At home COVID tests just became more accessible and affordable. On Jan 10th the Biden Administration released a directive that health insurers and group health plans cover the cost of FDA-authorized or approved over the counter at-home COVID-19 tests purchased on or after Jan 15th.
The goal is to remove financial barriers and expand access to COVID-19 testing for million of people.
As with any new initiatives or directives, information evolves quickly and often creates questions and confusion. Here are some of the key questions and answers for employers and employees:
- Who is eligible?
Anyone with private, employer sponsored, or student health commercial insurance is eligible for reimbursement.
- What is covered?
Up to eight (8) OTC COVID-19 diagnostic antigen rapid home tests per 30-day period for each person covered under your plan. Each test is counted separately so a kit that includes two tests you are covered for up to four of those kits.
Note: No order from a physician is needed and tests must be used to diagnose potential infection. Test used for employment, school or recreational purposed are not eligible for reimbursement.
- How do I get reimbursed?
Typically, OTC tests will be covered under pharmacy benefits, so check your benefits card if you have questions for your prescription benefits. Be sure to keep your receipts to submit with your claim.
- If I already purchased at home OTC COVID-19 Tests, can I still get reimbursed?
Plans and insurers are only required to cover tests purchased on or after January 15th, 2022.
- Where can I find OTC COVID-19 tests?
You can buy tests at pharmacies, retail location or online, but demand is extremely high, so we suggest calling ahead to one or more pharmacies to check inventory before.
- Where can I learn more general information?
The most comprehensive information is available at Federal Administration Over-the-CounterCOVID-19 HHS News.
- Where can I learn about my specific carrier requirements?
For specific information from YOUR carrier check the links below:
Horizon Blue Cross Blue Shield
Evolution Healthcare – contact your client manager for claim form
- If I am covered by Medicare, how do I get an at home test?
HHS is providing up to 50 million free, at home test to community health centers and Medicare-certified health clinics for distribution to patients and community members. For more information visit the HRSA Website.
Brian Honan | Partner
PF Compass Employer Guidance & Benefit Solutions
440 Route 22, E., Suite 190
Bridgewater, NJ 08807
Tel (973) 732-0697