FAQ: OTC & Flex Card Benefits

No. Your KelseyCare Advantage card is your member ID card. Your OTC or OTC/Flex Card is a separate card that only contains your OTC or OTC/Flex benefits.

All KelseyCare Advantage plans have OTC benefits.

If you are a member of our Honor (HMO) plan, your plan includes OTC benefits only.

If you are a member of our Classic (HMO), Freedom (HMO-POS), Signature (HMO), Secure (HMO), or Thrive (HMO-POS) plans, you have both OTC and Flex benefits.

OTC benefits give you an allowance every quarter (every 3 months) to buy approved health and wellness products. You can buy these approved products at participating retail stores or through our Over-the-Counter Catalog.

Flex benefits give you an allowance every year (every 12 months) to help with out-of-pocket costs, including preventive services, associated with dental care, vision care, and hearing services. You can only use the Flex allowance at licensed providers.

Your OTC Card can only be used in-person (not online) at the following participating retail stores:

• Kelsey Pharmacies
• CVS
• Dollar General
• Family Dollar
• Kroger
• Walgreens
• Walmart

You can also shop for approved OTC items in the following ways:

• By phone: 800-688-2719 (TTY: 711)
• Through mail-in order form. Find the order form and mail-in address in our OTC Catalog found on our website HERE or on KCAOTC.com.
• Through the OTC-Anywhere mobile app. Download the OTC-Anywhere app free on the Apple App Store or Google Play.
  Find more info about the app in our OTC Catalog HERE.

Watch this video for a quick overview of how to order products online using your over-the-counter (OTC) benefit.

They are both on one card.

• If you have OTC and Flex benefits, they are both on your OTC/Flex Card. The OTC/Flex Card is blue.

• If you have OTC benefits only (Honor members only), you have an OTC Card. The OTC card is white.

Your OTC allowance is added to your card at the beginning of every quarter (January, April, July, October). Your OTC allowance must be used within the quarter it is added. Unused amounts do not roll over and cannot be used once the quarter ends.

Your Flex allowance is added to your card all at once for the entire year.

Allowances are automatically added to your card. You don’t have to take any action to get it.

• New members: If you are a new KelseyCare Advantage member, you should have already received your OTC or OTC/Flex Card.
• Members who changed plans from OTC only to OTC/Flex: If your plan had OTC only last year but this year your plan includes Flex, you should have already received your new OTC/Flex card.
• Members who do not receive a new card: If you were a member in 2023 and your former and current plans both have Flex benefits, you will not receive a new card. For your convenience, last year’s OTC/Flex Card will continue to work.

If you are due to receive a new OTC or OTC/Flex Card and have not yet received it, or if you need help getting a new card, please call 800-688-2719 (TTY: 711) for help.

The card works like a typical credit card. You do not need a pin number to use it. Keep in mind that your card will only work in certain places and for certain items.

• To use your OTC allowance, the card will only work on approved OTC items at participating retail stores. You can also shop by phone, mail-in order form, and through the OTC-Anywhere mobile app.

To use your Flex allowance, the card will only work at licensed providers (optometrists, dentists, etc.) and only on out-of-pocket costs, including preventive services, associated with dental care, vision care, and hearing services. If you try to use your OTC Card or OTC/Flex Card on items or in locations other than what is listed above, your card will not work.

You do not have to use your entire OTC allowance at one time. You can make smaller purchases throughout the quarter. If you are shopping in person at a participating retail store, you are not limited to how many times you can shop per quarter. If you are shopping through the OTC catalog, you can only purchase 4 times per quarter. Please keep in mind that your OTC allowance must be used before the end of the quarter.

It must be an approved OTC item at a participating retail store. You can log into your account on KCAOTC.com and see photos of approved items. All approved items are also located in the OTC catalog HERE.

Members have access to the OTC catalog online and can also download the app to see the list of approved items. When you log into your account at KCAOTC.com, you will see descriptions and photos of approved items.

If your card was rejected at one location but approved at another, the rejected charge was probably through a non-participating retail store. Your OTC allowance can only be used at participating retail stores.

If your OTC or OTC/Flex Card was denied on expenses that should have been approved, contact 800-688-2719 (TTY: 711) for assistance.

That depends on what type of service the doctor provides. The Flex Card will only work at licensed providers (optometrists, dentists, etc.) and only on out-of-pocket costs associated with dental care, vision care, and hearing services.

Yes. According to the Evidence of Coverage (EOC), your Flex Card can be used toward “out-of-pocket costs associated with dental care including preventive services, such as cleanings and x-rays, and comprehensive services, such as extractions, crowns, dentures, fillings, and other services when provided by a licensed dentist, dental surgeon, or other licensed dental provider.”

Yes. According to the Evidence of Coverage (EOC), your Flex Card can be used for ”out-of-pocket costs associated with vision care including preventive services, such as eye exams, and other services when provided by a licensed vision provider. Also, eligible are costs prescription grade eyeglasses including frames, lenses, upgrades and contact lenses.”

Yes. According to the Evidence of Coverage (EOC), your Flex Card can be used for “out-of-pocket costs associated with hearing services including preventive services, such as hearing exams, hearing aid fitting and evaluation, hearing aids, and other services when provided by a licensed provider or audiologist.”

For detailed information about what is covered in your plan, please review your Evidence of Coverage (EOC at KelseyCareAdvantage.com/members/plan-documents. You can also learn more at KCAOTC.com or by calling 800-688-2719 (TTY: 711).

Watch this video for a quick overview of how to order products online using your over-the-counter (OTC) benefits.