COVID-19 testing FAQs - Hero Image

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.

What are the highlights of the at-home COVID-19 test purchased on or after January 15, 2022?

Member specific coverage

Question:

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.

Question:

How many COVID-19 tests will be allowed per member, per month?
Under this program, each covered member is able to be reimbursed for 8 over-the-counter (OTC) COVID-19 tests every 30 days.

Question:

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?
Please consult your Pharmacy Benefit Manager.

Question:

How can I purchase approved over-the-counter (OTC) at home COVID-19 test kits and receive reimbursement?
Please consult your Pharmacy Benefit Manager.

General Questions

Question:

Can I purchase an OTC at-home COVID-19 test that costs more than $12?
Please consult your Pharmacy Benefit Manager.

Question:

Are there state-specific differences that apply to the reimbursement of at-home over-the-counter (OTC) COVID-19 test?
Please consult your Pharmacy Benefit Manager.

Question:

Will the result of COVID-19 test have to be reported in order to receive reimbursement?
Please consult your Pharmacy Benefit Manager.

Question:

How will a member receive reimbursement?
Please consult your Pharmacy Benefit Manager.

Question:

How long will it take for a member to receive reimbursement?
Please consult your Pharmacy Benefit Manager.

Question:

Can members submit a COVID-19 home test purchased prior to January 15?
Please consult your Pharmacy Benefit Manager.

Question:

Is a physician order or clinical assessment required for reimbursement for COVID-19 home test?
Please consult your Pharmacy Benefit Manager.

Question:

Can members submit a photo of a receipt?
Please consult your Pharmacy Benefit Manager.

For all additional questions, contact Surest Help at 866-683-6440.