[UCRRA] At-Home Over-the-Counter COVID-19 Tests

[Cristina L Otegui]

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January 20, 2022
To:
UCR Emeriti & Retirees

From:
UCR Benefits Office on Behalf of UC Office of the President (UCOP)

Re:
At-Home Over-the-Counter COVID-19 Tests

Effective January 15, 2022, the Biden-Harris Administration requires insurance companies and group health plans to cover the cost of FDA approved at-home over-the-counter (OTC) COVID-19 tests.

The following program guidelines can be found on the Health and Human Services (HHS) website at: https://www.hhs.gov/about/news/2022/01/10/biden-harris-administration-requires-insurance-companies-group-health-plans-to-cover-cost-at-home-covid-19-tests-increasing-access-free-tests.html.

*       Health plan providers are required to cover up to 8 free at-home OTC COVID-19 tests per individual per month. There is no limit on the number of tests if tests are ordered or administered by a health care provider following an individualized clinical assessment, including those who may need the tests due to underlying medical conditions.

*       Members should keep receipts for at-home OTC COVID-19 tests purchased on or after January 15, 2022, if they paid out of pocket for reimbursement.

*       Health plan providers are not required to cover the costs for tests (including at-home over-the-counter COVID-19 tests) required for employment purposes.

*       For members on Medicare plans, Medicare continues to pay for COVID-19 diagnostic tests performed by a laboratory, such as PCR and antigen tests, with no cost share when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional.  Medicare members can access one lab-performed test without cost share per patient per year without an order.

*       Medicare Advantage plans may decide individually to offer coverage for at-home OTC COVID-19 tests. We are awaiting on the UC Medicare plans to confirm their stance on coverage for at-home OTC COVID-19 tests.

*       Further details on reimbursement for FDA approved at-home OTC COVID-19 tests can be found at the FAQ contained in the Health and Human Services (HHS) website at: https://www.hhs.gov/about/news/2022/01/10/biden-harris-administration-requires-insurance-companies-group-health-plans-to-cover-cost-at-home-covid-19-tests-increasing-access-free-tests.html.

Free testing resources and additional information on the at-home OTC COVID-19 tests may be found in the following resources:

*       HHS.gov - Community-Based Testing Sites for COVID-19: https://www.hhs.gov/coronavirus/community-based-testing-sites/index.html

*       HRSA.gov - Expanding Access to COVID-19 Testing Supplies: https://www.hrsa.gov/coronavirus/testing-supplies

*       CMS.gov - How to get your At-Home Over-The-Counter COVID-19 Test for Free: https://www.cms.gov/how-to-get-your-at-home-OTC-COVID-19-test-for-free

*       CMS.gov - FAQs About Affordable Care Act Implementation Part 51: https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-center/faqs/aca-part-51.pdf

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