COVID-19 testing FAQs
COVID-19 over-the-counter (OTC) at home testing
On January 10, 2022, the Departments of Labor, Treasury and Health and Human Services released guidance to support the Administration’s directive that health insurers and group health plans cover the cost of FDA-authorized or approved over-the-counter (OTC) at-home COVID-19 tests purchased on or after January 15, 2022.
Over-the-counter (OTC) Test Reimbursement Form
What are the highlights of the at-home COVID-19 test purchased on or after January 15, 2022?
- Beginning January 15, 2022, Surest will cover most group health plan members’ FDA authorized or approved over-the-counter (OTC) at-home COVID-19 diagnostic tests without a doctor’s prescription. This at-home COVID-19 test benefit includes up to 8 tests per member every 30 days.
- To obtain tests without up-front cost or the need to submit a form for reimbursement, Surest members can obtain tests at any in-network pharmacy counter with their prescription benefits member ID. These tests must be obtained directly from the pharmacy counter to avoid needing to submit a form for reimbursement.
- If a member purchases an at-home COVID-19 test at any in-store or online retailer other than the in-store pharmacy counter of their in-network pharmacy, they may submit purchase receipt(s) showing the purchase date and test cost**** **for reimbursement to Surest for a maximum reimbursement of up to $12 per test. Many COVID-19 tests are sold as a two-pack so that means the test pack would be reimbursed at $24 (up to $12 for each test).
- Surest members can search Benefits.Surest.com for the specific over-the-counter (OTC) at-home COVID-19 diagnostic test they wish to purchase to be linked to their Pharmacy Benefit Manager’s website.
Member specific coverage
Which OTC at-home COVID-19 tests are part of this program?
Any FDA-authorized or approved test is covered as part of the program. Typically, FDA-authorization is shown on the test packaging.
How many COVID-19 tests will be allowed per member, per month?
Each covered member is able to be reimbursed for 8 over-the-counter (OTC) COVID-19 tests every 30 days. Some test kits contain 2 tests per kit—each of those tests is counted individually toward the limit of 8 every 30 days. For example, if a covered member purchases 4 tests kits with 2 tests in each kit, that equals 8 tests for that member.
How can I purchase approved over-the-counter (OTC) at home COVID-19 test kits without any out of pocket expense or having to submit a claim?
- You may obtain an at-home COVID-19 diagnostic test at any in network pharmacy counter at no up-front cost and will not have to submit a form for reimbursement.
- Be sure to have your member ID card with you.
- From the Federal government: The Federal government has launched a national website where each household can receive a one-time shipment of four free OTC at-home Covid-19 tests shipped directly from covidtests.gov. For more information on this program go to covidtests.gov.
How can I purchase approved over-the-counter (OTC) at home COVID-19 test kits and receive reimbursement?
If a member purchases an at-home COVID-19 test from an out of network pharmacy or other retailer, they may submit their purchase receipt(s) for reimbursement to Surest for a maximum reimbursement of up to $12 per test. Many COVID-19 tests are sold as a two-pack so that means the test pack would be reimbursed at up to $24 (up to $12 for each test).
How do Surest members submit over-the-counter (OTC) at-home COVID-19 test costs for reimbursement?
The member must submit an over-the-counter (OTC) test reimbursement form and provide a receipt showing the over-the-counter (OTC) at-home COVID-19 test purchase date and cost. The maximum reimbursement is up to $12 per test. This form is also found in the Resources section of Benefits.Surest.com and at the top of this page. Members print this form, fill out the required fields, include a copy of the sales receipt, and mail it to Surest.
Can I purchase an OTC at-home COVID-19 test that costs more than $12?
Yes. If you get an FDA-authorized test at in-network retail pharmacy counters, you won’t need to pay anything out-of-pocket (please see the Coverage section above). At any other location, you may purchase an FDA-authorized test, but you will only be reimbursed at a maximum of up to $12 per test.
Are there state-specific differences that apply to the reimbursement of at-home over-the-counter (OTC) COVID-19 test?
Yes. In certain situations, state-based guidelines may impact coverage to plans regulated by state law. Please check with your state and plan administrator for additional detail.
Will the result of COVID-19 test have to be reported in order to receive reimbursement?
What if I purchased other items with my COVID-19 tests and those items appear on my receipt?
Only the purchase of over-the-counter (OTC) at-home COVID-19 tests—at a maximum of up to $12 per test—will be reimbursed.
How will a member receive reimbursement?
Members will be reimbursed by receiving a check in the mail.
How long will it take for a member to receive reimbursement?
Typically, reimbursement is mailed within 30 days assuming all requested information is complete.
Can members submit a COVID-19 home test purchased prior to January 15?
Is a physician order or clinical assessment required for reimbursement for COVID-19 home test?
Can members submit a photo of a receipt?