Over-the-Counter COVID-19 Test Coverage

On January 10, the Biden Administration issued guidance requiring all group health plans and health insurers to cover OTC COVID-19 tests without member cost share effective January 15, 2022. This new requirement:

Allows consumers with commercial health coverage to seek reimbursement from their health plan for OTC tests they purchase online or in-person without the direct involvement of a health care provider.
Requires health plans to cover, without cost sharing, up to 8 OTC tests per member per 30 days (if kits contain 2 tests, then no more than 4 kits per 30 days).
Maintains the policy that plans are only required to cover tests intended for diagnosis or treatment (versus routine screenings for employment, school or recreational purposes).

Note: This mandate is in effect until the end of the federal public health emergency. Any tests purchased pursuant to a physician’s order will not be subject to the quantity limit.

Insurers are incentivized to work with preferred pharmacies to remove upfront costs for members. If insurers do not set up a preferred pharmacy network will have to cover more of the costs.

General information:

We are pending information from Cigna + Oscar.

Information for additional medical carriers:

Blue Shield
- How to file a claim for COVID-19 test reimbursement
- Subscriber's Statement of Claim Form
Sharp Health Plan
- COVID-19 FAQs on Testing
Sutter Health Plus
- Information About COVID-19 Coverage, Cost and Access to Care
Western Health Advantage
- Getting care, at-home tests, vaccines and more