COVID-19 Tests: Reimbursement from Health Plans
Under the Families First Coronavirus Response Act (FFCRA) and the CARES Act, individuals enrolled in a private health plan who purchase an over-the-counter COVID-19 test may be reimbursed by the health plan/insurer for up to eight tests per 30-day period. A family of four could be reimbursed for up to 32 tests by their health plan per month.
Enrollees will not need a prescription, an order from a health care provider, or a clinical assessment to be eligible for reimbursement for the purchase of the over-the-counter COVID-19 tests. Tests purchased are to be used for an individual enrollee’s own personal use and are not to be used for employment purposes or for resale.
- If a plan/insurer sets up a network of convenient options, with pharmacies or retailers (including online retailers), where enrollees can get tests without an up-front payment, then a plan/insurer may limit the reimbursement fee given to an enrollee who purchases an OTC test outside of the network to $12/test.
- If a plan/insurer does not set up a network of convenient options where enrollees can obtain tests, then plans/insurers must reimburse enrollees for the full cost of the test(s), even if it’s more than $12.
- Example: if an individual buys a two-pack of test for $34, and the plan or insurer has not set up a system to cover costs upfront, then the plan or insurer will have to reimburse the full $34 instead of $24.
Health plans may require documentation for reimbursement to be paid, such as a copy of a receipt and/or a UPC code. This policy goes into effect on Saturday, January 15, 2022 and will remain in place throughout the declared public health emergency.