UCOP received additional information to follow-up on the previously-sent communication on January 19, 2022. We are providing a chart – Health Plan Guidelines - At-Home Over-the-Counter COVID-19 Tests that addresses how each health plan will administer the new requirement and guidance for At-Home Over-the-Counter (OTC) COVID-19 tests that were approved by the Federal and Drug Administration.
Effective January 15, 2022, commercial health plans are required to cover eight (8) individual tests per person enrolled in the plan per month. The chart shows how each plan will administer this coverage. Kaiser Permanente will send additional communications once they have confirmed how they will cover these tests—the chart is highlighted by TBD in the Kaiser Permanente section as placeholders.
The requirement provides two paths for coverage:
- Direct coverage allows a plan to set up a network of convenient options such as preferred pharmacies or retailers, including online retailers, in which members on their plans can get the costs of their tests covered up front at zero-cost share (at the point-of-sale). If a plan establishes this type of direct coverage option, then the plan is permitted to limit the reimbursement for tests purchased outside of their network to $12 per test (or the actual price of the test, if less). Many commercially available at-home tests run about $24 or less for a two-pack of tests (which counts as two tests). Navitus for Anthem PPO plans (commercial and Medicare) are set up under this model.
- Plans without direct coverage must reimburse the full cost of the test, even if the test costs more than $12. For example, if a member buys a two-test-pack for $34, then the plan would have to reimburse the $34 instead of $24. Members are not able to obtain tests having no upfront costs. Health Net is under this model at this time.
Members who are on plans that provide direct coverage are advised to purchase their tests at pharmacy counters when using preferred pharmacies or retailers at zero-cost share at point-of-sale. Non-pharmacy cashiers cannot adjudicate these purchases and may require members to pay out-of-pocket.
The following websites offer free testing resources and additional information on the At-Home OTC COVID-19 tests.
- Four (4) free at-home COVID-19 tests may be ordered at COVIDtest.gov or the USPS Order for Free At-Home COVID-19 Tests website
- HSH.gov – Press Release – BIDEN-Harris Administration Requirement for Insurance Companies and Group Hel Plans Coverage.
- HHS.gov – Community-Based Testing Sites for COVID-19
- HRSA.gov – Expanding Access to COVID-19 Testing Supplies
- CMS.gov – How to get your At-Home Over-The-Counter COVID-19 Test for Free
- CMS.gov – FAQs About Affordable Care Act Implementation Part 51-pdf