Federal requirements went into place on January 15, 2022 requiring coverage for at-home COVID-19 tests at no cost to members under group insurance plans.
Coverage for OTC COVID-19 Tests
The WMHIP-BCBS program allows for the reimbursement of up to 8 at-home, over-the-counter (OTC) rapid diagnostic COVID-19 tests per member every 30 days. (Note: this is the number of total tests – if a member purchases a kit with two tests in it, that counts as two tests).
Tests must be purchased on or after January 15, 2022, to qualify for reimbursement.
If you purchase an OTC COVID-19 test from an authorized retailer, you will be eligible for reimbursement if you meet the following criteria:
- The tests must be FDA authorized and they list all authorized tests on their website, but there are steps you need to take to find them:
- Qualifying tests include OTC antigen or molecular tests.
- To see a list of at-home tests that are eligible, you’ll need to type “OTC” in the search box on the web pages. That will bring up a list of tests that are part of the at-home rapid diagnostic COVID-19 reimbursement program (Please note: The BinaxNOW test in the antigen page which is listed as “Telehealth Proctor Supervised” is not reimbursable under this program).
- The new program does not cover tests used for employment purposes.
How will the new program work for members?
BC/BS members must complete the member reimbursement form and mail it in (along with receipts) after purchasing the at-home rapid diagnostic COVID-19 tests. Member reimbursement form is attached and can also be found at: www.bcbsm.com/coronavirus under the testing question or available through your member account.
Steps for reimbursement
Members should fill out the form, attach receipts, and submit the form online or mail the form to the address listed on the member reimbursement form. BC/BS will then input the form for claims processing and mail a check back to the member, if the submission qualifies.
BC/BS intent is to process these claims as soon as possible, however, due to ongoing mail delays and without knowing the volume of requests they will receive, it could take up to 60 days for members to receive reimbursement.