Services, or Hearing Services and Visa® 
is accepted. 
Cannot be used for procedures such as 
cosmetic dentistry and teeth whitening. 
Unused amount expires at the end of 
the plan year. 
Allowance amounts cannot be 
combined with other benefit allowances. 
Limitations and restrictions may apply.   
Over-the-Counter (OTC) Allowance 
$50 maximum benefit coverage 
amount per month for over-the-counter 
(OTC) prepaid card to purchase eligible 
OTC health and wellness products at 
participating retailers.