WIXLIB

ITEM #DESCRIPTIONPACKAGINGSTRENGTHPRICE1476Underpad, Disposable - 23” x 24” *50 ct- 16.001299Underpad, Disposable - 23” x 36” *25 ct- 12.001477Underpad, Disposable - 30” x 30” *10 ct- 10.001348Washcloth with Lanolin64 ct- 8.50In-Home Diagnostics1253Blood Pressure Monitor, DesktopAutomatic ‡1 ct- 40.001501Blood Pressure Monitor, Wrist ‡1 ct- 30.001502Blood Pressure Monitor, Wrist Talking ‡1 ct- 35.001416EZ Detect Colon Cancer Test Kit ‡1 ct- 17.001505Finger Pulse Oximeter ‡1 ct- 32.001771Heart Rate Monitor Watch ‡1 ct- 40.001251Home Access Cholesterol Test ‡1 kit- 32.00Motion Sickness1263Driminate Antiemetic12 ct50 mg 7.001366Meclizine HCL Antiemetic100 ct12.5 mg 9.00Pain Relievers & Fever Reducers1001Acetaminophen100 ct325 mg 6.501600Acetaminophen100 ct500 mg 7.001311Arthritis Pain Reliever100 ct650 mg 12.001095Aspirin100 ct325 mg 5.501096Aspirin, Enteric Coated100 ct325 mg 6.001002Aspirin, Enteric Coated, Low Dose120 ct81 mg 6.001802Aspirin, Low Dose, Chewables36 ct81 mg 5.501367Capsaicin External Analgesic2 oz0.025% 9.501944Cold/Hot Menthol Medicated Patch5 ct5% 9.001861Heating Pad, 12” X 15” *1 ct- 26.001859HeatWraps - Back & Hip2 ct- 11.001860HeatWraps - Neck, Shoulder, & Wrist3 ct- 11.001004Ibuprofen100 ct200 mg 8.001871Lidocaine Patch5 ct4% 13.001923Menthol Gel8 oz2% 9.001365Migraine Relief100 ct250 mg, 250 mg,65 mg 8.00Remember to keep this catalog* ‡ – See Page 159

ITEM #DESCRIPTIONPACKAGINGSTRENGTHPRICE1097Naproxen100 ct220 mg 10.001332Pain Reliever, PM - Extra Strength100 ct500 mg, 25 mg 9.001475Pain Relieving Muscle Rub2 oz2.5% 6.001739Salonpas Pain Relief Patches5 ct- 14.001261Wellpatch Migraine4 ct- 10.00Pediculicide (lice treatment)1929Lice Elimination Kit1 kit- 29.001271Lice Treatment Shampoo4 oz- 11.001269Permethrin Lice Treatment59 ml1% 16.001.5 oz10% 8.50Personal Care1076Acne Gel 10% Benzoyl Peroxide1368Ammonium Lactate Moisturizing Lotion8 oz12% 12.001065Hand Sanitizer8 oz- 4.50Sleep Aids1724Nasal Strips, Medium30 ct- 13.001725Nasal Strips, Large30 ct- 13.001276Sleep Tablets50 ct25 mg 7.50Smoking Cessation1372Nicorelief Gum ‡50 ct4 mg 25.001369Nicotine Patch, Step 1 ‡14 ct21 mg / 24 hr 35.001370Nicotine Patch, Step 2 ‡14 ct14 mg / 24 hr 35.001371Nicotine Patch, Step 3 ‡14 ct7 mg / 24 hr 35.001 ct- 10.00Supportive Items1225Ankle Support1767Arthritis Gloves, Small1 pair- 27.001766Arthritis Gloves, Medium1 pair- 27.001765Arthritis Gloves, Large1 pair- 27.001487Back Support Elastic - 24” to 46”1 ct- 23.001488Back Support Elastic with Lumbar1 ct- 27.001770Carpal Tunnel Brace, Small1 ct- 25.001769Carpal Tunnel Brace, Medium1 ct- 25.001768Carpal Tunnel Brace, Large1 ct- 25.0010 Order Online: www.healthalliance.org/OTC

ITEM #DESCRIPTIONPACKAGINGSTRENGTHPRICE1398Compression Knee High Socks, Men’s Black,Medium (Shoe Size 8 - 10) ‡1 pair15 - 20 mmHg 18.001399Compression Knee High Socks, Men’s Black,Large (Shoe Size 10.5 - 12) ‡1 pair15 - 20 mmHg 18.001400Compression Knee High Socks, Men’sWhite, Medium (Shoe Size 8 - 10) ‡1 pair15 - 20 mmHg 18.001401Compression Knee High Socks, Men’sWhite, Large (Shoe Size 10.5 - 12) ‡1 pair15 - 20 mmHg 18.001409Compression Knee High Socks, Women’sBlack, Small (Shoe Size 4-5)1 pair8 - 15 mmHg 18.001410Compression Knee High Socks, Women’sBlack, Medium (Shoe Size 5.5 - 7.5)1 pair8 - 15 mmHg 18.001411Compression Knee High Socks, Women’sBlack, Large (Shoe Size 8 - 10.5)1 pair8 - 15 mmHg 18.001406Compression Knee High Socks, Women’sNude, Small (Shoe Size 4 - 5)1 pair8 - 15 mmHg 18.001407Compression Knee High Socks, Women’sNude, Medium (Shoe Size 5.5 - 7.5)1 pair8 - 15 mmHg 18.001408Compression Knee High Socks, Women’sNude, Large (Shoe Size 8 - 10.5)1 pair8 - 15 mmHg 18.001760Deluxe Criss Cross Back Support, Small 28” to 32”1 ct- 24.001759Deluxe Criss Cross Back Support, Medium 33” to 37”1 ct- 24.001758Deluxe Criss Cross Back Support, Large 38” to 42”1 ct- 24.001224Elbow Support1 ct- 15.001465Knee Stabilizer1 ct- 23.001481Knee Support, Elastic, Small1 ct- 11.001482Knee Support, Elastic, Medium1 ct- 11.001483Knee Support, Elastic, Large1 ct- 11.001484Knee Support, Elastic, Small with Stays1 ct- 19.001485Knee Support, Elastic, Medium with Stays1 ct- 19.001486Knee Support, Elastic, Large with Stays1 ct- 19.001463Night Wrist Support Smart Glove1 ct- 30.001457Rib Belt - Female (one size fits most)1 ct- 19.001456Rib Belt - Male (one size fits most)1 ct- 19.00Remember to keep this catalog* ‡ – See Page 15 11

ITEM #DESCRIPTIONPACKAGINGSTRENGTHPRICE1230Wrist Splint1 ct- 22.001227Wrist Support1 ct- 10.00Therapeutic Skin & Sun Care1821Calamine Lotion6 oz- 7.001893Moisturizing Body Lotion with Aloe8 oz- 7.501852Scar Gel50 gm- 15.001284Sunscreen Lotion SPF 303.5 oz- 7.50Vitamins & Minerals1820Biotin Gummy ‡60 ct5,000 mcg 13.001373Calcium Vitamin D ‡60 ct600 mg / 400 IU 7.001823Calcium Vitamin D Gummy ‡60 ct500 mg, 1000 IU 13.001291Calcium Carbonate Supplement Tablets ‡60 ct600 mg 7.001420Centrum Silver Chewables ‡60 ct- 18.001829Coenzyme Q-10 ‡30 ct50 mg 12.001385Daily Multiple Vitamin Tablets withMinerals ‡100 ct- 8.501393Daily Multivitamin ‡100 ct- 8.001972Daily Multivitamin Gummy ‡120 ct- 13.001375Ferrous Gluconate Iron Supplement ‡100 ct240 mg 7.501376Ferrous Sulfate Iron Supplement ‡100 ct325 mg 7.501155Fiber Tablets ‡60 ct500 mg 10.001741Fish Oil, Soft Gels ‡60 ct1000 mg 8.001849Flaxseed ‡100 ct1000 mg 11.001850Folic Acid ‡100 ct800 mcg 6.501003Glucosamine / Chondroitin ‡60 ct250 mg, 200 mg 12.001114Glucosamine Joint / Muscle ‡60 ct500 mg 11.001866Immune Support Chewables ‡50 ct- 11.501417Iron ‡110 ct27 mg 8.001869Leg Cramps Pain Relief Caplets ‡50 ct- 14.001418Magnesium ‡110 ct250 mg 7.001879Melatonin ‡100 ct5 mg 12.001971Melatonin Gummy ‡120 ct5 mg 13.001378Niacin ‡100 ct100 mg 6.0012 Order Online: www.healthalliance.org/OTC

ITEM #DESCRIPTIONPACKAGINGSTRENGTHPRICE1930Niacin, No Flush ‡60 ct500 mg 12.001886One Daily Men’s Multivitamin ‡100 ct- 10.001887One Daily Women’s Multivitamin ‡100 ct- 10.001395Rena-Vite ‡100 ct- 13.501392Senior Multivitamin ‡90 ct- 11.001734Stress Formula Tablets with Zinc ‡60 ct- 10.001379Vitamin A ‡100 ct10,000 iu 8.001016Vitamin B-1 ‡100 ct100 mg 7.501381Vitamin B-12 ‡100 ct1000 mcg 11.001974Vitamin B-12, Sublingual ‡30 ct5000 mcg 10.001388Vitamin B-6 ‡100 ct100 mg 8.001382Vitamin B-Complex ‡100 ct- 8.001915Vitamin B-Complex Gummy ‡70 ct- 13.001017Vitamin C ‡100 ct500 mg 7.501706Vitamin C ‡100 ct1000 mg 10.001916Vitamin C Gummy ‡60 ct250 mg 12.001390Vitamin D ‡100 ct1000 iu 9.001978Vitamin D Gummy ‡120 ct2000 iu 13.001384Vitamin E, Soft Gels ‡100 ct400 iu 11.001419Zinc Chelated ‡100 ct50 mg 7.00Wart Remover1288Dr. Scholl’s Wart Removal System20 ct- 15.001075Wart Remover, Liquid9 ml17% 10.001289Wartners Wart Removal System1 ct- 19.0090 ct- 17.50Weight Loss1735Vitafusion Fiber Weight Management ‡Remember to keep this catalog* ‡ – See Page 15 13

ORDER GUIDELINESORDER ONLINEORDER BY MAILORDER BY PHONEYou may place an orderonline using your HealthAlliance Medicare OTCwebsite atwww.healthalliance.org/OTC.You may place your order bymailing in the order form thatcomes with your catalog.If you have questions or wouldlike to place an order over thephone, OTC Advocates areavailable Monday – Fridayfrom 7:00 a.m. to 10:00 p.m.CST at 1-855-824-2021(TTY: 771).Remember to save yourusername and passwordto order again during yournext benefit period.If the end of the benefitperiod is approaching andyou do not think your orderform will be received intime, you may order onlineor call in your order. For delivery, please allow 7 - 10 business days from the time your order is placed. You must use your full benefit amount in one order. Unused benefits will not roll over into the nextquarter. Your order total may not exceed your benefit amount. Cash, checks, credit cards or money orders arenot accepted under this OTC benefit. Your order total will be applied to the benefit period in which the order is received. OTC products are intended for member use only to help with a health or medical need. HealthAlliance Medicare prohibits the use of this benefit to order OTC items for family members andfriends. Due to the personal nature of these products, returns are not accepted. Items in the OTC catalog may change throughout the year. For the most up-to-date listing of OTCproducts available, go to www.healthalliance.org/OTC. OTC items are available through home delivery only. Products may not be purchased at a localretail pharmacy or through any source other than the Health Alliance Medicare OTC benefitchannels listed above.14 Order Online: www.healthalliance.org/OTC

NOTICES If you disenroll from Health Alliance Medicare, your OTC benefit will automatically terminate. Health Alliance Medicare is a Medicare Advantage Organization with a Medicare contract. Enrollmentin Health Alliance Medicare depends on contract renewal. This information is available for free in other languages. Please call our customer service number at1-800-965-4022 from 7:00 a.m. to 7:00 p.m. CST. The health information provided in the catalog is general in nature and is not medical advice or asubstitute for professional health care.* Part B/D - Under certain circumstances some items may be covered under either Part B or Part D. Whenyou are eligible to receive these items under Part B or Part D you may not purchase these items throughyour Part C supplemental OTC benefit. For your convenience, we’ve marked these items with an (*).‡ Dual-purpose items are medicines and products that can be used for either a medical condition or forgeneral health and well-being. In order to purchase these items under your plan, your personal physicianmust recommend them to you for a specific diagnosed condition. Please speak to your physician beforeordering these items.Remember to keep this catalog* ‡ – See Page 15 15

DISCRIMINATION IS AGAINST THE LAWHealth Alliance complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color,national origin, age, disability or sex. Health Alliance does not exclude people or treat them differently because of race,color, national origin, age, disability or sex. Health Alliance: Provides free aids and services to people with disabilities to communicate effectively with us, such as:o Qualified sign language interpreterso 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:o Qualified interpreterso Information written in other languagesIf you need these services, contact customer service.If you believe that Health Alliance has failed to provide these services or discriminated in another way on the basis ofrace, color, national origin, age, disability, or sex, you can file a grievance with: Health Alliance Medicare, MemberServices, 3310 Fields South Drive, Champaign, IL 61822 or 316 Fifth Street, Wenatchee, WA 98801, telephone formembers in Illinois, Indiana, Iowa and Ohio: 1-800-965-4022; telephone for members in Washington: 1-877-750-3350TTY: 711, fax: 217-902-9705, MemberServices@healthalliance.org. You can file a grievance in person or by mail, faxor email. If you need help filing a grievance, Member Services is available to help you. You can also file a civil rightscomplaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through theOffice for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phoneat: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building,Washington, DC 20201, 1-800-368-1019, TTY: 1-800-537-7697.Complaint forms are available at CIÓN: Si habla Español, servicios de asistencia lingüística, de forma gratuita, están disponibles para usted. IA,IL, IN, OH: Llame 1-800-965-4022, WA Llame: 1-877-750-3350 (TTY: 務，免費的，都可以給你。IA, IL, IN, OH: 呼叫 1-800-965-4022, WA: 呼叫1-877-750-3350(TTY: 711)。UWAGA: Jeśli mówić Polskie, usługi pomocy języka, bezpłatnie, są dostępne dla Ciebie. IA, IL, IN, OH: Zadzwoń1-800-965-4022, WA: Zadzwoń 1-877-750-3350 (TTY: 711).Chú ý: Nếu bạn nói Tiếng Việt, các dịch vụ hỗ trợ ngôn ngữ, miễn phí, có sẵn cho bạn. IA, IL, IN, OH: Gọi1-800-965-4022, WA: Gọi 1-877-750-3350 (TTY: 711).주의 : 당신이한국어, 무료 언어 지원 서비스를 말하는 경우 사용할 수 있습니다. 1-800-965-4022 IA, IL, IN, OH:전화 WA: 1-877-750-3350 전화 (TTY: 711).ВНИМАНИЕ: Если вы говорите русский, вставки услуги языковой помощи, бесплатно, доступны для вас. IA,IL, IN, OH: Вызов 1-800-965-4022, WA: Вызов 1-877-750-3350 (TTY: 711).Pansin: Kung magsalita ka Tagalog, mga serbisyo ng tulong sa wika, nang walang bayad, ay magagamit sa iyo. IA, IL,IN, OH: Tumawag 1-800-965-4022, WA: Tumawag 1-877-750-3350 (TTY: 711).: ﻭﻻﻳﺔ ﻭﺍﺷﻨﻄﻦ ،1-800-965-4022 ﺍﺗﺼﻞ ﺑﺎﻟﺮﻗﻢ : ﺃﻭﻫﺎﻳﻮ ، ﺇﻧﺪﻳﺎﻧﺎ ، ﺇﻳﻠﻴﻨﻮﻱ .ً ﻓﺈﻥ ﺧﺪﻣﺎﺕ ﺍﻟﻤﺴﺎﻋﺪﺓ ﺍﻟﻠﻐﻮﻳﺔ ﻣﺘﻮﻓﺮﺓ ﻟﻚ ﻣﺠﺎﻧﺎ ، ﺇﺫﺍ ﻛﻨﺖ ﺗﺘﻜﻠﻢ ﺍﻟﻌﺮﺑﻴﺔ : ﺍﻧﺘﺒﺎﻩ (711 )ﺇﺫﺍ ﻛﻨﺖ ﺗﻌﺎﻧﻲ ﻣﻦ ﺍﻟﺼﻤﻢ ﺃﻭ ﺻﻌﻮﺑﺔ ﻓﻲ ﺍﻟﺴﻤﻊ ﻓﺎﺗﺼﻞ ﻋﻠﻰ ﺍﻟﺮﻗﻢ 1-877-750-3350 : ﺍﺗﺼﻞ ﺑﺎﻟﺮﻗﻢ Aufmerksamkeit: Wenn Sie Deutsch sprechen, Sprachassistenzdienste sind kostenlos, zur Verfügung. IA, IL, IN, OH:Anruf 1-800-965-4022, WA: Anruf 1-877-750-3350 (TTY: 711).ATTENTION: Si vous parlez français, les services d'assistance linguistique, gratuitement, sont à votre disposition. IA,IL, IN, OH: Appelez 1-800-965-4022, WA: Appelez 1-877-750-3350 (TTY: 711).ધ્યા: તમે વાત તો ુજરાતી, ભાષા સહાય સેવાઓ, મફત, તમારા માટ ઉપલબ્ છે . IA, IL, IN, OH: કૉલ 1-800-965-4022,WA: કૉલ 1-877-750-3350 (TTY: 711).注意：あなたは、日本語 65-4022 IA, IL, IN, OH: コール 1-877-750-3350 WA: コール（TTY: 711)。LET OP: Als je spreekt pennsylvania nederlandse, taalkundige bijstand diensten, gratis voor u beschikbaar zijn. IA, IL,IN, OH: Bel 1-800-965-4022, WA: Bel 1-877-750-3350 (TTY: 711).УВАГА: Якщо ви говорите український, вставки послуги мовної допомоги, безкоштовно, доступні для вас. IA,IL, IN, OH: Виклик 1-800-965-4022, WA: Виклик 1-877-750-3350 (TTY: 711).ATTENZIONE: Se si parla italiano, servizi di assistenza linguistica, a titolo gratuito, sono a vostra disposizione. IA,IL, IN, OH: Chiamare 1-800-965-4022, WA: Chiamare 1-877-750-3350 (TTY: 711).cmp-nondiscrim15MED-0318

2019 OVER–THE–COUNTER (OTC) PRODUCTORDER FORMSTEP 1 - COMPLETE YOUR INFORMATION BELOWMember ID (found on plan member ID card)Date of BirthFirst NameStreet NumberLast NameStreet NameCityDaytime PhoneStateMIApt/Suite #Zip CodePlease check box if this is a new addressEmail (Optional)@STEP 2 - PRODUCT SELECTIONCash, checks, credit cards or money orders are not accepted under this OTC benefit.Item #ProductQuantityUnit PriceTOTAL1 . .2 . .3 . .4 . .5 . .Subtotal from Other Side .Total Order .To order additional products, please see reverse. Please mail the completed form back in thepostage-paid envelope provided.If you place your order using an order form, your order total will be applied to the month in which we receiveyour form. For example, if you mail your order form on June 29th, but we receive it on July 1st, your ordertotal will be applied to your July benefit, not your June benefit.Y0034 19 70439 C

STEP 2 - PRODUCT SELECTION (Continued)Cash, checks, credit cards or money orders are not accepted under this OTC benefit.Item #ProductQuantityTOTALUnit Price6 . .7 . .8 . .9 . .10 . .11 . .12 . .13 . .14 . .15 . .16 . .17 . .18 . .19 . .20 . .Subtotal .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 receiveyour form. For example, if you mail your order form on June 29th, but we receive it on July 1st, your ordertotal will be applied to your July benefit, not your June benefit.Y0034 19 70439 C

As a member of Health Alliance Medicare, you have a 40 Over-the-Counter (OTC) benefit every quarter. This benefit allows you to get OTC products you may need. Be sure to use your 40 benefit before the end of every quarter. Simply order online, call 1-855-824-2021 (TTY: 771), or