CurrentBlue Cross Blue Shield - IowaPolicy H-8095-001

Over-the-Counter (OTC) Benefit

Defines the OTC benefit administered by NationsOTC/NationsBenefits for Wellmark (WMAHP) Blue Medicare Advantage HMO members in Iowa, including covered items, quarterly allowance, retailer requirements, and member cost-sharing.

Policy Summary

PayerBlue Cross Blue Shield - Iowa

PolicyOver-the-Counter (OTC) Benefit

Policy CodePolicy H-8095-001

Change TypeNo material changes

Effective Date01/01/2022

Next Review Date

Key ActionMembers must use plan-authorized retailers (online, phone, or mail) and use the quarterly allowance in the quarter earned; it does not roll over.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

quarterlyallowance frequency

zeromember cost share

300+available items

01/01/2022effective

OTC Benefit Coverage Criteria

OTC Benefit Criteria

Policy Summary

PayerBlue Cross Blue Shield - Iowa

PolicyOver-the-Counter (OTC) Benefit

Policy CodePolicy H-8095-001

Change TypeNo material changes

Effective Date01/01/2022

Next Review Date

Key ActionMembers must use plan-authorized retailers (online, phone, or mail) and use the quarterly allowance in the quarter earned; it does not roll over.

SourceLink

On This Page

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Members must be enrolled in WMAHP Blue Medicare Advantage HMO in Iowa to be eligible for the OTC benefit administered by NationsOTC/NationsBenefits.

Covered items: non-prescription medications and first-aid supplies (examples include vitamins, sunscreen, pain relievers, first aid supplies, and cough and cold medicine).

Allowance amount and timing: members receive a quarterly allowance that must be used in the quarter earned; allowances are issued in January, April, July, and October and do not roll over.

Access and retailer requirements: members must use plan-authorized retailers (online, by phone, or by mail) to redeem the OTC quarterly allowance and to verify balance and participating retailers via NationsBenefits or phone.

Cost sharing and exclusions: the OTC benefit has zero member cost share; members pay the full cost for items not covered under this benefit. The OTC benefit is not part of Medicare Part D and costs under this benefit do not count toward the plan's medical combined out-of-pocket maximum.

Plan-specific terms: scope of the benefit, reimbursement methodology, maximum allowed payment amounts, and member cost-sharing are determined by WMAHP and detailed in the plan Evidence of Coverage or Summary of Benefits.

OTC Items and Allowance Schedule

OTC itemsmixed

No procedure or diagnosis codes specified; OTC benefit covers non-prescription items such as vitamins, sunscreen, pain relievers, first aid, cough/cold medicine.

Quarterly allowance schedule

Allowance scheduleQuarterly allowances are available in January, April, July, and October.

Use-it-or-lose-it timingAllowances must be used in the quarter earned and do not roll over to the next quarter.

Member verificationMembers can verify available balance and participating retailers via NationsBenefits or by phone.

Items availableMore than 300 OTC items are available under the benefit.

Retailer and Timing Requirements

Billing Rule

Use plan-authorized retailers and spend allowance within the quarter

Members who participate must use plan-authorized retailers (online, by phone, or by mail) to access the OTC quarterly allowance. The allowance must be used in the quarter earned and does not roll over to subsequent quarters.

Use the plan-authorized retailer channels only: online, by phone, or by mail.
Allowances are issued quarterly and must be spent in the quarter earned; no rollover to the next quarter.

Key Definitions

OTC Benefit — definition

DefinitionOver-the-Counter (OTC) benefit: a program administered by NationsOTC/NationsBenefits that allows eligible members to purchase covered non‑prescription medications and first‑aid supplies using a quarterly benefit.

Covered items examplesIncludes vitamins, sunscreen, pain relievers, first aid supplies, and cough & cold medicine.

Cost sharingWMAHP has zero cost share for the OTC benefit; members pay full cost for items not covered under this benefit.

Access requirementsMembers must use plan‑authorized retailers (online, by phone, or by mail) as administered by NationsBenefits to use the quarterly allowance.

Original Medicare — note on OTC coverage

DefinitionOriginal Medicare: federal Medicare Part A and Part B; Original Medicare does not cover over‑the‑counter products or medication services.

Plan relationshipWMAHP Blue Medicare Advantage HMO uses Original Medicare as the base program and may offer enhanced benefits (such as OTC) beyond Original Medicare.

Benefit determinationBecause Original Medicare does not cover OTC benefits, the scope, reimbursement methodology, maximum payment amounts, and member cost sharing for OTC are determined by WMAHP and detailed in the plan Evidence of Coverage or Summary of Benefits.