Zero-Cost Over the Counter COVID-19 Tests for State Group Insurance Members
Friday, Feb 04, 2022In compliance with the federal Families First Coronavirus Response Act (FFCRA), effective January 15, 2022, the State Employees’ Prescription Drug Plan (Rx Plan) will cover approved OTC COVID-19 tests through the end of the federal public health emergency (PHE) as provided below. The federal PHE has a current expiration date of April 16, 2022; however, the PHE can be extended in 90-day increments.
Coverage Details for State Group Insurance Members:
- Coverage is available to all non-Medicare Advantage Plan* enrolled members of the State Group Health Insurance Program (Program) and their covered dependents.
- Coverage is available for up to eight (8) OTC COVID-19 tests per 30-days, per covered member.
- Reimbursement for out-of-pocket costs used to purchase OTC COVID tests is available for the lesser of the full out-of-pocket cost or $12 per test.
- Coverage is limited to OTC COVID-19 tests that do not require a prescription from a health care provider.
- Coverage is limited to specific OTC COVID-19 tests authorized, cleared, or approved by the U.S. Food and Drug Administration (FDA).
- Coverage is limited to OTC COVID-19 tests used to detect a COVID-19 infection. OTC COVID-19 tests are not covered when used for employment, school, or other purposes.
- CVS Caremark mail order pharmacy does not carry OTC COVID-19 tests.
How to Obtain OTC COVID-19 Tests Covered by the Program:
- Visit a CVS Caremark network retail pharmacy.
- Request an approved OTC COVID-19 test at the pharmacy counter. If purchased through this method, there will be no out-of-pocket cost for the member and the claim will be processed automatically;
- Some CVS Caremark network retail pharmacies may offer an online option for purchasing approved OTC COVID-19 tests.
- If available, there will be no out-of-pocket cost for the member, with the exception of applicable shipping or delivery costs, for which members will be responsible.
- If the member is required to pay at the time of the online purchase, a paper claim may be filed for the lesser of the full out-of-pocket cost or $12 per test.
- Visit any non-network retail pharmacy and use the general checkout counter. o The member will be required to pay-in-full and file a paper claim with CVS Caremark for reimbursement for the lesser of the full out-of-pocket cost or $12 per test.
Paper claims can be filed online by registering and logging in to CVS Caremark’s website at Caremark.com;
- Once logged in, hover over “Plan & Benefits” and a dropdown window appears;
- Click on “Submit Prescription Claim”;
- Click on “Submit at-home COVID-19 test reimbursement claim”; and follow the prompts.
- Paper claims will require proof-of-purchase documentation, with a legible cash register receipt dated January 15, 2022 or later. The receipt must show the name of the OTC COVID-19 test, pharmacy or store name, date of purchase, and purchase price.
Questions? Rx Plan members may contact CVS Caremark directly by calling (888)766-5490.
General FAQs created by the U.S. Department of Labor regarding requirements of health insurers and plans relating to at home COVID-19 testing can be found at the following link:
*Members enrolled in a Medicare Advantage – Prescription Drug (MA-PD) plan, or a Capital Health Plan retiree advantage plan offered by the DSGI, should contact their respective health plan for more information.