Your form and receipt to: WellCare/ Ohana OTC DMR Center P.O. Box 31396 Tampa, FL 33631-3396 Sample Claim Form: Purchase Date Merchant Name .
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How to fill out the OVER-THE-COUNTER (OTC) ITEMS CLAIM FORM - WellCare online
Filing a claim for eligible over-the-counter items can be a straightforward process when you understand how to fill out the WellCare OTC Items Claim Form. This guide will walk you through each step to ensure that your claim is completed accurately and submitted for reimbursement.
Follow the steps to fill out the OTC Items Claim Form online.
- Press the ‘Get Form’ button to obtain the OTC Items Claim Form and open it in your preferred editor.
- Begin filling out the form by entering the member's name in the designated field.
- Input the member ID in the corresponding section of the form.
- Provide the address of the member. If the address has changed, check the box indicating a new address.
- Fill in the city, state, and ZIP code.
- Enter a telephone number where the member can be reached.
- List the purchase date of each item on the claim in the appropriate field.
- Specify the merchant's name and ZIP code where the items were purchased.
- In the item name/description field, provide clear descriptions of each item, including package size and total item cost.
- For each item, calculate the total cost, including any applicable taxes, and ensure it is noted correctly on the form.
- If there are multiple counts of the same item, use a new line for each count, ensuring all items are listed.
- Calculate the grand total for all items and enter it in the grand total field.
- The member must sign and date the form at the bottom to certify the accuracy of the information.
- Once completed, save any changes made to the document, and choose to download, print, or share the form as needed.
Start filling out your OTC claim form online today to ensure quick reimbursement!
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Can I buy milk with my OTC card?
It can be used to purchase eligible food items such as fresh fruits and vegetables, milk, bread, eggs. You can find a complete list of eligible items by clicking on this link: Full list of eligible items.
Does Wellcare cover over the counter drugs?
As a part of your plan, you have an Over-the-Counter (OTC) benefit. We give you a fixed dollar amount to buy the OTC medications and products you need to stay well. These are everyday things like bandages, pain relievers, cold remedies, toothpaste and much more.
How do I use my OTC benefits?
To use your OTC Card, take your card and your covered OTC item(s) to the checkout at any participating store or pharmacy.
Can I buy shampoo with my OTC card?
OTC cards do not cover the following items: Prescription medications. Standard dental hygiene products (toothpaste, floss, mouthwash, etc.) Hair care products (shampoo, etc.)
What items can be purchased with OTC card?
Over-the-Counter. (OTC) Covered Items. ... Abdominal Supports & Rib Belts. Acid Controllers. ... Anti-Diarrheals. Anti-Diarrheal Tabs, Liquids & Caps. Antifungal Treatments. Antifungal Powders, Creams, Liquids & Sprays. ... Anti-Gas. Mixed/Miscellaneous Anti-Gas. Anti-Itch Treatments. ... Antiparasitic Treatments. ... Braces.
Can I buy toothpaste with my OTC card?
OTC items are not eligible for reimbursement if they are normally used for general health, are not used to treat a medical condition (e.g. toothpaste, mouthwash, lotion, shampoo) or are cosmetic in nature (e.g. teeth whitening products, wrinkle reducers). See additional examples in the OTC Chart.
Can I buy soda with OTC?
Grocery Plus benefit Items that do not qualify include non-food and pet items, alcohol, baby formula, candy, chips, coffee shop items, desserts, fresh baked goods, soda, and tobacco.
Can I use my Wellcare OTC card at Walmart?
Pay for any cost above your benefit amount (and non-covered items) as you normally would when you check out. Participating retailers include CVS, Walgreens, Duane Reade, Walmart, Dollar General, Family Dollar, Rite Aid, and select independent pharmacies.
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