The Departments of Health and Human Services, Labor, and Treasury published new guidance requiring commercial health insurance providers and group health plans to cover the cost of FDA-approved, rapid, over-the-counter (OTC) COVID-19 tests during the federally determined public health emergency. According to the guidance:

• Members with employer-sponsored or individual health insurance coverage can be reimbursed by their group health plan for OTC COVID-19 tests.
• Members do not need a prescription to be reimbursed for OTC COVID-19 tests.
• To be reimbursable, these tests must be FDA approved. A list of FDA-approved tests is available here.
• OTC testing used for employment or school purposes is not covered under this mandate and is not eligible for reimbursement under the medical plan.
• Members can be reimbursed for up to eight FDA-approved OTC tests per month.
• This mandate became effective January 15, 2022 and will continue through the COVID-19 public health emergency period.

For BCBS of WNY-  For OTC tests purchased on or after January 15, 2022, members can submit a claim form with a copy of their test receipt (showing the date of purchase) and universal product code (UPC) found on the test box to BCBS online or by mail. A separate claim form must be submitted for each member.

For Independent Health – They are working with their participating pharmacy network to set up a process to bill IH directly so members won’t have to pay out-of-pocket and submit a claim form for reimbursement, but this may take time to develop.  Until a direct claim submission process is established, or if a member chooses to purchase an authorized kit from a different vendor, the member may have to submit a claim for reimbursement. The Federal Government requires health plans to reimburse up to $12 per test. (If the test kit contains two tests, members will be reimbursed up to $24).

Univera will be releasing guidelines shortly.

To obtain a claim form or ask questions, you can contact your insurance carrier's phone number on the back of your ID card.