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COVID Insurance Updates

Covid-19 Updates

To expand Americans’ access to Covid-19 testing, new regulations were introduced by the Biden-Harris Administration this week. Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter Covid-19 diagnostic test (FDA approved) will be able to have those tests covered at 100% by their plan or insurance as part of the Families First Coronavirus Response Act, as long as the emergency order remains in place. (Note: This is the number of total tests. If a member purchases a kit with two tests in it, that counts as two tests.) 

What is covered under the regulations?

  • Insurance companies and health plans are required to cover at no cost to the member, up to 8 individual, over-the-counter at-home tests per covered individual within a 30-day period without a prescription from a health care professional. This means a family of four, all on the same plan, can purchase up to 32 of these tests covered 100% by their health plan, per month.
  • COVID testing ordered by a health care professional when the test is medically necessary to diagnose and treat a patient’s symptoms continues to be covered 100%, with no member cost sharing applied and no limit to the number of tests.
  • Workplace mandated testing is not covered.

Who is this for?

  • All Individual Market and Commercial Group members, including self-funded and grandfathered. If an employer does not have pharmacy benefits through their insurance carrier, they’ll need to work with their Pharmacy Benefits Manager separately.

When can members start to purchase over-the-counter COVID tests for no cost?

  • Coverage starts on at-home tests purchased as of Jan. 15, 2022. We anticipate availability of tests will still be limited based on the nationwide shortage and strain on the healthcare system, including pharmacies.

Other Important Notes:

  • If a member purchases a kit with two tests in it, that counts as two tests.
  • Tests must be purchased on or after Jan. 15, 2022, to qualify for the new program.
  • The tests must be authorized by the U.S. Food and Drug Administration. The FDA lists all authorized tests on its website, but there are steps members need to take to find them:
    • Qualifying tests include over-the-counter antigen or molecular tests.
    • To see a list of at-home tests that are payable, members will need to type “OTC” in the search box on the web pages. That will bring up a list of tests that are part of the at-home rapid diagnostic COVID-19 relief program.