Below is in regards the OTC COVID coverage and how Sharp/SIMNSA are handling.
The federal government issued a public notice requiring employer group health plans and health insurance issuers to provide first-dollar coverage of FDA-approved over-the-counter (OTC) COVID-19 tests, regardless of an order or clinical assessment, starting January 15, 2022. Please review the information below regarding coverage for testing, claim reimbursement, and other important details.
What is covered?
Reimbursement for FDA-approved OTC COVID-19 tests will be limited to 8 tests per member, per month and will last until the end of the public health emergency (renewed at this time through mid-April). If you purchase a test kit that includes two rapid tests, that will count as two of your eight covered tests. Diagnostic test kits are covered even when the test is purchased without an individualized clinical assessment or an order from a health care provider.
Insurance companies require a participant or other enrollee to provide a signed attestation that the OTC tests are to be used only for diagnostic (not employment, travel, or other) purposes. The attestation may also include that the OTC test has not and will not be reimbursed from other sources and is not for resale.
What are the different types of COVID-19 tests?
- Rapid antigen home tests are a fast, easy way to get a quick result if members have symptoms, think they have been exposed to someone with COVID-19, or plan to gather indoors with those who may be at risk including unvaccinated children, older individuals, and those who are immunocompromised. Results are typically available within 30 minutes.
- PCR tests are usually processed in a lab and results are typically available in 1-3 days. PCR tests are typically ordered by a health care provider after health assessment.
Where can I find a test?
- Visit COVIDtests.gov for information on free tests that may be available through government services.
- At-home diagnostic tests can be purchased over the counter online, at a local pharmacy, or from a big-box store.
How do I get reimbursed?
- Sharp Members
- In order to be reimbursed, please complete and submit the claim form attached. The form should be submitted to the address on page 1.
- You will need the brand name and the Universal Product Code (UPC) from the at-home test box to complete the form. An itemized sales receipt is also required. The UPC is listed underneath the barcode and is typically a 12-digit number.
- It will take Sharp ~30 days from the date they receive your request to process your reimbursement. If your request is approved, you will receive a check for your total reimbursement amount by mail. If your request is denied, you will be notified by mail.
- SIMNSA Members
- Due to the cross-border nature of coverage that SIMNSA provides, they are not governed by federal US law and are therefore not required to provide no cost coverage for at-home testing. SIMNSA will continue to cover tests only if ordered by a provider.
Additional information
- You can still use in-person diagnostic COVID-19 testing sites. These may include your doctor’s office, a pharmacy or health clinic, or an urgent care center.
- Currently, there is a nationwide shortage of rapid antigen home tests. Most pharmacies will limit to 1-2 kits or have delivery dates 3-4 weeks out.
- The federal mandate does not cover workplace-required testing.
- COVID home test kits purchased before January 15 are not eligible for reimbursement under this program.
If you have any questions, please contact Glenda Palafox in Human Resources at 619-522-6173.