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Amwins Connect Coronavirus (COVID-19) Resources

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!

COVID-19 News

 

  • No Cost Over-the-Counter COVID Tests
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.

Read more

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.

COVID Resource Center

At Home Test Flyer

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.

OTC Home Test Reimbursement

COVID Resource Center

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.

OTC Home Testing FAQ

COVID Resource Center

 

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.

OTC Home Testing Reimbursement FAQs

At Home Test Flyer

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.

How to File a Reimbursement

COVID Testing Grid

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.

COVID Resources

COVID Member Flyer

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.

OTC Home Testing FAQ

COVID Resource Center

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.

OTC Home Testing Reimbursement FAQs

At Home Test Flyer

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.

COVID Testing

Claim Form Instructions

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.

OTC Home Testing FAQ

COVID Resource Center

 

Individuals can request free rapid antigen home tests, without shipping fees, from the federal government. 

 

Additional Resources
COVID Employer Resources and FAQ
Broker Resources - CA
Member Access to Care - CA
Vaccine Coverage - CA

Compliance News

03/30/2023

Question of the Month: Why Would A Plan Need an ERISA Wrap Document?

Why would a plan need a wrap document? Question: Why do plans need wrap documents? Answer: Wrap documents are generally used for either (or both) of the following: Supplementing alrea...
03/22/2023

Most Employers Now Required to File Electronic IRS Information Returns Beginning in 2024

Most Employers Now Required to File Electronic Information Returns Beginning in 2024 On February 21, 2023, the IRS released Final Rules amending the existing requirements related to mandatory e-fil...
03/16/2023

IRS Announces ACA Pay or Play Penalties for 2024

IRS Announces ACA Pay or Play Penalties for 2024 The IRS released 2024 penalty amounts on March 9, 2023. This notice is related to the ACA Employer Mandate Penalties. The IRS notice can be reviewed...
View All

Legislation

12/20/2022

Further By HealthEquity Shares Recent Legislation that May Impact Consumer-Directed Benefits

Further by HealthEquity has shared the below updates around recent legislative changes that may impact consumer-directed benefits. Internal Revenue Service (IRS) Releases 2023 Index Figures On...
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...
View All
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