytime Cold/Flu Relief Softgel Daytime Cold/Flu Relief Liquid Daytime/Nite-time Cold/Flu Caplets 16 $5 555 DayQuil Softgels 16 $10 4 oz. $5 556 DayQuil Liquid 8 oz. $10 20 $5 674 Mucinex Day/Night Caplets 30 $20

8 COLD/COUGH/FLU REMEDIES (CONTINUED) Diphenhydramine 25 Mg. Capsules Green Tea, Multi Flu/ Severe Cold Honey Lemon 24 $3 Benadryl 6 $9 933 TheraFlu, Multi-Symptom Severe Cold Lemon 6 $18 57 Mucus Relief DM Tablets 30 $9 557 Mucinex DM 20 $19 58 Mucus Relief Tablets 30 $8 558 Mucinex 20 $17 59 Nasal Decongestion Spray 1 oz. $4 559 Afrin Nasal Spray 0.5 oz. $ Nasal Decongestion PE Tablets Nite-Time Cold/Flu Relief Softgels Nite-Time Cold/Flu Relief Liquid 36 $4 Sudafed PE 16 $5 561 NyQuil Caplets 16 $10 4 oz. $7 562 NyQuil Liquid 8 oz. $10 63 Saline Nasal Spray 1.5 oz. $3 563 Ocean Nasal Spray 1.5 oz. $8 64 Sore Throat Spray 6 oz. $5 Chloraseptic Sore Throat Spray 211 Sugar-Free Cough/ Throat Drops 25 $3 Halls Sugar-Free Cough Drops 65 Tussin DM Syrup SF 4 oz. $4 565 Robitussin DM Syrup 4 oz. $10 66 Tussin Syrup 4 oz. $4 Robitussin Syrup 67 Vapor Rub 3.53 oz. $5 Vicks Vaporub 451 HBP Cough Cold 16 $6 651 Coricidin 20 $ Acetaminophen PM 500mg 50 $3 658 Tylenol PM 24 $15 DENTAL AND DENTURE CARE 69 Denture Adhesive Cream 2.4 oz. $5 569 Fixodent 2.4 oz. $8

9 DENTAL AND DENTURE CARE (CONTINUED) 70 Denture Cleaner 40 $4 570 Efferdent 20 $5 71 Fluoride Toothpaste 6.4 oz. $4 571 Colgate 4 oz. $5 72 Adult Toothbrush - Medium 73 Dental Floss Sensitive Teeth Toothpaste Toothache Relief Liquid/Gel 313 Dental Floss, Waxed 314 Dental Floss, Mint Waxed 1 $2 572 Colgate Toothbrush - Soft 1 $4 130 Yards $2 573 Reach Dental Floss 55 yards 4.3 oz. $5 Sensodyne 0.33 oz. 55 Yards 55 Yards $4 576 Anbesol Liquid/Gel $1 573 Reach Dental Floss 0.41 oz. 55 Yards $1 Reach Dental Floss $3 $11 $3 315 Denture Brush 1 $1 GUM Denture Brush 318 Toothpaste 0.85 oz. 330 Toothbrush, Rechargeable 1 $ Toothbrush, Rechargeable Replace Heads $1 Colgate Toothpaste Oral-B Toothbrush, Rechargeable 2 $9 Oral-B Toothbrush, Heads 332 Flosser, Mechanical 1 $12 Power Flosser 333 Water Jet, Battery Operated 1 $23 Oral-B Vitality Water Jet EAR CARE 77 Ear Syringe 1 $3 Apex Ear Syringe 78 Ear Wax Drops 0.5 oz. $7 578 Debrox Ear Wax Drops 0.5 oz. $9

10 EYE CARE 79 Artificial Tears 0.5 oz. $6 579 Visine Tears 0.5 oz. $9 437 Eye Drops, Sensitive, Single Use 0.4 oz., 30 ct. $6 Visine Eye Drops Sensitive 238 Eye Wash 3.9 oz. $5 Collyrium Eye Wash 93 Red Eye Relief Drops 0.5 oz. $4 593 Visine Drops 0.5 oz. $8 452 Ketotifen Fumarate, Eye Itch Relief 0.17 oz. $21 Eye Itch Relief 473 Lutein, 20mg, Eye Vitamin 30 $17 Ocuvite FIBER SUPPLEMENTS 94 Fiber Gummies 60 $ Vitafusion Fiber Well Gummies 90 $20 95 Fibertab Tablets 90 $9 FiberCon Caplets 281 Psyllium Powder, Orange 13 oz. $ Metamucil Orange 114 $40 Psyllium Powder, Orange Sugar Free 782 Metamucil Orange Sugar Free 114 $40 Psyllium Powder, Orange Sugar Free 783 Metamucil Orange Sugar Free 72 $35 FIRST AID AND MEDICAL SUPPLIES Elastic Bandage** 1 $1 ACE 3 Elastic Bandage** 96 Adhesive First Aid Tape** 1 $2 ACE Adhesive First-Aid Tape** 189 Aid Ankle Support 1 $7 Futuro Aid Ankle Support 191 Aid Elbow Support 1 $7 Futuro Aid Elbow Support 192 Aid Hand Support 1 $7 Futuro Aid Hand Support

11 FIRST AID AND MEDICAL SUPPLIES (CONTINUED) 166 Aid Knee Support 1 $7 Futuro Aid Knee Support 190 Aid Wrist Support 1 $7 Futuro Aid Wrist Support 97 Alcohol Pads** 100 $3 Dynarex Alcohol Pads** 163 Anti-Embolism Stockings LG 1 $13 Futuro Anti-Embolism Stockings LG 164 Anti-Embolism Stockings MED 1 $13 Futuro Anti-Embolism Stockings MED 165 Anti-Embolism Stockings SM 1 $13 Futuro Anti-Embolism Stockings SM 162 Anti-Embolism Stockings XL 1 $13 Futuro Anti-Embolism Stockings XL 98 Athletic Bandage** 1 $2 ACE Athletic Bandage** 340 Back Support, Curad** 1 $39 Futuro Back Support, Curad** 339 Back Support, Generic with Suspenders** 1 $19 Futuro Back Support With Suspenders** 99 Bandages Assorted** 100 $6 599 BAND-AID Bandages** 100 $ Bandages, 3/4 x 3 ** 50 $1 ACE Bandages, 3/4 x 3 ** 326 Bath Mat, 27 x 13 1 $13 Softex Bath Mat 341 Blood Pressure Monitor Audio, Full Audio** 1 $60 Omron Blood Pressure Monitor Audio** 334 Blood Pressure Monitor, LG Cuff** 1 $41 Omron BP Monitor, LG Cuff** 342 Blood Pressure Monitor, Wrist** 1 $25 Omron Blood Pressure Monitor, Wrist** 335 Blood Pressure Monitor, XL Cuff** 1 $41 Omron BP Monitor XL Cuff** 366 Brace, Carpal Tunnel Night Brace** 1 $53 Futuro Carpal Tunnel Night Brace**

12 FIRST AID AND MEDICAL SUPPLIES (CONTINUED) 373 Brace, Thumb** 1 $10 Futuro Thumb Brace** 100 Butterfly Closures** 12 $2 ACE Butterfly Closures** 346 Cane Adjustable 29 to 38 1 $20 NOVA Adjustable Cane Cane Folding Adjustable 32 to 36 Cane, Adjustable Quad Bariatric** Cane, Adjustable Quad Non-Bariatric** 101 Corn and Callus Remover 1 $15 NOVA Folding Cane 1 $41 1 $ oz. $4 NOVA Quad Bariatric Cane** NOVA Quad Non-Bariatric Cane** Dr. Scholl s Corn and Callus Remover 102 Cotton Balls 100 $3 J & J Cotton Balls 312 Cotton Balls 76 $1 J & J Cotton Balls 103 Cotton Swabs 150 $3 603 Q-Tips Cotton Swabs 170 $ Diabetic Socks Ladies Size 5-10 Black Diabetic Socks Ladies Size 5-10 White Diabetic Socks Men Size Black Diabetic Socks Men Size White Ear and Forehead Thermometer, 4-in-1 3 Pack $7 3 Pack $7 3 Pack $7 3 Pack $7 258 Elastic Knee Support 1 $3 Dr Scholl s Diabetic Socks Ladies Dr Scholl s Diabetic Socks Ladies Dr Scholl s Diabetic Socks Men Dr Scholl s Diabetic Socks Men 1 $32 Innovo Thermometer Futuro Elastic Knee Support 104 First Aid Kit 1 $8 ACE First Aid Kit 105 Flexible Tip Thermometer 1 $10 Veridian Flexible Tip Thermometer

13 FIRST AID AND MEDICAL SUPPLIES (CONTINUED) 376 Foam Pillow, 20x14x5** 1 $33 Certa icomfort Foam Pillow** 235 Gauze Pad Sterile 4 x4 ** ply $14 ACE Gauze Pad Sterile 4 x4 ** 236 Gauze Surgical Sponge Sterile 4 x4 ** ply $6 ACE Gauze Surg. Sponge Sterile 4 x4 ** 237 Gauze Value Surgical Sponges 4 x4 ** ply $5 ACE Gauze Value Surgical Sponges 4 x4 ** 369 Glove, Carpal Tunnel - LG** 1 $48 Thermoskin Glove, Carpal Tunnel - LG** 368 Glove, Carpal Tunnel - MED** 1 $48 Thermoskin Glove, Carpal Tunnel - MED** 367 Glove, Carpal Tunnel - SM** 1 $48 Thermoskin Glove, Carpal Tunnel - SM** 338 Gloves, For Arthritis - LG** 1 Pair $29 IMAK Gloves, For Arthritis - LG** 337 Gloves, For Arthritis - MED** 1 Pair $29 IMAK Gloves, For Arthritis - MED** 336 Gloves, For Arthritis - SM** 1 Pair $29 IMAK Gloves, For Arthritis - SM** 343 Heart Rate Monitor Watch** 1 $30 Fitbit Heart Rate Monitor Watch** 239 Heating Pad, Dry Heat, 12x15 1 $21 ACE Heating Pad, Dry Heat, 12x Humidifier - Ultrasonic 1 $57 Honeywell Humidifier - Ultrasonic 221 Hydrogen Peroxide 8 oz. $2 Swan Hydrogen Peroxide 320 Hydrogen Peroxide 4 oz. $1 Swan Hydrogen Peroxide 106 Ice Bag 1 $4 Carex Ice Bag 284 Liquid Bandage Liquid Bandage oz oz. $6 784 New-Skin Liquid Bandage 0.3 oz. $9 785 New-Skin Liquid Bandage 1 oz. $13

14 FIRST AID AND MEDICAL SUPPLIES (CONTINUED) 107 Liquid Wart Remover 0.31 oz. $7 607 Compound W Wart Remover 0.31 oz. $ Medicated Foot Powder 4 oz. $8 Gold Bond Medicated Foot Powder 108 Oral Digital Thermometer 1 $5 Luminiscope Oral Digital Thermometer 351 Pulse Oximeter** 1 $40 SantaMedical Pulse Oximeter** 220 Rubbing Alcohol 70%** 16 oz. $3 Swan Rubbing Alcohol** 324 Shower Safety Benches, Without Back 1 $45 NOVA Shower Safety Benches, W/O Back 109 Stretch Gauze** 1 $2 ACE Stretch Gauze** Support, Knee with U Buttress, LG** Support, Knee with U Buttress, MED** Support, Knee with U Buttress, XL** 319 Surgical Tape** 345 Thermometer, Audio Ear and Forehead 1 $48 1 $48 1 $48 1 x 10Yd. Copper Fit Knee Support, w/u Butt. LG** Copper Fit Knee Support, w/u Butt. MED** Copper Fit Knee Support, w/u Butt. XL** $1 ACE Surgical Tape** 1 $53 Dual Scan Thermometer, Audio 322 Toilet Safety Rails 1 $59 NOVA Toilet Safety Rails 321 Toilet Seat, Raised 1 $30 NOVA Toilet Seat, Raised 323 Toilet Seat, Raised Lock Top with Arms 1 $73 NOVA Toilet Seat, With Arms 328 Transfer Bench, Adjustable 1 $94 NOVA Transfer Bench, Adjustable 327 Tub and Stair Safety Treads 4 $3 Carex Tub and Stair Safety Treads 325 Tub Safety Bar, Suction 1 $60 Lumex Tub Safety Bar, Suction

15 FIRST AID AND MEDICAL SUPPLIES (CONTINUED) 439 Wound Wash Spray 3 oz. $12 Arm & Hammer Wound Wash Spray 444 Ear Dry Drops 1 oz. $10 Ear Clear Swimmer s Ear 445 Snoring Nose Strips 10 ct. $12 Breathe Right 446 Arm Sling 1 $14 ACE Arm Sling 448 Ethyl Alcohol Gel 4 oz. $4 Hand Sanitizer Gel 453 Flex Seal Spray Bandage 4 oz. $10 New-Skin Liquid Bandage 454 Hydrogen Peroxide Spray 4 oz. $9 MEDI-FIRST Hydrogen Peroxide Spray Bandage-Antibiotics 653 BAND-AID Plus Antibiotic 20 $12 HEADACHE RELIEF 110 Headache Relief Tablets 50 $6 610 Excedrin Migraine 24 $7 HEMORRHOIDAL PREPARATIONS 111 Hemorrhoid Ointment 2 oz. $7 611 Preparation H Ointment 2 oz. $ Hemorrhoid Pads 100 $7 612 Tucks Medicated Pads 100 $ Hemorrhoid Relief Suppositories 12 $7 613 Preparation H Suppositories 24 $12 LACTOSE INTOLERANCE 114 Lactase Enzyme 60 $ Lactaid Tablets 32 $11 MOTION SICKNESS MEDICATION 115 Motion Sickness Tablets 12 $3 615 Dramamine Motion Sickness 12 $7

16 OTHER PRODUCTS 447 Cooling Towel 1 $10 Perfect Fitness Cooling Towel 464 Men s Washable Underwear SM 1 $30 Depend Men s Washable Underwear SM 465 Men s Washable Underwear MD 1 $30 Depend Men s Washable Underwear MD 466 Men s Washable Underwear LG 1 $30 Depend Men s Washable Underwear LG 467 Men s Washable Underwear XL 1 $30 Depend Men s Washable Underwear XL 468 Ladies Washable Panty SM 1 $30 Prevail Ladies Washable Panty SM 469 Ladies Washable Panty MD 1 $30 Prevail Ladies Washable Panty MD 470 Ladies Washable Panty LG 1 $30 Prevail Ladies Washable Panty LG 471 Ladies Washable Panty XL 1 $30 Prevail Ladies Washable Panty XL 472 Adult Washcloths Disposable 48 $5 Prevail Washcloths Disposable 455 Unisex Overnight Briefs/XL 20 $25 Depend Overnight Briefs/XL 456 Unisex Overnight Briefs/L 20 $20 Depend Overnight Briefs/L 457 Unisex Overnight Briefs/M 20 $20 Depend Overnight Briefs/M PEDICULICIDES-HEAD LICE TREATMENTS 136 Lice Comb 1 $3 RID Lice Comb 137 Lice Treatment Shampoo 4 oz. $ LiceMD Lice Shampoo 4 oz. $14 SLEEPING AIDS 138 Night Time Sleep Tablets 50 $4 638 Sominex Tablets 16 $7 139 Sleep Aid Tablets Doxylamine 16 $6 639 Unisom Tablets 16 $8

17 SMOKING CESSATION PRODUCTS 196 Nicotine Gum 2mg 20 $10 Nicorette 2mg 197 Nicotine Gum 4mg 20 $10 Nicorette 4mg TOPICAL OINTMENTS AND CREAMS Antibiotic Ointment 697 Antibiotic Ointment 698 Vitacilina Antibiotic Ointment Vitacilina Antibiotic Ointment 0.5 oz. $5 1 oz. $7 140 Anti-Itch Cream 1.25 oz. $4 640 Benadryl Cream 1 oz. $8 278 Benzoyl Peroxide 10% Gel 42.5g $5 678 Clearasil Vanishing Cream 1 oz. $ Clotrimazole 1% Cream 0.5 oz. $6 641 Lotrimin AF Cream 142 Cold Sore Treatment 1 $7 Herpecin Cold Store Treatment 0.42 oz. $12 Cold Sore Treatment 675 Abreva Cream 2 g. $32 Diaper Rash Ointment 699 Vitacilina Bebe Diaper Rash Ointment 1.76 oz. $6 143 Hydrocortisone 1% Cream 1 oz. $5 Cortaid Cream 413 Hydrocortisone Maximum Strength 1 oz. $3 Eczema Maximum Strength Cream 144 Muscle Rub Cream 1.25 oz. $3 644 Bengay Cream 2 oz. $8 145 Petroleum Jelly 4 oz. $3 645 Vaseline Jelly 171 SPF 50 Sunblock 4 oz. $6 Coppertone SPF 50 Sunblock 3.75 oz. $5 146 Tolnaftate 1% Cream 1.25 oz. $6 646 Tinactin Cream 1 oz. $ Triple Antibiotic Ointment 1 oz. $5 647 Neosporin Ointment 0.5 oz. $8

18 VITAMINS AND MINERALS 148 Adult Multi-Vitamins 100 $8 648 Centrum Vitamins 130 $ Biotin Gummy 5,000mcg 60 $10 Vitafusion Biotin Gummy 419 Calcium 500Mg+Vitamin D3 1,000IU Gummy 60 $16 Vitafusion Calcium + Vitamin D3 Gummy 149 Calcium Vitamin D 60 $7 649 Caltrate D Tablets 60 $16 Calcium Chewable Tablets 692 Windmill Calcium Chewable Tabs. 500Mg 60 $5 150 Calcium Tablets 60 $5 Calcium Tablets 232 FDC Vit. B Complex with Vitamin C + Iron 100 $ FDC Vitamin D Tablets 400IU 100 $6 151 Ferrous Sulfate Iron 325mg Tablets 100 $6 152 Folic Acid 400mcg Tablets 100 $ Magnesium 500mg Tablets 100 $5 416 Multi-Vitamin Gummy 60 $10 Windmill Vit. B Comp. with VIT. C+IRON Nature s Bounty Vitamin D 400IU Nature Made Ferrous Sulfate Iron 325mg Windmill Folic Acid Tablets Mcg. Nature Made Magnesium 500mg Vitafusion Multi-Vitamin Gummy 100 $7 100 $7 Silver Multi-Vitamins 676 Centrum Silver Vitamins 125 $ Vitamin A 10,000 IU Softgels 100 $4 Nature s Way Vitamin A 10,000 IU 156 Vitamin B mcg 100 $8 Nature Made B-12 Vitamins 157 Vitamin B-Complex 100 $6 Nature Made Vitamin B-Complex 158 Vitamin B-Complex Gummy 70 $10 Vitafusion Vitamin B-Complex Gummy 159 Vitamin C 500mg Tablets 100 $5 Nature Made Vitamin C 500mg

19 VITAMINS AND MINERALS (CONTINUED) 193 Vitamin C Gummy 60 $10 Vitafusion Vitamin C Gummy 418 Vitamin D3 Gummy, 2,000 IU 60 $10 Vitafusion Vitamin D3 Gummy, 2,000 IU 160 Vitamin E 400 IU 100 $8 Nature Made Vitamin E 400 IU 161 Zinc 50mg Tablets 100 $5 Sundown Naturals Zinc 50mg 460 Potassium Gluconate 595Mg 100 $7 Potassium Gluconate 463 Glucose Tab 50 ct. $8 DEX4 Glucose Tab

20 We re always just a phone call away! If you re ready to enroll or have enrollment questions, call (CA), (HI), (TX)*, (TX)**, or (All Others). Representatives are available from 8 a.m. to 8 p.m., 7 days a week. If you re already a member, call the number for your state/plan listed below. Alabama (AL): WellCare Value (HMO) Arkansas (AR): Arizona (AZ): California (CA): Connecticut (CT): Florida (FL): WellCare Rx (HMO), WellCare Value (HMO-POS), WellCare Advance (HMO-POS), WellCare Preferred (HMO), WellCare Premier (PPO) WellCare Liberty (HMO SNP), WellCare Access (HMO SNP) WellCare Value (HMO) WellCare Liberty (HMO SNP) Easy Choice Plus Plan (HMO), Easy Choice Best Plan (HMO), Easy Choice Rx (HMO) Easy Choice Freedom Plan (HMO SNP) WellCare Preferred (HMO), WellCare Rx (HMO-POS), WellCare Value (HMO) WellCare Liberty (HMO SNP), WellCare Access (HMO SNP) WellCare Dividend (HMO), WellCare Value (HMO), WellCare Value (HMO-POS), WellCare Essential (HMO-POS), WellCare Dividend Prime (HMO), WellCare Elite (HMO), WellCare Premier (PPO),WellCare Prime (PPO), WellCare Guardian (HMO SNP), WellCare Champion (HMO SNP) WellCare Select (HMO SNP), WellCare Access (HMO SNP), WellCare Liberty (HMO SNP), WellCare Reserve (HMO SNP) Georgia (GA): Hawaii (HI): Illinois (IL): Kentucky (KY): WellCare Value (HMO), WellCare Advance (HMO-POS), WellCare Choice (HMO), WellCare Premier (PPO), WellCare Prime (PPO) WellCare Access (HMO SNP), WellCare Liberty (HMO SNP) Ohana Value (HMO) Ohana Liberty (HMO SNP) WellCare Advance (HMO-POS), WellCare Value (HMO-POS), WellCare Rx (HMO), WellCare Plus (HMO), WellCare Choice (HMO-POS) WellCare Value (HMO), WellCare Essential (HMO-POS), WellCare Advance (HMO-POS) WellCare Access (HMO SNP), WellCare Liberty (HMO SNP)

21 Louisiana (LA): WellCare Rx (HMO), WellCare Value (HMO) WellCare Liberty (HMO SNP), WellCare Access (HMO SNP) WellCare Value (HMO) WellCare Access (HMO SNP) Maine (ME): WellCare Today s Options Advantage Plus 150A (PPO), WellCare Today s Options Advantage Plus 550B (PPO), WellCare Today s Options Advantage 300 (PPO) WellCare Today s Options Premier 300 (PFFS), WellCare Today s Options Premier 200 (PFFS) Mississippi (MS): North Carolina (NC): New Jersey (NJ): WellCare Value (HMO), WellCare Essential (HMO-POS), WellCare Advance (HMO-POS) WellCare Liberty (HMO SNP), WellCare Access (HMO SNP) WellCare Value (HMO) WellCare Access (HMO SNP) WellCare Rx (HMO), WellCare Value (HMO-POS) WellCare Liberty (HMO SNP) WellCare Value (HMO), WellCare Rx (HMO), WellCare Choice (HMO), WellCare Preferred (HMO), WellCare Essential (HMO), WellCare Advance (HMO), WellCare Today s Options Classic (HMO), WellCare Premier (PPO) WellCare Access (HMO SNP) WellCare Liberty (HMO SNP) New York (NY): WellCare Today s Options Advantage Plus 750B (PPO), WellCare Today s Options Advantage Plus 450A (PPO), WellCare Today s Options Advantages 300 (PPO), WellCare Today s Options Advantages Plus 550B (PPO), WellCare Today s Options Advantages Plus 150A (PPO) WellCare Today s Options Premier Plus 650B (PFFS), WellCare Today s Options Premier Plus 250A (PFFS), WellCare Today s Options Premier 300 (PFFS), WellCare Today s Options Premier 200 (PFFS) South Carolina (SC): WellCare Value (HMO), WellCare Elite (HMO), WellCare Advance (HMO-POS), WellCare Prime (PPO), WellCare Premier (PPO) WellCare Access (HMO SNP)

22 Tennessee (TN): WellCare Dividend (HMO), WellCare Rx (HMO), WellCare Value (HMO-POS), WellCare Advance (HMO-POS) WellCare Access (HMO SNP) WellCare TexanPlus Classic (HMO)*, WellCare TexanPlus Value (HMO), WellCare TexanPlus Choice (HMO-POS) WellCare TexanPlus Classic (HMO)** Texas (TX): WellCare TexanPlus Classic (HMO)***, WellCare Dividend Prime (HMO), WellCare Value (HMO-POS) WellCare Liberty (HMO SNP), WellCare Access (HMO SNP), WellCare TexanPlus Star (HMO SNP) Retiree MA PD CY (HMO) Hours of operation are Monday Friday, 8 a.m. to 8 p.m. Between October 1 and February 14, representatives are available Monday Sunday, 8 a.m. to 8 p.m., or visit us anytime at or Nurse Advice Line (24 hours, 7 days a week) TTY for all of the above * Texas Service Area: Austin, Brazoria, Chambers, Fort Bend, Galveston, Hardin, Harris, Jefferson, Liberty, Montgomery, Orange, Waller ** Texas Service Area: Colin, Dallas, Rockwall, Tarrant *** Texas Service Area: Bexar, El Paso, Travis, Williamson

23 Multi-Language Insert Multi-Language Interpreter Services ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call (TTY: 711). ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY: 711). WCM_14436Z Internal Approved WellCare 2018 NA9WCMINS14857E_0000

24 Discrimination is Against the Law WellCare Health Plans, Inc., complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. WellCare Health Plans does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. WellCare Health Plans, Inc.: Provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters Written information in other formats (large print, audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languages If you need these services, contact WellCare Customer Service for help or you can ask Customer Service to put you in touch with a Civil Rights Coordinator who works for WellCare. If you believe that WellCare Health Plans, Inc., 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: WellCare Health Plans, Inc. Grievance Department P.O. Box Tampa, FL Telephone: TTY: 711 Fax: OperationalGrievance@wellcare.com You can file a grievance in person or by mail, fax, or . If you need help filing a grievance, a WellCare Civil Rights Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue SW. Room 509F, HHH Building Washington, DC , (TDD) Complaint forms are available at * This Nondiscrimination Notice also applies to all subsidiaries of WellCare Health Plans, Inc. WCM_14439E WellCare 2018 NA9WCMINS14857E_0000

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28 WellCare Health Plans, Inc. 는 Medicare 와계약을맺은 HMO, PPO 플랜입니다. D-SNP 는 State Medicaid 프로그램과계약을맺고있는플랜입니다. 플랜가입은계약갱신에따라결정됩니다. 이정보는혜택을모두설명한전문이아닙니다. 자세한정보를원하시면해당플랜측에문의해주십시오. 제한사항, 자기부담금및제약사항이적용될수있습니다. 혜택, 보험료및 / 또는자기부담금 / 공동보험은매년 1 월 1 일변경될수있습니다. 일부플랜은심혈관질환, 만성심부전또는당뇨병진단을받았고 Medicare 에등록되어있는개인에게제공될수있습니다. 주정부및 Medicare 를통한의료지원을받는당사자를대상으로몇가지플랜이제공될수있습니다. 보험료, 자기부담금, 공동보험및공제액은받으시는추가지원의수준에따라다를수있습니다. 더욱자세한사항은플랜으로문의해주십시오. P.O. Box Tampa, FL