Customer Care
866.570.5474
Find My Rep
Sales Directory
Send Us Your RFP
Contact Quoting
The Coronavirus (COVID-19) pandemic has introduced the need to take immediate action to ensure the health and well-being of ourselves, and our families. As insurance industry professionals, this outbreak has also raised a host of questions that continue to evolve daily.
As your dedicated partner, we understand that you need access to information quickly. That’s why we’ve prepared this resource to ensure you have the resources and support you need during this time. We are monitoring this situation vigilantly and we encourage you to bookmark this page and check back often for updates.
Stay updated with all the COVID-19 news!
No Cost Over-the-Counter COVID Tests
As of January 15, 2022, health plans are required to cover the cost of 8 FDA approved over-the-counter (OTC) in-home diagnostic tests, per member per month. The guidance is applicable to self-insured and fully insured group health care plans, including grandfathered health plans (“plans”):
- Plans and issuers must cover the cost of OTC COVID-19 tests, including tests obtained without a health care provider’s order or authorization.
- Coverage must be provided without cost-sharing (deductibles, co-payments, and coinsurance) or prior authorization requirements.
- Plans must reimburse participants for the cost of testing per the plan’s claims procedures. Plans are not required to reimburse sellers of the kits directly but may do so voluntarily.
- The guidance “strongly encourages” plans to provide direct coverage for OTC COVID-19 tests by reimbursing sellers directly without requiring participants to seek reimbursement.
Carrier Responses
| CARRIER | CLAIM SUBMISSION PROCESS | RETAIL PURCHASE WITHOUT CLAIM SUBMISSION | RESOURCES |
|---|---|---|---|
| Banner|Aetna |
Members can submit for reimbursement through Banner|Aetna's member portal. | Members can show their ID card to a network pharmacy to receive the test at no cost. Note that not all network pharmacies are prepared to process through insurance at this time; if the pharmacy is unable to process then members can purchase the test and submit for reimbursement. | |
| Blue Cross Blue Shield of Arizona | Members must mail a completed OTC Home Test Reimbursement Form along with their UPC barcode label from the test package. | Not available at this time. | |
| Cigna Administered by Oscar | Members can obtain tests through Cigna + Oscar’s Direct Coverage program. | C+O recommends members show their ID card to the pharmacy and request they will your insurance. They understand this may not be accepted as many pharmacies are still working through how to set up this process. | OTC Home Test Reimbursement |
| Humana | Members must mail a completed OTC Test Reimbursement Form along with the original itemized receipt to the address on the back of the members ID card. | Members can show their ID card to a network pharmacy to receive the test at no cost. Note that not all network pharmacies are prepared to process through insurance at this time; if the pharmacy is unable to process then members can purchase the test and submit for reimbursement. | OTC Test FAQs |
| UnitedHealthcare | Members can submit for reimbursement through UHC's member portal. | Members who have pharmacy benefits administered by OptumRx will have no up-front cost when purchasing through Walmart Pharmacy or Rite Aid Pharmacy (members can determine they are through OptumRx by the logo on their ID card). UHC is working to add additional retailers. |
| CARRIER | CLAIM SUBMISSION PROCESS | RETAIL PURCHASE WITHOUT CLAIM SUBMISSION | RESOURCES |
|---|---|---|---|
| Aetna | Members can submit for reimbursement through Aetna's member portal. | Members can show their ID card to a network pharmacy to receive the test at no cost. Note that not all network pharmacies are prepared to process through insurance at this time; if the pharmacy is unable to process then members can purchase the test and submit for reimbursement. | |
| Anthem Blue Cross | Members can submit for reimbursement through Anthem's member portal (select Claims & Payment after logging in). Members can also order tests online using the Sydney Health mobile app or at anthem.com/ca. |
Not available at this time. | Article on OTC Tests |
| Blue Shield of California | Members can submit for reimbursement using the Blue Shield Statement of Claim form. | Not available at this time. | |
| Cigna + Oscar | Members can obtain tests through Cigna + Oscar’s Direct Coverage program. | C+O recommends members show their ID card to the pharmacy and request they bill your insurance. They understand this may not be accepted as many pharmacies are still working through how to set up this process. | OTC Home Test Reimbursement |
| Health Net | Members can submit for reimbursement using the Health Net claim form. | Not available at this time. | - |
| Kaiser Permanente® | Members can submit for reimbursement through Kaiser's member portal. To submit, select "Coverage & Costs", then select "Submit a medical claim". |
Members may visit a participating retail pharmacy, such as Walmart and Rite Aid, to pick up tests at no cost. Visit kp.org to see a list of participating retailers. Members will need to present their photo ID and Kaiser ID card at the pharmacy counter. Availability of tests may vary. |
COVID Resources |
| MediExcel Health Plan | A claims reimbursement process will be available soon. | Not available at this time. MediExcel hopes to have resources available soon. | COVID Resources |
| Sharp Health Plan | Members can submit for reimbursement using the Sharp OTC COVID test reimbursement form. | Not available at this time. | COVID Resources |
| Sutter Health Plus | Members can submit for reimbursement using the Sutter claim form. | Not available at this time. | |
| UnitedHealthcare | Members can submit for reimbursement through UHC's member portal. | Members who have pharmacy benefits administered by OptumRx will have no up-front cost when purchasing through Walmart Pharmacy or Rite Aid Pharmacy (members can determine they are through OptumRx by the logo on their ID card). UHC is working to add additional retailers. |
|
| Western Health Advantage | A Claim Reimbursement webpage is available through the WHA Pharmacy partner OptumRx and will accept receipts dated on or after January 15, 2022. | Members may visit a preferred network pharmacy to receive tests at no cost. Preferred network locations will be updated as more become available; check the WHA COVID page for a current list. | COVID Testing Reimbursement Letter |
| CARRIER | CLAIM SUBMISSION PROCESS | RETAIL PURCHASE WITHOUT CLAIM SUBMISSION | RESOURCES |
|---|---|---|---|
| Aetna | Members can submit for reimbursement through Aetna's member portal. | Members can show their ID card to a network pharmacy to receive the test at no cost. Note that not all network pharmacies are prepared to process through insurance at this time; if the pharmacy is unable to process then members can purchase the test and submit for reimbursement. | |
| Anthem (CT & NH) |
Members can submit for reimbursement through Anthem's member portal (select Claims & Payment after logging in). Members can also order tests online using the Sydney Health mobile app. |
Not available at this time. | OTC Testing Coverage |
| BCBSRI | Members can submit a completed reimbursement form along with the receipt for reimbursement. | Members can visit a pharmacy in the BCBSRI pharmacy network to receive a test at no-cost. Note: not all pharmacies are ready to process requests and members may need to submit for reimbursment. | OTC Testing Coverage |
| Cigna + Oscar (CT) |
Members can obtain tests through Cigna + Oscar’s Direct Coverage program. | C+O recommends members show their ID card to the pharmacy and request they will your insurance. They understand this may not be accepted as many pharmacies are still working through how to set up this process. | OTC Home Test Reimbursement |
| EmblemHealth | Members can submit for reimbursement through EmblemHealth's online prescription reimbursement site; must include receipt. | Not available at this time. | |
| Empire BlueCross BlueShield | Members can submit for reimbursement through Empire's member portal (select Claims & Payment after logging in). Members can also order tests online using the Sydney Health mobile app. |
Not available at this time. | OTC Testing Coverage |
| Harvard Pilgrim HealthCare | Members must mail a completed At-Home Test Reimbursement Form along with a copy of the receipt for reimbursement. | Commercial members can visit a Walmart of Rite Aid Pharmacy and purchase tests with no upfront cost. | COVID Guide to Care |
| Healthfirst | Members should call Healthfirst Members Services at 1-888-250-2220 for help with reimbursement. | Members can visit a pharmacy in the Healthfirst pharmacy network to receive a test at no-cost. | OTC Testing Coverage |
| UnitedHealthcare & Oxford | Members can submit for reimbursement through UHC's member portal. | Members who have pharmacy benefits administered by OptumRx will have no up-front cost when purchasing through Walmart Pharmacy or Rite Aid Pharmacy (members can determine they are through OptumRx by the logo on their ID card). UHC is working to add additional retailers. |
Individuals can request free rapid antigen home tests, without shipping fees, from the federal government.
08/04/2022
Health Cost Transparency Guide for Employers
The Consolidated Appropriations Act (CAA), No Surprises Act (NSA), and the Transparency in Coverage Final Rule (TiC Final Rule) impose several new requirements on employer-sponsored group health plans...
08/04/2022
2023 Affordability Percentage Decreased
In Revenue Procedure 2022-34, the IRS slightly decreased the affordability percentage from 9.61% to 9.12% for 2023. This percentage determines which applicable large employers may face penalties under...
06/27/2022
Supreme Court's Roe v. Wade Decision: What Employers Should Know
Supreme Court's Roe v. Wade Decision: What Employers Should Know The Supreme Court released its decision regarding abortion rights on June 24, essentially reversing the previous Roe v. Wade and Pla...
06/22/2022
San Francisco: MCO and HCAO Updates
Minimum Compensation Rate Updates For-Profit Rate Effective July 1, 2022, the For-Profit Rate increases to $19.15 per hour. Posters and Forms reflecting this rate increase will be available in Jun...
05/04/2022
Proposed Rule Addresses the Family Glitch in Marketplace Plans
The Biden-Harris Administration is proposing a rule to fix the ACA’s “family glitch.” Under the ACA, people who don’t have access to affordable health insurance at work may qualify for a premium t...
04/07/2022