bcidahootc.com 2019 OVER-THE-COUNTER BENEFIT CATALOG A special health plan benefit with no cost to you as a member of True Blue Rx, True Blue Rx Option I, True Blue Rx Option II, True Blue No Rx, True Blue Special Needs Plan or Secure Blue No Rx. Simply order online at bcidahootc.com, call 1-855-283-3784 (TTY: 711), or mail us your completed order form. Your order will be shipped FREE directly to your door. Keep This Catalog Handy. Information on how to place your OTC order can be found on the next page. Y0010_MK 19262_C
Transcript
bcidahootc.com
2019 OVER-THE-COUNTER BENEFIT CATALOG
A special health plan benefit with no cost to you as a member of True Blue Rx, True Blue Rx Option I, True Blue Rx Option II, True Blue No Rx, True Blue Special Needs Plan or Secure Blue No Rx.Simply order online at bcidahootc.com, call 1-855-283-3784 (TTY: 711), or mail us your completed order form. Your order will be shipped FREE directly to your door.
Keep This Catalog Handy.Information on how to place your OTC order can be found on the next page.
Now you can save money on hundreds of items you need with your over-the-counter benefit. Here’s how it works:• Every quarter, you get a $60 allowance to spend on the over-the-counter items
in this catalog.
• Items in this catalog are intended for your use only. Please do not use your benefit to order for your friends or family members.
• Orders are available through home delivery only. Items may not be purchased at a local retail pharmacy or through any source other than this catalog.
Ordering
• Your order total cannot not exceed your benefit amount. Do not send any payment, as it cannot be accepted.
• Mailed orders are processed in the quarter they are received, not the quarter they were mailed. If you’re ordering close to the end of the quarter, order online or by phone to make sure you get the most out of your benefit.
Shipping and Returns
• Due to the personal nature of these products, returns are not accepted.
• For delivery, please allow 7 - 10 business days from the time your order is placed.
The health information provided in the catalog is general in nature and is not medical advice or a substitute for professional healthcare. If you disenroll from Blue Cross of Idaho Care Plus, your OTC benefit will automatically terminate.
* ‡ § ** – See Page 3 3Catalog items may change throughout the year. For the most up-to-date listing of OTC products available, go to bcidahootc.com.
ORDER ONLINE
You can place an order online at bcidahootc.com.
Remember to save your username and password to order again during your next benefit period.
ORDER BY MAIL
You may place your order by mailing in the order form that comes with your catalog.
If you’re ordering near the end of the quarter, order online or call for fastest service.
ORDER BY PHONE
If you have questions or would like to place an order over the phone, OTC advocates are available Monday – Friday from 6 a.m. to 9 p.m. (MST) at 1-855-283-3784 (TTY: 711). Language assistance is available.
On the following pages, you’ll see a few special characters next to certain items. Here’s what they mean:
* Part B/D - Under certain circumstances some items may be covered under either Part B or Part D. If you are eligible to get these items under Part B or Part D, you cannot get them through your OTC benefit. Talk to your doctor for help if you need an item marked with an *.
‡ Dual-purpose items are medicines and products that can be used for either a medical condition or for general health and well-being. In order to get these items under your plan, your doctor must recommend them to you for a specific diagnosed condition. Please talk to your doctor before placing an order for these items.
§ Scales are only available to members with congestive heart failure or liver disease in order to monitor weight changes. Scales are not allowable for other conditions or diseases. Please talk to your doctor to make sure you’re eligible before ordering.
** If you are a True Blue Special Needs Plan member, these items may be covered under your Medicaid benefit. If you are eligible to get these items under your Medicaid benefit, you cannot get them through your OTC benefit. Talk to your care coordinator if you are a Special Needs Plan member and need an item marked with an **.
Blue Cross of Idaho Care Plus, Inc. is a Medicare Advantage plan with a Medicare and Idaho Medicaid contract. Enrollment in Blue Cross of Idaho Care Plus depends on contract renewal. This information is not a complete description of benefits. Call 1-888-494-2583 (1-800-377-1363) for more information.
Nondiscrimination Statement: Discrimination is Against the Law Blue Cross of Idaho complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Blue Cross of Idaho does not exclude people or treat them differently because of race, color, national origin, age, disability or sex. Blue Cross of Idaho: • Provides free aids and services to people with disabilities to
communicate effectively with us, such as: • Qualifed 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: • Qualifed interpreters • Information written in other languages
If you need these services, contact Blue Cross of Idaho’s Customer Service Department. Call 1-888-494-2583 (TTY: 1-800-377-1363), or call the customer service phone number on the back of your card. If you believe that Blue Cross of Idaho 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 fle a grievance with Blue Cross of Idaho’s Grievances and Appeals
Department at: Manager, Grievances and Appeals 3000 East Pine Avenue, Meridian, Idaho 83642 Telephone: (800) 274-4018 ext.3838, Fax: (208) 331-7493Email: grievances&[email protected]: 1-800-377-1363
You can fle a grievance in person or by mail, fax, or email. If you need help fling a grievance, our Grievances and Appeals team is available to help you. You can also fle a civil rights complaint with the U.S. Department of Health and Human Services, Offce for Civil Rights electronically through the Offce for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/ portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800-537-7697 (TTY). Complaint forms are available at http://www.hhs.gov/ocr/offce/fle/index.html. Reference: https://federalregister.gov/a/2016-11458 ATTENTION: If you speak Arabic, Chinese, French, German, Korean, Japanese, Persian (Farsi), Romanian, Russian, Serbo-Croatian, Spanish, Sudanic Fulfulde, Tagalog, Ukrainian, or Vietnamese, language assistance services, free of charge, are available to you. Call 1-888-494-2583 (TTY: 1-800-377-1363).
Arabic (رقم 2583-494-888-1 برقم اتصل بالمجان. لك فرتتوا اللغویة المساعدة خدمات فإن اللغة، اذكر تتحدث كنت اذ إ ملظوحة: .
:1363-377-800-1) ولابكم الصم اھتفChinese 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-888-494-2583 (TTY: 1-800-377-1363)。 French ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement.Appelez le 1-888-494-2583 (ATS: 1-800-377-1363). German ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verf ügung. Rufnummer: 1-888-494-2583 (TTY: 1-800-377-1363). Japanese 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。 1-888-494-2583 (TTY: 1-800-377-1363 ）まで、お電話にてご連絡ください。 Korean 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-888-494-2583 (TTY: 1-800-377-1363) 번으로 전화해 주십시오.
Persian-Farsi شما بریا ارن اگی برت ینابزوص تسھیالت دینک، می گفتگو فارسی ابزن بھ ار توجھ:گ ی. بگیرد تماس 1-888-494-2583
(TTY: 1-800-377-1363) باب.ادش می مھ فراRomanian ATENȚIE: Dacă vorbiți limba română, vă stau la dispoziție servicii de asistență lingvistică, gratuit.Sunați la 1-888-494-2583 (TTY: 1-800-377-1363). Russian ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-888-494-2583 (телетайп: 1-800-377-1363). Serbo-Croation OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno.Nazovite 1-888-494-2583 (TTY- Telefon za osobe sa oštećenim govorom ili sluhom: 1-800-377-1363). Spanish ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.Llame al 1-888-494-2583 (TTY: 1-800-377-1363). Sudanic Fulfulde MAANDO: To a waawi [Adamawa], e woodi ballooji-ma to ekkitaaki wolde caahu. Noddu 1-888-494-2583 (TTY: 1-800-377-1363). Tagalog PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-888-494-2583 (TTY: 1-800-377-1363). Ukrainian УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером 1-888-494-2583 (телетайп: 1-800-377-1363). Vietnamese CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-888-494-2583 (TTY: 1-800-377-1363).
ORDER FORMQuestions? Call us at 1-855-283-3784, Monday - Friday from 6 a.m. to 9 p.m. (MST).
STEP 1 - COMPLETE YOUR INFORMATION BELOWMember ID (found on member ID card) Date of Birth
First Name Last Name MI
Street Number Street Name Apt/Suite #
City State Zip Code
Daytime Phone Email (Optional) Please check box if this is a new address
@
STEP 2 - PRODUCT SELECTION
Cash, checks, credit cards or money orders are not accepted under this OTC benefit.
Item # Product Quantity Unit Price TOTAL
1
2
3
4
5
$ . $ .
$ . $ .
$ . $ .
$ . $ .
$ . $ .
Subtotal from Other Side $ .
Total Order $ .
Please do NOT include any payment.This benefit is provided at no cost to you from Blue Cross of Idaho Care Plus.
To order additional products, please see reverse. Please mail the completed form back in the postage-paid envelope provided.
If you place your order using an order form, your order total will be applied to the month in which we receive your form. For example, if you mail your order form on June 29th, but we receive it on July 1st, your order total will be applied to your July benefit, not your June benefit.
Y0010_MK19263_C
STEP 2 - PRODUCT SELECTION (Continued)
Cash, checks, credit cards or money orders are not accepted under this OTC benefit.
Item # Product Quantity Unit Price TOTAL
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
.$ .$
.$ .$
.$ .$
.$ .$
.$ .$
.$ .$
.$ .$
.$ .$
.$ .$
.$ .$
.$ .$
.$ .$
.$ .$
.$ .$
.$ .$
.Subtotal $Please do NOT include any payment.This benefit is provided at no cost to you from Blue Cross of Idaho Care Plus Medicare Advantage plan.
Please mail the completed form back in the postage-paid envelope provided.
If you place your order using an order form, your order total will be applied to the month in which we receive your form. For example, if you mail your order form on June 29th, but we receive it on July 1st, your order total will be applied to your July benefit, not your June benefit.
