Updated Guidance on Coverage of OTC COVID-19 Tests

Posted on January 18, 2022

Over-the-Counter, At-Home COVID-19 Tests Must Be Covered Effective 1/15/22
(carrier polices for coverage available below in PDF format)

On January 10, 2022, the Depts. of Labor, Health and Human Services (HHS), and the Treasury issued FAQ guidance regarding the requirements for group health plans and health insurance issuers to cover over-the-counter (OTC) COVID-19 diagnostic tests.

As of Jan. 15, 2022, the cost of these tests must be covered, even if they are obtained without the involvement of a health care provider.

Plans and insurance issuers may place some limits on coverage, such as:

  • Requiring individuals to purchase a test and submit a claim for reimbursement, rather than providing direct coverage to sellers.

  • Providing direct coverage through pharmacy networks or direct-to-consumer shipping programs and limiting reimbursements to other sources (the actual cost of the test, or $12, whichever is lower).

  • Setting limits on the number or frequency of OTC COVID-19 tests that are covered (no less than 8 tests per month or 30-day period).

  • Taking steps to prevent, detect and address fraud and abuse.

Click on the links below for carrier communications regarding their new COVID-19 at-home-testing policies.