The federal government issued a public notice requiring commercial health plans to cover up to eight at-home testing kits per month per covered individual for diagnostic use starting January 15 and continuing through the Coronavirus public health emergency period, which we anticipate will be extended to April 15, 2022.
To meet the Jan. 15 deadline for compliance for U.S. Health Carriers will cover at-home testing kits as a medical benefit starting January 15. Tests purchased prior to January 15 are not eligible for reimbursement under the new federal guidance.
Purchasing OTC Testing Kits, Quantity Limits
Members may receive reimbursement for up to eight over-the-counter (OTC) COVID-19 at-home tests per covered individual in the household per 30-day period (or per calendar month) without a health care provider order or individualized clinical assessment.
**Health plans may count each test separately, even if multiple tests are sold in one package; i.e. if one package includes eight tests, it counts as eight tests and not one test package toward the quantity limit.**
While this test quantity limit applies to OTC COVID-19 at-home tests purchased without the involvement of a health care provider, plans continue to cover COVID-19 tests performed by health care providers and those tests are not subject to this quantity limit.
Member Reimbursement
According to the federal mandate, health plans must reimburse the costs of diagnostic OTC testing, regardless of where it was obtained (in- or out-of-network). All Insurance Carriers will have reimbursement/coverage policies and processes for the Jan 15 deadline. Please note, at this time not all carriers have defined what their policies are.
Our team is committed to keeping you informed and being a resource for you. If you have any questions regarding this email or any other compliance matter, please feel free to reach out to us.
