Over-the-Counter Medication Benefits

KelseyCare Advantage provides members with access to approved over-the-counter (OTC) products. The OTC Benefit provides members with $25 every quarter which can be used towards purchasing approved over-the-counter items through select pharmacy locations. Unused amounts do not carry over to the next quarter or the next calendar year. The approved KelseyCare Advantage OTC products cover a wide range of over-the-counter needs such as allergy relief products, cough and cold medicine, antacids, pain relievers, vitamins and minerals, first aid products and more.

Approved over-the-counter products are detailed in the OTC catalog. These products can be purchased at Kelsey Pharmacies or they can be mailed to your residence. For questions about this benefit, please contact KelseyCare Advantage Member Services at 713-442-9452 or toll-free at 1-866-534-0557 (TTY users can call 711) from 8 a.m. to 5 p.m. Monday through Friday. To make an order or purchase, please contact your local Kelsey Pharmacy.

Approved OTC products will be detailed in the OTC catalog. Confirm that you are reviewing the most current OTC catalog. These products can be purchased in-store, online through the Over-the-Counter portal on My Kelsey Online (MKO), or over the phone for in-store pick up or mail delivery.

Using Your OTC Benefit

• Review the OTC catalog for the list of approved over-the-counter products.

• Visit a Kelsey-Pharmacy in-person, contact your local Kelsey Pharmacy location, or use the Over-the-Counter online portal available through your My Kelsey Online (MKO) to place an order. Phone numbers, hours of operation and addresses are provided on the back cover of your OTC catalog.

• Your quarterly allowance is $25, which includes sales tax as applicable. Unused amounts will not roll over to the next quarter or year.

• If the total cost of your order is higher than the provided allowance, you will be responsible for paying the difference out of pocket before your order is processed. A Kelsey Pharmacy associate will assist with processing the remaining balance via phone or you can pay the remaining balance at Kelsey Pharmacy.

How to Order

Orders can be submitted over the phone or through the Over-the-Counter portal on My Kelsey Online (MKO) for mail delivery or in-store pick up. Items may also be purchased in-store at your local Kelsey Pharmacy.

Mail Delivery

Call Kelsey Pharmacy or order online through the Over-the-Counter portal available in My Kelsey Online (MKO) by 4 p.m. Monday through Friday to have your order mailed the following business day. Ordered products are delivered through standard mail and may take 7-10 business days for delivery. You will not be charged for any costs associated with mail delivery.

In-Store Pick-Up

Call Kelsey Pharmacy or order online through the Over-the-Counter portal available in My Kelsey Online (MKO) by 4 p.m. Monday through Friday to have your order prepared for in- store pick up after 1 p.m. the following business day. Items that are not picked up at the designated store within 14 days of order preparation will be returned to stock. Holidays and weekends may affect hours of operation and delivery schedules.

In-Store Purchases

Locate and confirm the operating hours of your local Kelsey Pharmacy by calling the pharmacy or visiting www.kelsey-seybold.com/pharmacy ahead of your visit.
Visit your nearest Kelsey Pharmacy and look for items with a “KCA Approved” OTC sticker for in-store purchases. Store associates can assist with finding specific approved products.

Return Policy

If a mail ordered item is defective, please contact Kelsey Pharmacy (phone numbers are provided on the back cover of this catalog) to discuss replacement options.

Due to the personal nature of these products, no other returns or refunds will be granted for over-the- counter (OTC) purchases. Lost or stolen OTC items are not refundable and will not be replaced.

Reimbursement Policy

Under specific circumstances, such as an instance where you forget to use your allowance when purchasing approved OTC products at participating Kelsey Pharmacies, you can contact us (phone numbers are provided on the back cover of this catalog) to determine if you qualify for reimbursement. Reimbursement requests will be reviewed by a dedicated team and you will be informed of the final decision.

To be eligible for reimbursement:

• You are required to have proof of purchase of an approved OTC product as detailed in this catalog at a participating Kelsey Pharmacy.

• You must have an available balance of your quarterly allowance at the time of purchase.

• You must have been eligible for the OTC benefit at the time of purchase.

Send us your request for payment, along with your bill and documentation of any payment you have made. It’s a good idea to make a copy of your bill and receipts for your records.

Mail your request for payment together with any bills or receipts to us at this address:
KelseyCare Advantage
Attn: Member Services
P.O. Box 841569 Pearland, TX 77584-9832

You must submit your claim to us within 12 months of the date you received the over-the-counter product. For further questions you can contact us at the phone numbers provided on the back cover of this catalog

Notices

• The preapproved products as listed in this catalog are non-prescription drugs, also known as OTC drugs, and health-related items that are not covered by Medicare Part A, Part B or Part D, and are a part of a supplemental medical benefit provided by KelseyCare Advantage annually. Some items, under certain circumstances, may be covered under either Part B or Part D, these items are identified throughout the catalog. When you receive these items under Part B or Part D, you may not purchase these items through your OTC benefit.

• The items covered by the benefit are limited to items that are consistent with CMS guidance. The list of approved OTC products may change at any time. Please note that the KelseyCare Advantage OTC benefit cannot be used towards the purchase of any items that are not on the list of approved products in this catalog.

• Products that are covered by this supplemental benefit are for the eligible member, OTC items may be purchased for the eligible member only. Medicare prohibits the use of this benefit to order OTC products for family members and friends.