Reimbursement for At-home Over-the-Counter COVID-19 Test Commercial Plan Members* Only
The information on this page applies to commercial plan members and certain self-funded plans* only.
The information on this page does not apply to Medicare Advantage plans, MediSource, MediSource Connect, Essential or Child Health Plus. Visit the Coronavirus Page for information about your plans.
If you are a commercial member:
- You may obtain tests at a pharmacy that is part of our At-home OTC preferred network. Simply show your Independent Health member ID card at the pharmacy counter. There is no cost when using one of these pharmacies. View Pharmacies.
- At all other pharmacies, members may pay for a test upfront at a pharmacy or other retailer and submit a claim form to be reimbursed up to $12 per test. To submit a claim, log in to your secure MyIH account and submit the online form.
Don’t have an Independent Health online account? Register for one today.
(*Some self-funded groups may choose to have OTC tests covered under the pharmacy benefit. Check with your employer to determine where to send claims for reimbursement.)
Types of Tests Covered
The FDA has a list of OTC tests that are covered under this guidance. These are tests that individuals get without a doctor’s order or clinical assessment, and perform on their own without sending them to a lab for processing.
Number of Tests Covered
Commercial members may get up to 8 OTC tests in a 30-day period without a doctor’s order. Since most test kits have two tests in them, a member would be able to get 4 test kits per 30-days. In order to ensure equal and fair access to OTC tests it is our expectation members will get no more than 2 tests per week and only when needed for diagnostic purposes.
This quantity limit does not apply to tests administered with a provider’s involvement or prescription. OTC tests that need to be sent to a lab (i.e., OTC PCR test) are covered only by a doctor’s order.
At-home OTC COVID tests are not recommended for children under the age of 2 and will not be covered for members under 2 years old.
We understand how important it is to manage this pandemic and correct use of testing is key. Testing should be done if symptomatic or exposed to an infected person, otherwise please save your OTC test for when you are experiencing symptoms.
Reimbursement Process – Commercial Plans
If you pay out-of-pocket for the test, you can submit a claim to be reimbursed. To submit a claim, log in to your secure MyIH account and submit the online form.
Don’t have an account? Register for one here.
This coverage applies to at-home OTC tests that members obtain on or after January 15, 2022.
Coverage for at-home OTC tests is subject to change pending federal guidance related to the public health emergency.
Other Important Information
- If you get a positive test result using an at-home OTC test, you do not need a PCR test to confirm that it is positive. Isolate according to CDC guidelines and monitor your symptoms. If your symptoms get worse, contact your primary care doctor.
- Testing should be done if symptomatic or exposed to an infected person, otherwise please save your OTC test for when you are experiencing symptoms.
- Be careful where you buy your at-home OTC test. We will reimburse up to $12 per test (so $24 for a box of 2). If you order online the online retailer may charge more than the reimbursement allowance.
- At this time there appears to be a limited supply of testing kits available at pharmacies and stores, and because the tests have expiration dates, we suggest you obtain only the number of tests you need at that time in order to let other individuals have access to these tests.
- You may not want to use your Flexible Spending Account (FSA), Health Reimbursement Account (HRA) or Health Savings Account (HSA) to pay for the tests that you are going be reimbursed for. You will have to re-fund your FSA, HRA or HSA, or face tax implications if you do not refund these types of accounts once you get reimbursed.
With the uncertainty everyone is facing, we know our members have many questions. We want you to rest assured that Independent Health’s coverage will be there for you when you need it.
Depending where you obtain your test, you may have to pay for the test up front. We have a network of pharmacies that bill us directly so you won’t have to pay out-of-pocket and submit a claim form for reimbursement.
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 it with a claim form to Independent Health for reimbursement. You will be reimbursed up to $12 per test. (Many test kits have two tests, so you will be reimbursed up to $24.).
No. The Federal Government’s regulation applies to at-home over-the-counter COVID-19 tests purchased on or after January 15, 2022.
Members may get up to 8 OTC tests in a 30-day period without a doctor’s order. Since most test kits have two tests in them, a member would be able to get 4 test kits per 30-days. In order to ensure equal and fair access to OTC tests it is our expectation members will get no more than 2 tests per week and only when needed for diagnostic purposes. This limit does not include at-home tests ordered or administered by a health care provider.
It may take up to 30 days to receive your reimbursement for the test.
This coverage is meant for at-home diagnostic testing only to see if a person is infected with the COVID-19 virus. Independent Health does not cover COVID-19 testing, including at-home OTC tests, those required for employment, activities, travel, etc.
We know that things are challenging and uncertain with the COVID-19 Coronavirus. Independent Health has identified some resources that may be helpful to you as you navigate this new normal.
Looking for additional information? These local resources may help.
We encourage all members to create their own Independent Health member accounts in order to review their benefits and have access to key details related to their plan.