Ambetter of Oklahoma is making COVID-19 tests available at no cost if the member goes to an in-network pharmacy.

If the member purchased the at-home COVID-19 test at any location outside of our pharmacies, we will reimburse the member for the cost of the test after completing the member reimbursement process. The reimbursement will be limited up to the amount set in the federal guidance ($12, or the cost of the test if less than $12, per test per covered individual) released on January 10, 2022.

We have information about coverage at in-network pharmacies, and how to submit for reimbursement on our website as well as the member portal.

Ambetter of Oklahoma will cover 8 at-home COVID-19 tests obtained over-the-counter per covered individual in a 30-day period, consistent with the federal guidance released on January 10, 2022.

Blue Cross and Blue Shield of Oklahoma At-Home Testing Guidance for Members

Effective, Jan. 15, 2022, Blue Cross and Blue Shield of Oklahoma (BCBSOK) will cover the cost of FDA-authorized, over-the-counter (OTC) COVID-19 tests through BCBSOK/Prime Therapeutics^® pharmacy benefits. OTC tests are covered with no out-of-pocket costs when purchased at the pharmacy counter for members with employer coverage or an individual or family plan with pharmacy benefits.

When using a pharmacy in Prime’s network, members should not be required to submit a separate claim for reimbursement. However, members will be charged for OTC tests purchased at the retail counter and will be required to submit a claim for reimbursement.

Submitting Claims for Reimbursement:

• If an in-network pharmacy cannot submit a claim electronically, members can submit a claim form for reimbursement.
• OTC tests purchased at an out-of-network pharmacy are also reimbursable.
• Plan members will be reimbursed up to $12 per test — up to 8 tests every 30 days per person. For example, members can purchase 4 boxes that include 2 over-the-counter COVID-19 tests.

• OTC tests for return to work or school, travel and recreational event requirements, etc., may not be covered.

Other Guidance

• Free OTC tests can be requested through the federal government’s website. These tests do not count toward the 8 tests per covered member every 30 days under BCBSOK plan coverage.
• If there is uncertainty whether a test kit is FDA-authorized, ask the pharmacist for help.
• Consumers without pharmacy benefits via BCBSOK/Prime may contact their health plan administrator for more information.

Medicare: OTC diagnostic tests are not covered at this time. COVID-19 tests ordered by a health care professional continue to be covered at no cost under member medical benefits.

BCBSOK/Prime Therapeutics® Member Claim Form

Starting January 15, 2022, Bright HealthCare will cover at-home OTC COVID-19 diagnostic tests for Individual and Family Plan and Small Group members. Members can purchase at-home OTC COVID-19 diagnostic tests online or at a pharmacy or store. Diagnostic COVID-19 tests must be authorized by the U.S. Food and Drug Administration (FDA).

After you purchase your test, submit a reimbursement claim form along with the proof of purchase to the Bright HealthCare mailing address listed on the form. You may also visit the Member Hub and send a secure message with the reimbursement form and proof of purchase attached. You can find the reimbursement claim form and instructions here.

Supply is currently limited nationwide. Please visit your pharmacy or your favorite retailers online or in person to find out if they have tests available.

Bright HealthCare will reimburse you for the actual cost of the test when you submit a reimbursement claim form and provide proof of purchase of a diagnostic COVID-19 test that has been authorized by the U.S. Food and Drug Administration (FDA).

If you have a health FSA or HSA: Please note that the cost of OTC COVID-19 tests cannot be reimbursed by Bright HealthCare if you use your FSA or an HSA to purchase the test, pursuant to federal law. If you are going to submit your test purchase for plan reimbursement, do not use your health FSA or HSA debit card to purchase the OTC COVID-19 tests.

Please visit https://brighthealthcare.com/covid-19 for more information.

Oklahoma Reimbursement Form English
Oklahoma Reimbursement Form Spanish

Effective January 15, 2022 and thru the end of the Public Health Emergency (PHE), OTC tests that are approved under the FDA Emergency Use Authorization In Vitro Diagnostics EUAs – Antigen Diagnostic Tests for SARS-CoV-2 |FDA will be covered at $0 cost to the customer, without a health care provider order or individualized clinical assessment. If you purchase an over-the-counter COVID-19 test from a pharmacy, store, or online retailer and are charged for your test, keep your receipt and submit a claim to Cigna for reimbursement. You will be reimbursed the costs of diagnostic OTC testing, regardless of where the tests are obtained (in- or out-of-network). Your plan can provide this coverage through reimbursement to you. Your plan can require you to sign an attestation that the test was purchased:

• for the covered individual;
• is not for employment purposes;
• has not and will not be reimbursed by another source, and
• is not for resale.

Your plan may require reasonable documentation of proof of purchase with a claim for reimbursement for the cost of an OTC COVID-19 test.

Cigna Member OTC COVID-19 Test Information

Cigna Member COVID-19 Over-the-Counter (OTC) Test Kit Claim Form

Over-the-Counter COVID-19 Test Guidance

Effective January 15, 2022, new federal guidance requires private health insurers to cover up to eight at-home COVID-19 tests per month for commercial plan members without cost sharing. Note that provider ordered tests do not count toward the monthly limit. This coverage requirement will last until the end of the Federal Public Health Emergency.

Specifics about the finalized guidance:

• Commercial plan members of CommunityCare (either through group or individual coverage) are able to be reimbursed by CommunityCare for over-the-counter tests they purchase through mail, retail, or online.
• Reimbursement for tests is limited to the lesser of the actual cost or $12 per test.
• CommunityCare is working with our pharmacy network to provide access via retail and mail order through direct coverage rather than member reimbursement; however, this is not a requirement of the final guidance.
• Members may obtain, without cost share, a maximum of eight over-the-counter tests per covered individual on a monthly basis. Note: the eight-test limit is measured per test, so if a testing kit has two tests per package, the limit would be four packages.
• The guidance clearly identifies that it does not impact prior guidance indicating plans are not required to cover the cost of surveillance testing, tests for return to work screening or other employment-related purposes.
• The guidance also allows health plans to continue fraud, waste, and abuse mitigation programs and permits plans to require a patient attestation to purpose.

CommunityCare is fully compliant with the new federal guidance regarding at-home diagnostic tests or over-the-counter COVID-19 testing as of January 15, 2022.

CommunityCare members may contact CommunityCare customer service at (918) 594-5242 with any questions.

The only type of policies subject to the Families First Coronavirus Response Act is the Company’s grandfathered plans. 

The Company’s procedure for claim reimbursement is as follows. Upon presentation of a receipt, the Company will reimburse each individual insured under a grandfathered policy for eight (8) over-the-counter COVID-19 tests per month at the rate of $12.00 per test. No physician’s order is required and the insured individual is not required to show symptoms of the disease. These grandfathered policies are not associated with preferred networks or point-of-sale purchase arrangements. 

Humana continues to evaluate its ability to contract with pharmacies and other retailers to develop a direct coverage network for its members. While the direct coverage network is being evaluated, Humana is following the guidance for indirect coverage as outlined in the federal guidance.  Humana added instructions to its COVID-19 FAQ pages as well as new links for COVID-19 OTC testing reimbursement within its website (located at https://www.humana.com/coronavirus/coverage-faqs).

Additional customer care guidelines were also created to assist members who have questions about indirect reimbursement or the forthcoming direct coverage network.  Members are able to submit a claim for reimbursement of their out of pocket costs by mail. Consistent with the federal guidance, Humana requires reasonable documentation of proof of purchase, including receipts and – for receipts that do not clearly indicate the specific services purchased – Universal Product Code (UPC). Humana follows standard claims reimbursement timelines and prompt payment statutes for submitted claims. Most reimbursements should be processed within 30 days.

Where can I obtain at-home COVID-19 tests?

If you go to the pharmacy counter, you may be able to present your member ID and ask them to bill your insurance just like you would a medication at no cost to you. Please note that many pharmacies are still working to set up this process and may require that you pay out of pocket for now. If that happens please see below for how to get reimbursed.Additionally, you are able to order up to 4 tests for free directly from the federal government via this site: https://www.covidtests.gov/ You can obtain a test through our network of pharmacies. Find one near you.

I paid for my at-home tests out of pocket. How do I get reimbursed?

Don’t sweat – if you purchased the tests on or after January 15, 2022, you’ll still be able to get reimbursed. Just follow the steps below:(Note: If you’re a Cigna + Oscar or Cigna Administered by Oscar small group member, we’ll share more info soon about how you’ll be reimbursed. You won’t be reimbursed if you follow the process below.) 

1. Please visit Caremark.com and sign in or register. Be sure to have your member ID available if you haven’t previously created an account with Caremark. (You can always access your member ID number through your online account here)
2. Select “Plan & benefits”
3. Select “Submit a prescription claim” and follow the prompts listed there

What are the requirements for reimbursement?

• Your tests must be purchased on or after January 15, 2022. 
• Your tests must be FDA authorized.
• You must be an active member enrolled in individually purchased health care or on a small group plan. Reimbursement doesn’t apply to Medicare Advantage plans.
• You will be reimbursed for up to 8 tests (not 8 test kits) per member per 30 day period. Ideally, the receipt should only include the purchase of tests and no other items (i.e. a receipt that includes only the at-home COVID test(s) purchased and not other non-reimbursable purchases) is preferred as it will allow us to process your request more quickly.

Reimbursement guidelines: 

FDA Authorized OTC COVID self-tests will be reimbursed and include the following.

• Abbott BinaxNOW 
• SD Biosensor COVID At Home Test
• Siemens’s CLINITEST Self Test
• iHealth COVID-19 Self Test
• Access Bio’s CareStart Self Test
• BD Veritor At-Home Test
• InBios SCov-2 Detect Self Test
• OraSure InteliSwab Rapid Test
• Cellitrion DiaTrust Home Test
• QuickVue At Home Test
• ACON Flowflex Home Test
• Ellume Home Test
• Detect COVID-19 Test
• Lucira Check-it COVID-19 Test
• Cue Covid-19 at home test

The only type of policies subject to the Families First Coronavirus Response Act is the Company’s grandfathered plans. 

The Company’s procedure for claim reimbursement is as follows. Upon presentation of a receipt, the Company will reimburse each individual insured under a grandfathered policy for eight (8) over-the-counter COVID-19 tests per month at the rate of $12.00 per test. No physician’s order is required and the insured individual is not required to show symptoms of the disease. These grandfathered policies are not associated with preferred networks or point-of-sale purchase arrangements. 

UnitedHealthcare (UHC) members have access to coverage information on the member website at myuhc.com. Members may also contact Customer Care via the number on their ID card to obtain additional information and ask questions. UHC has arranged preferred retail relationships for the program with Walmart, Sam’s Club, and Rite Aid and is continuing discussions with other potential retail partners. 

Eligible members will be able to obtain an at-home, OTC COVID-19 test without an upfront cost, or they may submit for reimbursement. For at-home, OTC COVID-19 tests purchased outside a preferred retail pharmacy, members may submit a claim with their receipt for reimbursement through the UHC member portal. 

A member can determine eligibility by looking at their UHC member ID card. 

• If OptumRx is shown on the front of the card: They are part of the UHC pharmacy benefit through OptumRx and may go to a program pharmacy with available inventory to get an at-home, OTC COVID-19 test at no cost. The member must purchase their at-home, OTC COVID-19 test(s) at the pharmacy counter to avoid upfront payment. The member must have their UHC ID card with them. 
• If a member purchases an at-home, COVID-19 test at any in-store or online retailer other than a program pharmacy: They may submit a purchase receipt(s) for reimbursement at the UHC member portal for a maximum reimbursement of $12 per test. 

In accordance with the FAQ issued by the U.S. Departments of Treasury, Labor, and Health and Human Services issued on January 10, 2022 and effective on January 15, 2022, Wellfleet Insurance Company is reimbursing its members for up to 8 tests per member per month, without out-of-pocket expense to members, for the cost of over-the-counter, FDA-approved Covid-19 tests.

To obtain reimbursement, members must submit to Wellfleet a completed electronic reimbursement form, including scanned or photographed copies of the purchase receipt and the UPC from the test’s packaging. Members can locate the reimbursement form, including instructions on how to submit the form, on their school’s Wellfleet Student website or by calling the telephone number on their Wellfleet ID card.