On January 10, the Departments of Labor, Health and Human Services (HHS), and the Treasury issued Frequently Asked Questions (FAQs)
that require group health plans/insurers to cover the costs of at-home, over-the-counter COVID-19 tests. Key requirements are as follows:
- Tests must be approved by the U.S. Food and Drug Administration (FDA).
- Tests must be purchased on or after January 15, 2022.
- The requirement will continue through the Coronavirus public health emergency period, which is expected to extend to at least April 15, 2022.
- Tests can be purchased online, at a pharmacy, or at a retail store.
- Each individual may purchase up to eight COVID-19 tests per month (note the per-test limit, not per-kit limit; kits may contain multiple tests).
- Plans and insurers may provide tests through existing pharmacy or direct delivery networks, as long as they take reasonable steps to ensure access.
- If individuals obtain tests outside of the above channels, tests may be limited to reimbursement of $12 per test (or the cost of the test if under $12).
- Tests for employment purposes are not required to be covered.
- There is currently no limit on COVID-19 tests ordered or administered by a healthcare provider.
Note this blog only covers the federal mandate, not any state-specific mandates.
How will insurance carriers comply?
Vita is working with all major insurance carriers to identify more details for fully insured plans. Vita clients are encouraged to reach out to their benefits account management teams if there are any questions about how specific insurance carriers are receiving claims or processing reimbursements. Below are links to major medical carriers’ coronavirus pages: