OVER-THE-COUNTER COVID-19 TEST REIMBURSEMENT

Insurance companies and group health plans will now cover the cost of FDA approved over-the-counter, at-home COVID-19 tests, starting January 15th. The new coverage requirement means that consumers with private health coverage can go online or to a pharmacy or store, buy a test, and either get it paid for up front by their health plan, or get reimbursed for the cost by submitting a claim to their plan. Test costs are covered or reimbursed without the need for a health care provider’s order or individualized clinical assessment, and without any cost-sharing requirements such as deductibles, co-payments or coinsurance, prior authorization, or other medical management requirements.

Insurance companies and health plans are required to cover 8 free over-the-counter at-home tests per covered individual per month. That means a family of four, all on the same plan, would be able to get up to 32 of these tests covered by their health plan per month. There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions.

United Healthcare

If you’re a UnitedHealthcare individual and employer group health plan member with an OptumRx logo on your member ID card, you can receive an over-the counter (OTC) at-home COVID-19 test(s) at no out-of-pocket cost to you, if you purchase them at the in-store pharmacy counter at a Preferred Retailer. A Preferred Retailer is a pharmacy that UnitedHealthcare has made arrangements with to provide OTC at-home COVID-19 tests with no out-of-pocket costs to you. View the most up-to-date list of the Preferred Retailers and their websites.

When at-home COVID-19 tests are purchased at any in-store or online retailer, other than the preferred retailers, members may submit their receipt(s) for reimbursement through the UnitedHealthcare member portal. UnitedHealthcare will reimburse the member a maximum of $12 per test.

• Eligibility and reimbursement: A member can determine if they are eligible by looking at their UnitedHealthcare member ID card.

• If OptumRx is shown on the front of the card: They are part of the UnitedHealthcare pharmacy benefit through OptumRx and may go to any preferred retailer with available inventory to get a COVID-19 OTC test at no cost. The member must purchase their COVID-19 test(s) at the pharmacy counter to avoid upfront payment. The member must have their UnitedHealthcare ID card with them.

• If a member purchases an at-home COVID-19 test at any in-store or online retailer other than a preferred retailer pharmacy counter: They may submit a purchase receipt(s) for reimbursement at the UnitedHealthcare member portal for a maximum reimbursement of $12 per test. Reimbursement for tests purchased at Walmart.com and the Walmart checkout counters found at the front of the store also must be submitted through the UnitedHealthcare member portal.

Note: Many COVID-19 tests are sold as a two-pack. The test pack would be reimbursed at $24 ($12 for each test).

BCBS of MI

Blue Cross and BCN members will be able to fill out an online form and mail it in (along with receipts) after purchasing the at-home rapid diagnostic COVID-19 tests. You can find the online form on bcbsm.com/coronavirus, under the testing question or it is available through your member account. The form will be updated to comply with the federal program. Once we get qualifying forms from members, we will mail checks to them. Here are the specific steps:

• Members should fill out the form, attach receipts, and submit the form online or mail the form to us. We will then input the form for claims processing and mail a check back to the member if the submission qualifies.

• Our intent is to process these claims as soon as possible, however, due to ongoing mail delays and without knowing the volume of requests we will receive, it could take up to 60 days for members to receive reimbursement.

Aetna

Submit a claim for reimbursement after you buy OTC COVID-19 tests at a pharmacy, retail store or online. Just log onto your Aetna member website, click on “submit a claim for reimbursement“ and follow the claims submission instructions. Once your claim is approved, a check will be mailed to you.

For more details, visit the Aetna FAQ page.

Priority Health

If you have a MyPriority or employer-sponsored plan with pharmacy benefits through Priority Health and you purchase an over the counter (OTC) COVID-19 test from an authorized retailer, you will be eligible for reimbursement if:

• The at-home test you received is approved by the Food and Drug Administration.

• You fill out and submit the reimbursement form, with the UPCs (barcode on the test kit packaging) and original receipts from the authorized pharmacies or retailers as proof of purchase.

• Lastly, there is a limit of 8 tests or 4 kits per member per month.

Note: We are unable to reimburse for purchases from non-authorized sources including neighbors, Facebook Marketplace, etc.