Covered Categories - Independent Care Health Plan€¦ · Acne Creams, Gels, Lotions & Patches Acne Soaps & Cleansers Acne Astringents & Toners Mixed/Miscellaneous Facial & Body Acne

Covered Categories

2020

INCOMM HEALTHCARE

CATEGORIES

Batteries | 2

Cold & Allergy | 2

Compression Support | 2

Diabetes Care | 2

Digestive Health | 3

Eye & Ear Care | 3

Feminine Care | 4

First Aid | 4

Foot Care | 4

Health Supports | 5

Home Diagnostics & Patient Aids for Daily Living | 5

Home Health Care | 6

Incontinence | 6

Oral Care | 6

Pain Relief | 7

Patient Skin Care | 7

Physical Fitness & Exercise Equipment | 7

Skin Care | 8

Smoking Deterrents | 8

Sun Care | 8

Vitamins & Dietary Supplements | 8

Weight Management & Nutritional Foods | 8

2INCOMM HEALTHCARE | OTC NETWORK

Hearing Aid Batteries

Cough, Cold, Flu & Sinus Liquids

Cough, Cold, Flu & Sinus Tabs & Caps

Mixed/Miscellaneous Cough, Cold, Flu & Sinus

Cold & Flu Preventatives/Symptom Reducers

Sore Throat Pain Relief

Throat & Cough Drops

Mixed/Miscellaneous Cough Drops, Sore Throat Relief

Allergy Liquids

Allergy Tabs & Caps

Mixed/Miscellaneous Allergy

Allergy Nasal Sprays, Drops & Inhalers

Decongestant Nasal Sprays, Drops & Inhalers

Nasal Moisturizers & Washes

Nasal Strips, Dilators & Snore Relief

Mixed/Miscellaneous Nasal

Medicated Lip Treatments

Asthma Preparations

Vapor Products (Includes Waterless Vaporizers)

Vaporizers, Humidifiers & Accessories

Mixed/Miscellaneous Respiratory Treatments

Mixed/Miscellaneous Low Compression (8-15mmHg)

Low Compression-Men’s & Unisex Knee High (8-15 mmHg)

Low Compression-Men’s & Unisex Thigh High (8-15 mmHg)

Low Compression-Women’s Knee High (8-15 mmHg)

Low Compression-Women’s Thigh High (8-15 mmHg)

Low Compression-Waist High & Pantyhose (8-15 mmHg)

Mixed/Miscellaneous Moderate to High Compression

Moderate to High Compression-Men’s & Unisex Knee High

Moderate to High Compression-Men’s & Unisex Thigh High

Moderate to High Compression-Women’s Knee High

Moderate to High Compression-Women’s Thigh High

Moderate to High Compression-Waist High & Pantyhose

Moderate to High Compression-Sleeves, Garments & Lymphdema Treatments

Sharps Containers & Supplies

Mixed/Miscellaneous Diabetes Care Accessories

COLD & ALLERGY

COMPRESSION SUPPORT

DIABETES CARE

BATTERIES

3INCOMM HEALTHCARE | OTC NETWORK

Diabetes Neuropathy & Skin Care

Diabetes Cough, Cold & Allergy

Diabetes Supplements

Urine Test Strips

Urine Test Tabs

Mixed/Miscellaneous Urine Testing

Antacid Liquids

Antacid Tabs & Caps

Multi-Symptom Products

Acid Controllers

Nausea & Motion Sickness

Mixed/Miscellaneous Stomach & Nausea Remedies

Fiber Products

Enemas, Laxative Suppositories, Kits, Etc.

Non-Liquid Laxatives (Non-Fiber) & Combination Stool-Softener Products

Laxative Liquids & Combination Stool-Softener Products

Stool Softeners

Mixed/Miscellaneous Laxatives

Anti-Diarrheal Tabs & Caps

Anti-Diarrheal Liquids

Diarrhea-Related Oral Rehydration Therapy

Mixed/Miscellaneous Anti-Diarrheals

Lactose Intolerance

Digestive Health Prebiotics & Probiotics

Anti-Gas

Mixed/Miscellaneous Anti-Gas

Hemorrhoid Treatments

Hemorrhoid Wipes & Washes

Mixed/Miscellaneous Hemorrhoid Preparations

Soft Lens Multi-Purpose Solutions

Soft Lens Saline Solutions

Soft Lens Cleaners

Soft Lens Rewetting Drops

Gas Permeable & Hard Lens Care

Mixed/Miscellaneous Contact Lens Care

Eye Relief Products

Dry Eye Relief

Eye Wash

Mixed/Miscellaneous Eye Preparations (Includes Sleep Masks)

Reading Glasses

Magnifying Glasses

DIGESTIVE HEALTH

EAR & EYE CARE

4INCOMM HEALTHCARE | OTC NETWORK

Mixed/Miscellaneous Reading Glasses & Magnifying Glasses

Ear Drops & Syringes

Mixed/Miscellaneous Ear Care

Lipoflavonoids

Hearing Aids

Feminine Antifungal

Adhesive & Liquid Bandages

Alginate & Collagen Dressings

Gauze, Non-Stick & Absorbent Dressings

Hydrocolloid & Hydrogel Dressings

Foam Dressings

Mixed/Miscellaneous Wound & Surgical Dressings

Transparent Dressings

Topical Antibiotics & Antimicrobials

Wound, Burn & Skin Treatments (Includes Epsom Salt)

Mixed/Miscellaneous Wound Treatments & Skin Relief (Includes Witch Hazel)

Scar Treatments

Skin Protectants (Includes Petroleum Jelly)

Lice Treatments & Accessories

Mixed/Miscellaneous Antiparasitic Treatments

Pinworm & Ringworm Treatments

First Aid Kits

Mixed/Miscellaneous First Aid Kits & Supplies

Finger Cots & Splints

General Itch Treatments

Jock Itch Treatments

Chronic Itch Treatments

Poison Ivy, Oak & Sumac Treatments

Mixed/Miscellaneous Itch Treatments

First Aid Tapes & Adhesive Wraps

Rubbing Alcohol

Hydrogen Peroxide

Saline Solutions & Sprays

Povidone Iodine

Mixed/Miscellaneous Wound Washes & Cleansers

Protective Gloves

Corn, Callus & Bunion Pads

Corn & Callus Removers

Antifungal Powders

FEMININE CARE

FIRST AID

FOOT CARE

5INCOMM HEALTHCARE | OTC NETWORK

Antifungal Creams & Liquids

Antifungal Sprays

Nail Fungus Treatments

Mixed/Miscellaneous Antifungal Treatments

Wart Remover Pads & Liquids

Mixed/Miscellaneous Wart Removers

Foot Pain Relief

Elastic Bandages

Protective Guards

Mixed/Miscellaneous Elastic Bandages & Athletic Treatments

Ankle & Foot

Hand & Wrist

Elbow & Arm

Knee

Thigh, Calf & Shin

Joint Warmers & Arthritis

Mixed/Miscellaneous Braces

Hot/Cold Therapy

Electric Heating Pads

Mixed/Miscellaneous Hot/Cold Therapy

Abdominal Supports

Rib Belts

Mixed/Miscellaneous Abdominal Supports & Rib Belts

Hernia Supports & Suspensories

Sacro & Back Braces

Arm Slings & Cervical Collars

Shoulder & Clavicle Braces

Mixed/Miscellaneous Orthopedic & Surgical Support

Stethoscopes & Accessories

Thermometers, Fever Strips & Accessories

Blood Pressure Kits & Accessories

Drug & Alcohol Tests

Mixed/Miscellaneous Home Diagnostics/Tests

Cholesterol Meters & Testing Kits

Pulse Oximeters & Heart Rate Monitors

Bathing & Oral Hygiene Aids

Mixed/Miscellaneous Patient Aids For Daily Living

Night Lights

Mobility Safety: Stair Rails, Stair Treads, Temporary Mobility Ramps

Eating & Drinking Aids

Grooming & Dressing Aids

HEALTH SUPPORTS

HOME DIAGNOSTICS & PATIENT AIDS FOR DAILY LIVING

6INCOMM HEALTHCARE | OTC NETWORK

Medical Alert IDs & Devices

Medicine Dosers, Pillboxes, Organizers & Reminders

Reachers, Grippers & Lifts

Reading, Writing & Telephone Aids

Bathtub Safety & Accessories

Bathtub & Toilet Rails & Frames

Elevated Toilet Seats & Accessories

Grab Bars & Handles

Sitz Baths & Bidets

Hand Held Showers

Mixed/Miscellaneous Bathroom Safety

Specialized Ankle & Foot Braces/Supports/Splints

Specialized Elbow & Arm Braces/Supports/Splints

Specialized Knee Hinged Braces/Supports/Splints

Specialized Knee Immobilizer Braces/Supports/Splints

Specialized Wrist & Hand Braces/Supports/Splints

Specialized Shoulder & Clavicle Braces/Supports/Splints

Specialized Thigh & Calf Braces/Supports/Splints

Mixed/Miscellaneous Specialized Orthopedic Braces/Supports/Splints

Canes for the Visually Impaired

Disposable Underwear

Disposable Briefs & Undergarments

Disposable Underpads

Disposable Pads, Shields, Guards & Drip Collectors

Mixed/Miscellaneous Disposable Incontinence

Reusable Garments

Reusable Underpads

Mixed/Miscellaneous Reusable Incontinence

Perineal - Only Cleansers & Washes

Perineal - Only Wipes & Towelettes

Perineal - Only Moisturizers, Barriers & Protectants

Perineal - Only Antifungals

Deodorizers

Mixed/Miscellaneous Incontinence Personal Care

Regular Toothpaste & Tooth Powder

Sensitive Toothpaste & Treatments

Whitening Toothpaste

Mixed/Miscellaneous Toothpaste & Treatments

HOME HEALTH CARE

INCONTINENCE

ORAL CARE

7INCOMM HEALTHCARE | OTC NETWORK

Manual Toothbrushes

Battery Toothbrushes & Refills

Rechargeable Toothbrushes & Refills

Mixed/Miscellaneous Toothbrushes & Accessories

Denture Adhesives

Denture Cleaners & Accessories

Denture Repair & Pain Relief

Mixed/Miscellaneous Denture Care

Floss & Flossers

Interdental

Gum Care

Dental Gum

Mixed/Miscellaneous Interdental, Floss & Gum Care

Oral Pain Relief & Mouth Sores

Dry Mouth

Temporary Dental Repair

Mixed/Miscellaneous Oral Remedies (Includes Fluoride Treatments)

Adult Acetaminophen

Feminine Pain Relief

Adult Aspirin & Combinations

Adult Ibuprofen & Other Anti-Inflammatories

Mixed/Miscellaneous Internal Pain Relief

Adult Nighttime Pain Relief

Adult Specialty Pain Relief

External Muscle/Joint Pain Relief Patches & Pads

External Muscle/Joint Pain Relief Creams, Ointments & Gels

External Muscle/Joint Pain Relief Lotions, Liquids, Roll-Ons & Sprays

TENS Units & Replacement Pads

Mixed/Miscellaneous External Pain Relief

Sleep Aids & Sedatives

Stimulants

Moisturizers, Barriers & Protectants

Antifungals

Mixed/Miscellaneous Patient Skin Support

Pedometers & Fitness Trackers

PAIN RELIEF

PATIENT SKIN CARE

PHYSICAL FITNESS & EXERCISE EQUIPMENT

8INCOMM HEALTHCARE | OTC NETWORK

Acne Creams, Gels, Lotions & Patches

Acne Soaps & Cleansers

Acne Astringents & Toners

Mixed/Miscellaneous Facial & Body Acne Medications

Nicotine Patches

Nicotine Gum & Lozenges

Mixed/Miscellaneous Smoking Deterrents

Sun Protection (< SPF 50)

Sun Protection (SPF 50+)

Mixed/Miscellaneous Sun Protection

Sport Sun Protection

Multivitamins

Eye Health Vitamins

Mixed/Miscellaneous Multivitamins

Vitamin B & Vitamin B Complex

Vitamin C

Vitamin E

Mixed/Miscellaneous Single Entity Vitamins

Vitamin D

Joint Health (Including Glucosamine)

Menopause Support (Soy)

Enzymes, Amino Acids & Hormones

CoQ10 Only (UBIQUINOL)

Heart Health & Essential Fatty Acids (Fish Oil, Flax, GLA, Etc.)

General Health Prebiotics & Probiotics

Calcium

Iron

Mixed/Miscellaneous Mineral Supplements

Multi-Minerals

Food Scales

Weight Management Tabs & Caps

Diuretics

Weight Loss Cleansing & Detox

Mixed/Miscellaneous Diuretics & Weight Loss Cleansing & Detox

SKIN CARE

SMOKING DETERRENTS

SUN CARE

VITAMINS & DIETARY SUPPLEMENTS

WEIGHT MANAGEMENT & NUTRITIONAL FOODS