Over-The-Counter (OTC) Benefits | Healthfirst

Over-the-Counter (OTC) Allowance

Learn how OTC benefits can help you save money on a variety of over-the-counter products and health-related items.

Benefits Overview

Viewing information for:

At Healthfirst, we understand some of the medications and health-related items you may need may not require a prescription. If you’re a member of a plan with an OTC allowance, you’ll receive a Healthfirst OTC card with a pre-funded monthly allowance upon enrollment, which you’ll need to activate.

Healthfirst Plans with OTC allowance:

  1. Life Improvement Plan (HMO SNP)
  2. CompleteCare (HMO SNP)
  3. Increased Benefit Plan (HMO)
  4. Signature (HMO) Choice Extras

Your 2021 Benefit Amount

Life Improvement Plan (HMO SNP) members will receive $145 per month for purchase of approved OTC non-prescription drugs and health-related items and healthy food and produce. Any unused balance will automatically expire at the end of each month or upon disenrollment from the plan.

CompleteCare (HMO SNP) members will receive $155 per month for purchase of approved OTC non-prescription drugs, health-related items and healthy food and produce. Any unused balance will automatically expire at the end of each month or upon disenrollment from the plan.

Increased Benefits Plan (IBP) members will receive $15 per month for purchase of OTC items (approved non-prescription drugs and health-related items). Any unused balance will automatically expire at the end of each month or upon disenrollment from the plan.

Signature (HMO) members may choose, as one of three Choice Extras, to receive $35 per quarter for purchase of OTC items (approved non-prescription drugs and health-related items). Any unused balance will automatically expire at the end of each quarter or upon disenrollment from the plan.

You must activate your Healthfirst OTC card before you can use it.

Learn More

You may purchase approved OTC nonprescription drugs and health-related items (such as aspirin, cold/flu medicine, and bandages) at any participating retailer. If you are a Healthfirst Life Improvement Plan or Healthfirst CompleteCare member, you can purchase select healthy foods and produce items in addition to the nonprescription, health-related items.

Resources

Life Improvement Plan (HMO SNP) Approved OTC/Healthy Food and Produce Purchases
Coming Soon

Life Improvement Plan (HMO SNP) OTC/Healthy Foods and Produce Reimbursement Form

CompleteCare Plan (HMO SNP) Approved OTC/Healthy Food and Produce Purchases
Coming Soon

CompleteCare (HMO SNP) OTC/Healthy Foods and Produce Reimbursement Form

Signature (HMO) Approved OTC Purchases

Signature (HMO) OTC Reimbursement Claim Form

Increased Benefit Plan (HMO) Approved OTC Purchases

Increased Benefit Plan (HMO) OTC Reimbursement Claim Form

For a complete list of participating pharmacies and retailers, you can:

  1. Visit www.otcnetwork.com/
    member
  2. Call Member Services at:
    1-888-260-1010
    8am–8pm, 7 days a week
    TTY English: 1-888-542-3821
    TTY Español: 1-888-867-4132

Home Delivery

Healthfirst members can order covered OTC items online or by phone for home delivery. If you are a Life Improvement Plan or CompleteCare member, you can also order selected healthy food items online or by phone for home delivery. Members can expect to receive their items within three to seven business days after an order is placed, unless a change is made to the order for any reason. To order OTC products for delivery:

  • Call 1-877-236-7027 (TTY 711), Monday to Friday, 8am–8pm. Language support services are available if needed.
  • Visit NationsOTC.com/Healthfirst.
    1. Enter your OTC card number to log in
    2. Update your account profile with shipping address details.
    3. To place an order, select products and complete the checkout process.

Limitations

Viewing information for:

Depending on your plan, you will receive an OTC card with a maximum limit for purchasing approved OTC nonprescription drugs, health-related items at participating pharmacy locations, and in the case of Life Improvement Plan and CompleteCare, healthy foods and produce items. For more information, view your Evidence of Coverage or contact Member Services for details.

Some items can be purchased only after a discussion with your provider.

While no prescription is needed before purchasing approved OTC nonprescription drugs and health-related items, some dual-purpose items* can be purchased only after a discussion with your provider. They’ll recommend the right OTC items for a specific diagnosis/condition.

*Dual-purpose items may include:

vitamins, minerals, supplements, hormone replacements, weight loss items, and diagnostic tools like blood pressure monitors.

  • OTC items may be purchased only for the enrollee, not for family members or friends
  • The OTC card is not a debit or credit card and cannot be converted to cash
  • It cannot be used to purchase Part B or Part D prescription drugs
  • Any unused balances will automatically expire at the end of each month or upon disenrollment from the plan

How to Activate & Use Your OTC Card

Step 1

Activate your card

<h2>Step 1</h2>
<h3>Activate your card</h3>

Activate your Healthfirst OTC card before its first use. To activate, please call Card Services at 1-888-682-2400 (24 hours a day, 7 days a week) or visit www.otcnetwork.com/member

Please note: Activate your card ONLY at the start of your plan’s effective date! Otherwise, it may activate under your previous plan.

You’ll need to provide:

  • The OTC card number printed on the front of the card
  • Your Healthfirst Medicare Plan Member ID card number
  • Your birthdate (two-digit month, two-digit day, and four-digit year; for example, 05/20/1930)

Step 2

Visit a participating location
(in-person or online)

<h2>Step 2</h2>
<h3>Visit a participating location <br />(in-person or online)</h3>

Take your activated Healthfirst OTC card to a participating store and select the approved items you want to purchase. Because you do not need a prescription, you won’t have to visit the pharmacy window.

You can use your Healthfirst OTC card at locations such as:

  • Pharmacy retail locations such as Duane Reade, Walgreens, CVS, Rite Aid, or Family Dollar
  • Online delivery option through NationsOTC

For a complete list of participating pharmacies and retailers, visit
www.otcnetwork.com/member or call our Member Services Representatives at 1-888-260-1010 (TTY 1-888-542-3821), 7 days a week, 8am-8pm.

Step 3

Pay for your items

<h2>Step 3</h2>
<h3>Pay for your items</h3>

Take your items to the checkout lanes. When you check out, swipe the card for payment. Purchases of approved items are automatically deducted from your card balance.

Coverage is provided by Healthfirst Health Plan, Inc., Healthfirst PHSP, Inc., and/or Healthfirst Insurance Company, Inc. (together, “Healthfirst”). Plans contain exclusions and limitations.

Healthfirst Health Plan, Inc. offers HMO plans that contract with the Federal Government. Healthfirst Medicare Plan has a contract with New York State Medicaid for Healthfirst CompleteCare (HMO SNP) and a Coordination of Benefits Agreement with the New York State Department of Health for the Healthfirst Life Improvement Plan (HMO SNP). Enrollment in Healthfirst Medicare Plan depends on contract renewal.
Healthfirst Medicare Plan, Inc. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-305-0408 (TTY 1-888-867-4132).

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1-866-305-0408 (TTY 1-888-542-3821).

Y0147_MKT21_46 1226-20_2021

Support when you need it

Contact Us