Over-the-counter at-home COVID-19 test FAQs

We are proud to do our part to protect our members from COVID-19. Beginning January 15, 2022, each of our fully insured members* can receive 8 FDA-approved, rapid, over-the-counter (OTC) at-home COVID-19 antigen tests a month at no cost from pharmacies or online pharmacies.

* Medicare Advantage is not currently included in this program.

Frequently Asked Questions

How do I get a free, at-home OTC COVID-19 test?

• Starting January 19, 2022, you can go to a local or online pharmacy that is part of your health plan’s pharmacy network to receive rapid at-home OTC COVID-19 antigen tests authorized by the U.S. Food and Drug Administration (FDA) to be used for diagnostic purposes. Your health plan will directly pay the pharmacy when you complete your transaction with no out of pocket expense to you. If you obtain the test from one of your health plan’s in-network pharmacies, you must obtain your test directly from the pharmacy counter and bring your health insurance card with you.
• If you purchased an FDA-approved, rapid at-home OTC COVID-19 antigen test on January 15 or after from another source not directly reimbursed by your health plan, you must file a claim to receive reimbursement. Keep your receipt and the product box or a photo of the box and submit a claim to us for reimbursement using our COVID-19 OTC Test Reimbursement Request form [pdf]. A separate form for each patient is required. Tests must be used for diagnostic purposes only.
• You also can pick up a free at-home rapid OTC COVID-19 antigen at many local libraries and community health centers. Go to your Department of Health website for more information.
• You can also order COVID-19 tests directly from the federal government by going to covidtests.gov or usps.com.

Will I have to pay for my test up front?

• Our fully insured members may select up to 8 at-home rapid OTC COVID-19 antigen tests at local or online in-network pharmacies for each covered member of their family each month. Your health plan should cover the cost of eligible tests when you complete your transaction with no out-of-pocket expense to you. Please be aware that most tests are packaged in sets of two. If you purchase boxes containing two tests each, you should be covered for four boxes.
• If you obtain a test from another source, keep your receipt and the product box or a photo of the box and submit a claim to us for reimbursement. A separate form for each patient is required. We are only covering diagnostic testing. We are not covering testing for employment purposes (including at-home rapid OTC COVID-19 antigen tests).

How much will I be reimbursed for an at-home rapid OTC COVID-19 test?

• If you submit a claim form, we will reimburse you the cost of the test if it is an at-home, rapid OTC COVID-19 antigen test used for diagnostic purposes. A receipt and the product box or a picture of the front of the box is required. A separate form for each patient is required.

What if I already bought and paid for at-home rapid OTC COVID-19 tests? Can I still get reimbursement for those?

• We will provide coverage only for tests bought on January 15 or later, as long as it is an FDA-approved at-home rapid OTC COVID-19 antigen test used for diagnostic purposes.

What if I buy more than one test at a time?

• Your health plan covers 8 tests per month for each person on your health plan, regardless of whether the tests are bought all at once or at separate times throughout the month.

If I pay up front, how do I get reimbursed?

• If you are charged for an FDA-approved at-home rapid OTC COVID-19 antigen test after January 15, keep your receipt and the product box or a photo of the box and submit a claim to us for reimbursement. A separate form for each patient is required. We are only covering diagnostic testing. We are not covering testing for employment purposes (including at-home rapid OTC COVID-19 antigen tests).

How long will it take to receive my reimbursement?

• We are still creating the reimbursement process but are dedicated to making it easy and efficient.

How many tests can I get reimbursed for?

• You may receive 8 individual at-home rapid OTC COVID-19 antigen tests to be used for diagnostic purposes per person on your health plan per month. That means a family of four can get 32 tests per month for free. Please be aware that most tests are packaged in sets of two, in this instance, a family of 4 would be covered for 16 boxes.

My employer requires I test myself multiple times per week and send them the results. Can I get these tests reimbursed by insurance?

• We are only covering diagnostic testing. We are not covering testing for employment purposes (including at-home rapid OTC COVID-19 antigen tests).

What is the difference between rapid OTC COVID-19 tests and the tests that are ordered and performed by my provider?

• Tests that your provider orders require a prescription or medical order to be reimbursed. These tests are available at no cost to you. Your provider will determine which test is best for you and your current situation based on your symptoms or exposure. If the test is a PCR test, it takes more time than other types of tests to receive your results. The PCR test is also more sensitive than antigen or rapid OTC tests for COVID. Your provider will then inform you of your results and report this information to the Department of Health.
• OTC tests do not require a prescription and are not sent back to labs for processing like DTC (direct-to-consumer) test. Rapid OTC tests may have limits on reimbursement to you. Additionally, these tests are less accurate than PCR tests that your doctor may order for you. The tests are easy to use and produce results quickly. These tests do not amplify results in the same way that a PCR test does and can miss early cases of COVID-19. If you use a rapid OTC test, you will be responsible for reading your results. Because this test is not as sensitive as the test that your doctor may order for you, if you test negative, you may still need to test again within a few days. If you test positive, you should isolate and notify your doctor of the results.

How reliable are test results?

• PCR tests ordered by your doctor have accuracy that approaches 100%. However, antigen and rapid OTC tests have a range of results from 70% to 90% depending on the test, if the test was performed accurately, and if you have symptoms. If you are asymptomatic, the rapid OTC tests correctly detect infection roughly 50% of the time.

Resources:

Self-Testing (CDC)
Learn when to consider using a test, how to use a test, how to collect a specimen, how to perform the test and what to do if your test is positive or negative.

Coronavirus Disease 2019 Testing Basics (FDA)
Learn about the types of tests, when to get tested, how OTC tests are different than those prescribed by a healthcare provider, tests and variants of COVID-19, types of samples for testing, understanding your test results and key terms

FDA-approved, over-the-counter (OTC) at-home COVID-19 antigen tests
See a list of all FDA-approved antigen tests under the Emergency Use Authorization (EUA), including attributes of the tests, which settings they can be used in and instructions for use.