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Sonder Over-the-Counter(OTC) CatalogWhat is OTC?Sonder Health Plans provides its members an Over-the-Counter (OTC) program that makesordering non-prescription drugs quick and easy at no cost to you. The Over-the-Counter (OTC)Catalog contains over 100 items that can help you save between 420 to 1500 over the courseof a year.Members receive a monthly Over-the-Counter allowance of 50 to 280 every quarter based onplan. Keep in mind, unused OTC benefits expire at the end of each quarter and therefore do notroll over to the following quarter.Choose from 16 different categories of products and supplies from our catalog. Choose from over100 items when placing new orders.How do I order?We make placing orders convenient for our members. On the following pages (page 2 and 3),you’ll find our OTC order form. Please fill out the form accordingly (if you have any questions,please contact our Member Services team for help).To place orders, you have four options: Call 1 (888) 428-4440 and place your order over the phone. TTY users should dial 711. Mail the OTC for toSonder Health PlansATTN: OTC Servicing Center,6190 Powers Ferry Road, Suite 320Atlanta, Georgia 30339 Email us your completed OTC Order Form at memberservices@sonderhealthplans.com Fax your completed OTC Order Form to (888) 217-6766Continue to Page 2 for the OTC Order Form. You can also find our OTC order formonline at www.sonderhealthplans.com/OTCpg. 1H1748 OTCCAT22 C
2022 Over-The-Counter (OTC) Order FormPlease mail this completed form to the following address:Sonder Health PlansATTN: OTC Servicing Center,6190 Powers Ferry Road, Suite 320Atlanta, Georgia 30339You may also email this form to: memberservices@sonderhealthplans.comOr fax this form to: (888) 217-6766pg. 2H1748 OTCCAT22 C
2022 Over-The-Counter (OTC) Order FormIf you place your order using an order form, the total will be applied to the quarter we receiveyour form. For example, if you mail your order form on July 29th, but we receive it on July 1st,your order total will be applied to your third quarter benefit, not your second quarter benefit.pg. 3H1748 OTCCAT22 C
2022 Over-The-Counter (OTC) rs16FDiapers16EWipes#Adult IncontinenceItem DescriptionQTYAdult Protective Diapers, Small 20-28” 20Adult Protective Diapers, Medium 282040”Adult Protective Diapers, Large 40-56” 20Adult Protective Diapers, X-Large 562068”Adult Protective Diapers, XX-Large 682080”Adult Wipes48AllergiesItem DescriptionQTYItemGeneric1A Comparable ofChlorpheniramine Maleate 4mg24ChlortrimetonGeneric1C Comparable ofDiphenhydramine HCI 25mg24Benadryl CapsGenericComparable of1DDeep Sea Nasal Saline 0.65%44mlOcean SalineNasal SprayNasacort Allergy1ETriamcinolone 55mcg10.8ml24 Hour1FFlonaseFluticasone Propionate (glucocorticoid) 50mcg 9.9mlAnalgesics#ItemItem DescriptionQTYGenericComparable2AAcetaminophen Tabs 500 mg100of TylenolEx 500mgGeneric2B Comparable ofAspirin 325mg100Bayer AspirinGeneric2E ComparableIbuprofen 200mg FC Tab.24of AdvilPrice 20 20 20 20 22 3Price 4 3 3 15 22Price 4 3 3pg. 4H1748 OTCCAT22 C
Generic2F ComparableMuscle Rubof Ben GayGeneric2G ComparableNaproxen Sodium 220 mg CPLof AleveGenericComparableof Bayer2HAspirin EC (Delayed Release) 81mgAspirinLow Dose81 mgGenericComparable Acetaminophen 500mg/Diphenhydramine HCI2Iof Tylenol25mgPMGenericComparableof Bayer2JAspirin 81mg ChewableAspirinLow DoseChewableGenericComparable2KCold and Hot Patchof Icy HotPatchGenericHeadache Formula2L ComparableAspirin/Acetaminophen/Caffeineof Excedrin2M Aspercreme Aspercreme with 4% Lidocaine Maximum StrengthAntacids#ItemItem Description3A Generic Comparable of Tums-Ex Calcium Carbonate 750mg3B Generic Comparable of Gas-XGas Relief TabletsGeneric Comparable of Alka3DAntacid & Pain ReliefSeltzerAnti-Diarrheals#ItemItem DescriptionGeneric Comparable of4ALoperamide 2mgImodiumGeneric Comparable of Pepto4BPink Bismuth Tablets (chewable)Bismol35g 350 7120 450 536 45 8100 776g 6QTY96100Price 5 512 6QTYPrice12 430 5pg. 5H1748 OTCCAT22 C
#Anti-HemorrhoidalsItem DescriptionItemGeneric Comparable of Cortaid5AHydrocortisone Oint, USP 1%Maximum StrengthGeneric Comparable of5BPrompt Relief Hem OintmentPreparation HGeneric Comparable of5CHemorrhoidal SuppositoriesPreparation H SuppositoriesCoughs and Colds#ItemItem DescriptionGeneric Comparable6A of Robitussin SugarSugar-Free Cough SyrupFree DmGeneric Comparable6BMedicated Chest Rubof Vicks6CMucinex DmMucinex DM 600mgGeneric Comparable6DNasal Sprayof Afrin Nasal SprayGeneric Comparable6H of Tylenol Sinus Sinus-Acetaminophen/Phenylephrine HCICongestion & PainGeneric Comparable6ISore Throat Sprayof ChlorasepticHalls Sugar-Free6KSugar-Free Cough DropsCough DropsGeneric Comparable6LExpectorant-Guaifenesin 400 mgof Mucus ReliefGeneric Comparable6MCepacolof CepacolEye Care#ItemItem DescriptionGeneric Comparable of7AEye WashCollyrium Eye Wash7B Generic Comparable of Visine Redness Reliever Eye Drops7E Generic Comparable of Zaditor Eye-Itch Relief AntihistamineQTYPrice28g 657g 712 13QTYPrice118ml 5100g 620 2015ml 324 5177ml 525 430 716 5QTYPrice118ml 615ml5ml 4 15pg. 6H1748 OTCCAT22 C
#9B9CItemGeneric Comparable of AceBandage 3”Butterfly ClosureCotton Balls9DIce Bag9AFirst Aid SuppliesItem DescriptionQTYPriceElastic Bandage1 6Butterfly ClosuresCotton Balls10100 2 4Ice Bag 9\”1 99FDigital ThermometerDigital Thermometer19G Generic Comparable of Q-TipsCotton Swabs3009HSterilizing Antiseptic WipesSterilizing Antiseptic Wipes 509IDisposable Face MaskDisposable Face Mask109JHand Sanitizer/Hand RubHand Sanitizer/Hand Rub 115ml9KHand GlovesSmall1509LHand GlovesMedium1509MHand GlovesLarge1509NHand GlovesExtra Large150First Aid Creams & Ointments & AntisepticsGeneric Comparable of Benadryl8AAnti-Itch Cream28gCream8B Generic Comparable of BacitracinBacitracin14g8C Generic Comparable of LotriminClotrimazole 1% Cream28g8D Generic Comparable of CortisoneHydrocortisone Cream28gGeneric Comparable of Zinc8EZinc Oxide Ointment28gOxide8F Generic Comparable of Neosporin Triple-Antibiotic Ointment 28g8H Generic Comparable of DebroxEar Wax Removal15mlLaxatives#ItemItem DescriptionQTY10A Generic Comparable of ColaceDocusate Sodium 100mg10010B Generic Comparable of FiberconFiber-Lax 500mg6010C Generic Comparable of MiralaxClear Lax Powder119gGeneric Comparable of Fleet10DEnema-Saline Laxative133mlEnema#ItemDigital Blood11APressure Kit*Miscellaneous ItemsItem DescriptionAutomatic Blood Pressure Kit 8 5 8 10 5 22 22 22 22 5 6 7 5 8 6 4Price 5 9 11 3QTYPrice1 25pg. 7H1748 OTCCAT22 C
BloodManual Self Taking Blood Pressure Kit1Pressure Kit*Generic11C ComparableAdhesive Bandage50of Band AidGenericComparableof11DSunscreen Lotion ble11EMotion Sickness Relief Tablets12ofDramamine11F Pill Organizer One Day At a Time Medicine Organizer-Weekly 1DEX411G GlucoseGlucose Tablets50Tablets11H Pill SplitterPill Splitter1Sleep-Aids#ItemItem DescriptionQTYGeneric Comparable of Simply15ASleep-tabs 25 mg24Sleep15BMelatonin-Sleep AidMelatonin Tablet 3mg6011B#Smoking CessationItem DescriptionItemQTYGenericComparable14BStop Smoking Gum-Nicotine Polacrilex Gum 4mg 40of Nicorette4mgTopical Foot & Topical Oral#ItemItem DescriptionQTY12ACallus RemoverCallus Removers612CCallus CushionCallus Cushions612EDental FlossersDental Flossers36Generic Comparable of12GDenture Cleanser40Polident12HToothpasteToothpaste68g 19 3 10 4 7 8 5Price 4 8Price 24Price 4 3 3 7 4pg. 8H1748 OTCCAT22 C
12IToothbrushToothbrushGeneric Comparable of12JDenture Adhesives ADH CRM FreshFixodentVitamins & Minerals#ItemItem Description13AFish OilFish Oil 1200mg13BProsightSupplement for Eyes13C Allbee With CB Complex with C13DVitamin BB Complex13EVitamin CVitamin C 500mgGeneric13F Comparable ofMultivitamin & MineralCentrum13GFolic AcidFolic Acid 800mcgGlucosamine13HGlucosamine ChondroitinChondroitin13JVitamin EVitamin E 400 IU13KVitamin DVitamin D3 (25mcg) 1000 IUAntioxidant13LAntioxidant TabletsTablets13MSeleniumSelenium 200mcg13P Ferrous SulfateFerrous Sulfate - 325mgGenericComparable of13QCalcium Citrate & Vitamin DCitracal CalciumCitrateGenericComparable of13ROne A Day Women's MultivitaminBayer One A DayWomen’sGeneric13S Comparable ofOyster Calcium Vitamin DOs-Cal*13TCoQ10CoQ10 100mg13UVitamin B12Vitamin B12 1000 mcg13VEmergen-C1000mg Vitamin C Plus Vitamin D & Zinc1 339g 5QTY9060100100100Price 9 6 8 8 860 6100 560 15100100 8 550 760100 7 360 760 10100 4305010 10 8 10pg. 9H1748 OTCCAT22 C
pg. 2 H1748_OTCCAT22_C 2022 Over-The-Counter (OTC) Order Form Please mail this completed form to the following address: Sonder Health Plans ATTN: OTC Servicing Center,
