Jan. 18, 2022 (revised Jan. 21, 2022)
Over-the-Counter (OTC) COVID-19 Test Kit Coverage
(Plan members with UIChoice, UISelect, SHIP, and UIGRADCare)
Effective Jan. 15, 2022, all self-funded health plans will cover OTC COVID-19 Tests during the national public health emergency. Wellmark Blue Cross & Blue Shield of Iowa has shared how CVS/Caremark will administer the mandate for our plan members (Employees, Students, and Retirees).
Coverage of OTC COVID-19 Tests through the Pharmacy Benefit
Who is eligible?
- All University of Iowa health plan members and their eligible covered dependents can receive OTC at-home COVID-19 test kits at no-cost or reimbursed to the plan member by CVS/Caremark.
- Wellmark also reminds plan members that are reimbursed OTC COVID-19 tests for personal use and should only be used by the policyholder and their eligible covered dependents on the same health plan that paid for those tests.
What is covered?
- Only qualifying tests purchased on or after Jan. 15, 2022, will be covered.
- To be covered, OTC COVID-19 tests need to have received an Emergency Use Authorization from (or are approved by) the Food and Drug Administration (FDA), subject to certain limitations.
What tests will Wellmark cover?
- Community-based testing. Iowa's program, called Test Iowa, has drive-up locations throughout the state. It includes an online assessment that was developed in coordination with the Iowa Department of Public Health. These programs do not submit health insurance claims and are free of charge.
- Health care provider testing. COVID-19 tests provided through the member's doctor or hospital will be processed through insurance and covered in full.
- OTC COVID-19 tests approved by the Food and Drug Administration (FDA). Please visit the FDA's website, find the search box near the middle of the page, and enter "OTC" to view the tests that qualify.
What tests are NOT covered by Wellmark?
- Wellmark will not cover OTC COVID-19 tests used for employment purposes, meaning that if you're required to test for COVID-19 weekly or on another routine basis, you should not be purchasing those and submitting them to CVS Caremark for reimbursement.
- COVID-19 testing performed for travel purposes, including, but not limited to, flying internationally or boarding a cruise, is not a covered health plan benefit.
- OTC COVID-19 tests only qualify for coverage and reimbursement if the test is both self-administered and self-read at home. No laboratory or health care provider is involved.
Purchasing test kits from an IN-NETWORK pharmacy
Members will be able to purchase tests in person at most national retail pharmacy chains like CVS and Walgreens without upfront payment.
Plan members can find in-network pharmacies by visiting CVS/Caremark online (If you do not already have a CVS/Caremark log-in, you will need to register your account first before accessing the search portal).
- If the plan member purchased a test kit at an in-network pharmacy window or counter, the test kit would be considered covered with no out-of-pocket costs at the time of purchase.
- If the plan member purchased a test kit at a national retail chain store (i.e., Walgreens, CVS Pharmacy) checkout (not at the pharmacy counter), the member would need to pay for that kit at the retailer's price and submit a claim to CVS/Caremark for reimbursement.
Please keep in mind that this is still relatively new and some pharmacies may not be ready to process point-of-sale claims.
Purchasing test kits from an OUT-OF-NETWORK pharmacy
Members who purchase OTC COVID-19 tests from out-of-network pharmacies or non-pharmacy retailers are still eligible for reimbursement. However, if the member uses an out-of-network pharmacy or non-network retailer, the member’s reimbursement may be limited to $12 per test (or $24 for a box of two tests).
How many tests can you receive reimbursement for?
CVS/Caremark is implementing a claims process that will track OTC COVID-19 test claims and apply a limit of eight OTC COVID-19 tests per member per month consistent with the guidance released.
- For example, if a family has five members on the same health plan, CVS can reimburse the family for up to forty OTC COVID-19 tests each month. Some test kits are sold with multiple tests in a single package. The limit number is based on individual tests.
How to submit for reimbursement?
If a plan member does pay out-of-pocket for qualified OTC COVID-19 tests, they will need to submit a claim form online to CVS to begin the reimbursement process. You will need to have a registered account before submitting a claim.
Once logged in to your CVS account, members should visit the Plan & Benefits tab and select “Submit Prescription Claim.” Then, if you’re eligible, you will see a link on the page that reads, “Submit at-home COVID-19 test reimbursement claim.
CVS will process and pay claims for OTC COVID-19 tests purchased on or after Jan. 15, 2022. Claims for OTC COVID-19 tests purchased before that date will not be covered or reimbursed.
Step-by-Step instructions and other relevant information can be found on Wellmark's website.
Order your free tests today!
There are two ways you may order or pick up free at-home COVID-19 test kits:
- Test Iowa offers a self-administered at-home test kit that can be sent directly to your residence or you may pick one up at a nearby pick-up site. Visit testiowa.com/en to find nearby pick-up site locations or submit a request to have one mailed to your home.
- Visit COVIDtests.gov where every home in the U.S. is eligible to order four at-home COVID-19 test kits for free. Orders will begin shipping out within 7-12 business days to those who submit their online request.
May 27, 2021
UI Health Insurance Plans Coverage Update
With the COVID outbreak, our health plans for faculty, staff, retirees, and students provided expanded coverage that is COVID-related. Listed below are the services impacted and the status of ongoing COVID-19 coverages.
- COVID-19 tests and related services. Members have no cost-share for appropriate testing and related services to diagnose or detect COVID-19. This is required by the Families First Coronavirus Response Act (FFCRA) and the Coronavirus Aid, Relief, and Economic Security (CARES) Act and remains in place as long as we are in a public health emergency, as declared by the federal government.
- COVID-19 Vaccine. The federal government intends to pay for all Americans' initial vaccination doses (and providers cannot bill health plans for such doses). Once the federal government stops paying for COVID-19 vaccination doses, our health plans will cover the vaccine as an ACA preventative service without cost-share, as required by the CARES Act.