Understanding OTC and Healthy Grocery benefits can be challenging because insurers use different program names, combine or separate benefits in various ways, and frequently redesign their supplemental offerings. This article clarifies the most essential points: what these benefits are, who qualifies, and how both members and retailers can access and use them through ProHealth Connect.
ProHealth Connect is the leading acceptance platform for independents to accept OTC, grocery, flex, and wellness allowance programs across Medicare Advantage and Medicaid plans.
Over-the-Counter (OTC) benefits are health-plan–funded allowances that members can use to buy non-prescription, health-related items. These benefits are provided by:
OTC benefits are not cash, EBT, WIC, or SNAP. They are insurance-funded and limited to items that support preventive care, chronic-condition management, and hygiene.
Common eligible items include:
Members receive these benefits automatically through their health plan—not through government programs or retailer enrollment.
Healthy grocery benefits are nutrition-focused allowances that help members purchase healthier foods. They address food insecurity, chronic disease, and nutrition needs.
Typical eligible items include:
These benefits are also insurance-funded, not EBT/SNAP/WIC.
Health plans may offer:
Because there is no industry-wide naming standard, different insurers use different terminology for the same types of benefits. One plan might call its program an “OTC + Grocery Card,” while another refers to a “Flex Card,” a “Wellness Allowance,” an “Essentials Card,” or a “Healthy Options Card.” This inconsistent naming makes it difficult for both members and retailers to understand what a card actually covers.
This terminology varies widely between insurers, but regardless of the card name, any eligible cards may be accepted with ProHealth Connect.
Eligibility depends on the member’s health plan, not the retailer.
A member qualifies if:
Members do not apply for these benefits at the store. They receive them automatically through their insurance plan.
To verify eligibility, members should contact their plan or check:
Retailers never determine member eligibility manually.
Consumers use their benefit in simple steps:
ProHealth Connect automatically handles:
Members and retailers don’t need to interpret plan documents or product lists. PHC’s system does it automatically.
Any retailer that sells eligible products can accept these benefits through ProHealth Connect.
Approved retailer types include:
Retailers do not need:
OTC and grocery benefits are insurance-funded, so the acceptance process is far simpler.
Retailers who want to accept OTC, healthy grocery, or combined benefits can enroll with ProHealth Connect through the following steps
Choose the appropriate form for your store.
Single-location retailers click the “Let’s Get Started” button, multi-location retailers click the "Multiple Locations? Click Here" button on the Retailer Page.
ProHealth Connect will respond within 24-48 hours with the PHC Contract.
The contract package will including the following:
Terminal will arrive in 8-10 business days, the PHC app can be downloaded immediately,
Training documents will be sent to your email or visit the Community Page for easy How-Tos
ProHealth Connect provides:
PHC is purpose-built to handle:
No matter what the plan calls the benefit, PHC interprets it and ensures proper acceptance.
You don’t apply at a store. OTC benefits come from your health insurance plan. Call your insurer to check eligibility.
OTC = health items. Healthy Grocery = nutritious foods. Some plans combine them into one benefit card.
Enroll with ProHealth Connect. PHC provides everything you need to accept OTC, grocery, flex, and wellness cards.
No. These are insurance-funded benefits, not government food assistance programs.
Because insurers use different names for similar benefits. ProHealth Connect handles all versions.
OTC and Healthy Grocery benefits vary widely across insurers, and the terminology is inconsistent across the industry. But ProHealth Connect unifies these rules, allowing:
ProHealth Connect is the national platform that connects insurance-funded benefit cards to retailers safely, accurately, and seamlessly.
