As of January 15, 2022, members can get reimbursed by their health plan without cost share for the costs of over-the-counter (OTC) diagnostic COVID-19 tests until the end of the Coronavirus Public Health Emergency.

How are the over-the-counter tests covered?

From January 15, 2022, until the end of the Coronavirus Public Health Emergency, each member on a group plan can get up to eight over-the-counter tests each month. If they purchase a test kit that includes two rapid tests, that will count as two of their eight covered tests. The federal requirement covers their cost for diagnostic tests.

When should an employee take a test?

The Centers for Disease Control and Prevention (CDC) provides guidelines for who should get a diagnostic test and when based on their current health vaccination status and history of infection.

Where can employees find a test?

Visit COVIDtests.gov for information on free tests that may be available through government programs.

AETNA –

Over-the-counter testing kits will be covered under the pharmacy benefit.

For Direct Member Reimbursement: Reimbursement for OTC COVID-19 tests without a prescription after purchase, starting January 15, 2022. Members should hold their claim submissions until Aetna has further details. Claims will initially be reimbursed at the billed cost until the direct coverage arrangement is in place.

Direct Coverage: Aetna is working to implement this arrangement through the retail pharmacy network as soon as possible. Plan will cover the cost of the OTC tests with direct reimbursement to the pharmacy and no upfront out of pocket cost for members. Aetna will adjudicate claims at a rate comparable to the pharmacy’s U&C rate. This is necessary to encourage broad pharmacy participation and adequate access to care. More information coming soon!

ANTHEM –

Members will be reimbursed for over-the-counter COVID-19 diagnostic tests purchased on or after January 15, 2022. Members may have to pay out of pocket at the time of purchase but should keep the receipt to submit a claim online. Log in to anthem.com/ca , go to Claims & Payment, and choose Submit a Claim.

BLUE SHIELD –

Blue Shield will provide coverage for at-home COVID-19 tests for personal use that were purchased on or after January 15, 2022, and will cover these tests without cost-sharing, medical management, or prior authorization for members in individual and group health plans. To be eligible for coverage, at-home COVID tests must be purchased by the participant, beneficiary, or enrollee for personal use, and not for employment purposes nor resale.

Members can submit a claim for a home test kit, mail this claim form with the receipt to Blue Shield. A separate form is required for each receipt:

Blue Shield of California

PO Box 272540

Chico, CA 95927-2540

The receipt will need to identify the following:

  • The retailer where the home test kit was purchased including physical address or website
  • Date of service/purchase
  • UPC code for the home test kit (located on the box or receipt)
  • Cost of the test

Please highlight these items if there is more than one item on the receipt. Please write on the receipt or invoice “Home COVID test.”

CIGNA –

In order to be reimbursed, customer claims can be submitted by following the directions on the back of the customer’s Cigna ID card. The submission needs to include:

  • The purchase receipt documenting the date of purchase and the price
  • UPC code for the OTC COVID-19 test
  • Signed, completed attestation stating the test:
    • is not for employment purposes
    • has not and will not be reimbursed by another source, and
    • is not for resale

KAISER –

Kaiser members may submit a reimbursement claim form via the member portal here for tests purchased on or after January 15, 2022.

Sharp Health Plan –

Sharp Health Plan will reimburse members for at-home over-the-counter COVID-19 tests purchased on or after January 15, 2022, with or without a prescription. Tests submitted for reimbursement must be authorized by the U.S. Food and Drug Administration (FDA). The FDA features lists of approved tests on its website.

  • Members may submit using the Member Reimbursement Request Form – At-home over-the-counter COVID-19 tests.
  • Sharp Health plan will cover 8 individual at-home over-the-counter COVID-19 tests per person enrolled in a plan per month. A family of four can get reimbursed for up to 32 tests per month regardless of whether the tests were bought all at once or at separate times throughout the month. Tests may be packaged individually or with multiple tests in one package (for example, two tests packaged in one box).
  • Reimbursement will take 30 days from the date Sharp receives the reimbursement request to process a reimbursement. If a request is approved, the member will receive a check by mail for the total reimbursement amount. The member will be notified by mail if the request is denied.

UNITEDHEALTHCARE –

UnitedHealthcare individual and employer group health plan members with an OptumRx logo displayed on the member ID card can now receive reimbursement for an OTC at-home COVID-19 test.

Members may do this in two ways:

  1. At an in-store pharmacy counter at one of UnitedHealthcare’s Preferred Retailers for OTC at-home COVID-19 tests: To get OTC at-home COVID-19 test(s) with no out-of-pocket costs, the member must make the purchase at an in-store pharmacy counter at a UnitedHealthcare Preferred Retailer – Members should present their ID card. 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.

Preferred Retailers: Walmart, Rite Aid and Bartell Drugs. UnitedHealthcare is working to continue to add more. Please be sure to check a Preferred COVID-19 Test Pharmacy’s website or mobile app for available test inventory and store hours before you visit an in-store pharmacy counter at one of the Preferred Retailers.

2. At any other in-store or online retailer: Members may submit a receipt for reimbursement online at myuhc.com. Members may also submit receipts through a reimbursement form (pdf).

  • Maximum reimbursement of $12 per test
  • Many COVID-19 tests are sold as a 2-pack kit ($12 for each test) and would be reimbursed at a maximum of $24 per kit

If you do not see an OptumRx logo on the member ID card, members may still submit for reimbursement at myuhc.com or through a reimbursement form (pdf).

We will provide information for Health Net and MediExcel as details become available.