On January 10, 2022, the Biden Administration announced that, beginning January 15, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter COVID test authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA) will be able to have the test costs covered by their plan or insurance. Insurance companies and health plans are required to cover up to eight over-the-counter at-home tests per covered individual per month.
We understand that finding available test kits may be challenging during this time. The Biden administration has also purchased 500 million over-the-counter at-home tests to be distributed for free. Currently, every home in the U.S. is eligible to order 4 free at-home COVID-19 tests. The tests are completely free, and orders will usually ship in 7-12 days. Please visit https://www.covidtests.gov/ for further information and to order a test.
Over-the-counter test purchases will be covered without the need for a health care provider’s order or individualized clinical assessment, and without cost sharing requirements such as deductibles, copayments, or coinsurance, and may not require prior authorization.
The cost of tests purchased from network pharmacies will be covered up front or you may pay out of pocket and apply for reimbursement. For tests purchased from an out-of-network pharmacy or retailer, the participant may be reimbursed the cost of the test; however, plans are not required to reimburse more than $12 per individual test.
We are committed to keeping you informed on the latest developments. We’ve provided some frequently asked questions (FAQs) regarding the COVID-19 At-Home Test Kits to guide you through the process, including the COVID-19 testing kit reimbursement forms. You can review them below.
ORDER FREE AT-HOME COVID-19 TESTS THROUGH USPS
Residential households in the U.S. can order one set of 4 free at-home tests from USPS.com. Here’s what you need to know about your order:
- Limit of one order per residential address
- One order includes 4 individual rapid antigen COVID-19 tests
- Orders will ship free starting in late January
COVID-19 AT-HOME TEST KITS – FAQs
Which at-home tests are covered?
Any FDA-authorized or approved tests purchased on or after January 15, 2022 are the tests that are covered. Typically, FDA-authorization is shown on the test packaging.
How is this covered under my WGAT plan?
Through your pharmacy benefits.
Coverage will be provided under your plan through your pharmacy benefit. Please note PinnacleRx Solutions is the pharmacy benefit manager for all WGAT plans. Your health care identification card contains important information about PinnacleRx.
Is there an out-of-pocket cost?
Test kits purchased at in-network pharmacies will adjudicate at point-of-sale with $0 copay.
The $0 co-pay is subject to a maximum of 8 tests per member per month until further notice.
All Other Retailers:
Test kits purchased at out-of-network pharmacies or retailers are eligible for a maximum member reimbursement of $12/test.
If I incur an out-of-pocket cost, am I eligible for reimbursement?
Yes – The member must complete and submit COVID-19 Test Kit Reimbursement Form with accurate information in addition to an itemized receipt. Maximum reimbursement is the lesser of the member’s out-of-pocket cost and $12. A separate claim form for each family member is required and itemized receipts must reflect the patient’s name.
Can you explain the reimbursement process?
At this time, reimbursement requests for claims incurring out-of-pocket costs can be submitted by completing a COVID-19 Test Kit Reimbursement Form with an itemized receipt.
We are working on developing an electronic claim reimbursement form and we will update this document when it is complete.
Is there a quantity limit on test kits?
Yes – Currently, each member is eligible to receive a maximum of 8 at-home test kits with a $0 co-pay each month. The maximum applies to the combined total of claims that adjudicated at point-of-sale and through member reimbursement.
How do I know if a pharmacy is in-network?
Please reference the Pharmacy Locator Page on the PinnacleRx Solutions’ website to locate in-network pharmacies.
What types of tests are not covered?
- Non-FDA authorized OTC tests
- Non-OTC tests (e.g. PCR tests, Laboratory Tests, and Physician Administered tests) are not part of the COVID-Test Kit program
- Work related testing. WGAT does not provide coverage of testing (including an at-home over-the-counter COVID-19 test) that is for employment purposes.
Where can I obtain a test?
You may obtain test kit at your local in-network pharmacy. Please use the Pharmacy Locator Tool to inquire with pharmacies in your area about availability.
WGAT is working with its in-network pharmacies and supply chain partners to develop a mail-order program for test kits.
We understand that finding available test kits may be challenging during this time. The Biden administration has also purchased at-home tests to be distributed for free. Currently, every home in the U.S. is eligible to order 4 free at-home COVID-19 tests.
The tests are completely free, and orders will usually ship in 7-12 days. Please visit https://www.covidtests.gov/ for further information and to order a test.
We will update this document when we have more information on this program. For updates in Spanish, please click here.