The Biden Administration recently released guidance which requires group health plans and health insurance issuers to cover over-the-counter COVID-19 tests authorized by the FDA beginning on January 15, 2022 for the remainder of the public health emergency. Test kits must be approved by the FDA (Emergency Use Authorization (EUA) kits).
Group health plans and health insurance issuers are required to cover at least eight free Over-the-Counter COVID-19 tests per covered individual on your health plan per 30-day period (or per calendar month). For example, a family of four all enrolled in the same group health plan would be able to get at least 32 OTC COVID-19 tests covered by their health plan per calendar month.
There is no limit on the number of COVID-19 tests, including OTC COVID-19 tests that must be covered by the health plan or issuer 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.
The tests are paid for by the health plan and are at no cost to the member providing the member obtains the tests through the network of pharmacies and retailers in the network. Prime Therapeutics has over 65,000 pharmacies nationwide in its network. Take the test kit to the pharmacy counter, present your pharmacy (Prime Therapeutics) benefit card, and pay for it there, asking for it to be put through insurance. There will be no cost to you at the point of sale. Please understand that the availability of test kits at pharmacies is not the responsibility of the health plans. Test kits purchased prior to January 15 will not be reimbursed.
If the member goes outside the pharmacy or retail network, the health plan cost is capped at $12 for each test and the member is responsible for the balance. In this case, please retain the receipts; further instruction will be forthcoming on the reimbursement process.
Those on EB health insurance can review the pharmacies in network by going to the EB Home page – Benefits and Wellness – Quick Links – Prime Therapeutics – Find a Pharmacy in network. You will be asked to register if you have not done so already. The EB Pharmacy is in network but has not yet received a supply of tests. We will communicate if and when they do. Those not on EB insurance must follow guidance from their insurance plan.
The process for test distribution for employees on CIGNA Global (expatriate employees only) is still in development. At this time, only tests purchased within the US will be covered. Tests purchased outside the US or purchased inside the US then shipped to overseas locations and submitted for a claim will not be covered. Claims may be submitted through the member’s account at www.envoy.com.
