The Biden Administration announced new federal guidance on Jan. 10, 2022 that people with employer-sponsored or individual health insurance coverage can seek reimbursement for the purchase of FDA emergency use authorized over-the-counter COVID-19 tests from their employer group or health insurer effective with tests purchased on or after Jan. 15, 2022. Over-the-counter, at-home, diagnostic tests that are emergency use authorized by the FDA (list of authorized tests can be found below) can qualify for reimbursement. Under the new federal guidelines, members can seek reimbursement of up to $12 per test for up to 8 FDA emergency use authorized tests per 30 days per member. That means a family of four can be reimbursed for 32 tests per 30 days for the amount of $12 per test, or the cost of the test if less than $12. Note: Members should only order/purchase and administer over-the-counter COVID tests based on the manufacturer recommendations. Please see the manufacturers warnings included on the over-the-counter test packaging for age recommendations. FDA emergency use authorized tests available for reimbursement:
In addition, to expand options to access testing, Highmark members can use their existing pharmacy network to receive over-the-counter tests without any up-front costs, eliminating the need for reimbursement (see below for more information on this option). Note: Tests may be packaged individually or with multiple tests in one package (for example, two tests packaged in one box). Plans are required to cover 8 tests per covered individual per 30 days, regardless of how they are packaged and distributed. Who is eligible for the over-the-counter test reimbursement?Highmark members with employer-sponsored or individual health insurance coverage can seek reimbursement for the purchase of FDA emergency use authorized over-the-counter COVID-19 tests. Highmark Medicare Advantage members are not eligible for reimbursement at this time. The Biden Administration did not include Medicare in the coverage requirements. However, beginning April 4, 2022 individuals with Medicare Part B can get up to eight free over-the-counter tests every calendar month through the end of the COVID-19 public health emergency from participating pharmacies or health care providers. Click here for additional information regarding Medicare over-the-counter test coverage. Highmark’s Medicare Advantage members can continue to have access to COVID-19 testing at no cost when ordered by a clinician. Highmark Medicare Advantage members can also receive up to 24 free tests through the federal government website covidtests.gov. How do I get over-the-counter tests without any out-of-pocket costs?There are three easy ways to get FREE over-the-counter, at-home COVID-19 tests with no out-of-pocket expense to you:
Please note that there are currently limited supplies and tests may take up to 4 weeks to arrive. Note: If you do not have prescription coverage through your Highmark plan, please verify options with your employer.
Note: supplies may be limited, and tests may not be available at all retail pharmacy locations.
To locate an in-network pharmacy members can visit the Highmark member website or call the number on the back of their Highmark insurance card or pharmacy benefit card for help. Note: If you do not have prescription coverage through your Highmark plan, please verify options with your employer. Yes. Just follow the step-by-step instructions found below to submit your claim via mail or through our online member portal. Note: CHIP members are eligible for reimbursement for tests purchased beginning 8/30/2021. Note: Beginning on February 14, 2022 members are eligible for a reimbursement amount of $12 per test, or the cost of the test if less than $12. How long will it take to receive my over-the-counter test reimbursement?Please allow up to 30 days for claims processing and for payment to be issued. How can I check on the status of my over-the-counter test reimbursement?Members can access the Member Portal to check their claim status or contact us via the message center if the claim is not yet appearing. If additional assistance is needed, members can call the customer service number on the back of their member identification card. You will need to submit the following documentation, following the instructions below, to receive reimbursement for your over-the-counter test:
Note: If the Member Submitted Health Insurance Claim Form is incomplete or any of the required documentation noted above is not included with your reimbursement request your claim will be rejected with a rejection reason indicating that additional information is needed. How do I get reimbursed for over-the-counter tests?Note: ** By submitting a manual claim for reimbursement of an over-the-counter COVID-19 test, the member is attesting that the test was purchased for personal use, not for employment purposes, and will not be reimbursed by another source or used for resale ** Mail-in claim reimbursement process:
For Highmark New York Members: Claims P.O. Box 4208 Buffalo, NY 14240 For All Other Highmark Members: Claims P.O. Box 890173 Camp Hill, PA 17089-0173 Note: ** Please submit a separate claim form for each patient. All expenses for one patient can be submitted with one claim form.** Digital member portal claim reimbursement process:
Note: ** Please submit a separate claim form for each patient. All expenses for one patient can be submitted with one claim form.** Why was I only reimbursed $12 per test when I paid more than that for my COVID-19 over-the-counter test?We encourage members to utilize our preferred pharmacy network to obtain tests at pharmacy locations or through mail order options with no out-of-pocket costs. Any tests purchased otherwise are reimbursed at $12 per test or the cost of the test if less than $12, as required by the federal mandate. |
How to get insurance reimbursement for covid test
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