New federal mandate requires insurers to cover costs for COVID-19 testing.
Here's what we know so far.
The federal government’s requirement for health plans — including self-insured employers — to cover the costs for FDA approved over-the-counter (OTC) COVID-19 tests starts January 15, 2022. Capital Blue Cross is here to help employers and our members. Our websitehas more details, but here are a few points you should know now:
What should members expect?
Members do not need a prescription or note from a doctor to get their OTC COVID-19 tests.
Members will have the most consumer-friendly experience by getting their tests at pharmacies using their plan’s prescription drug benefits. They won’t need to pay for the tests, save receipts, submit claims, or wait for reimbursement when done this way.
Members also can get tests from other in-store or online retailers; however, if they do, they will need to submit a claim form and include their receipts.
The requirement applies only to any new purchases of approved OTC COVID-19 tests on or after January 15, 2022. Members will not be reimbursed for any tests purchased prior to that date.
We will email members about OTC testing coverage tomorrow morning.
Are there any limits?
Each covered member is eligible to get up to eight tests every 30 days.
If packages or kits include more than one test, each individual one will count toward the eight-test maximum.
To be eligible for coverage, tests must be approved by the FDA for emergency authorized use during the public health emergency.
For Capital Blue Cross pharmacy coverage, claims reimbursements are capped at $12 per test. If members use their medical benefits, we must cover the entire cost of the test.
What should employers know?
Self-insured employers cannot opt out of this requirement.
Insurers and self-funded plans are not required to cover the tests for employment purposes.
Again, employees will have the most consumer-friendly experience by getting their tests at pharmacies using their plan’s prescription drug benefits. They won’t need to pay for the tests, save receipts, submit claims, or wait for reimbursement.
Please keep in mind that testing quantities are currently limited and supplies may vary from pharmacy to pharmacy. Capital Blue Cross cannot help increase the number of tests available at pharmacies or other retailers. For more information, visit our COVID-19 resource page.