important-alert Select members are eligible for COVID-19 at-home test reimbursements. Submit your claim in your MyIH account. Log in

At-Home Over-the-Counter COVID-19 Test Reimbursement

Coverage Information

At-home Over-the-Counter COVID-19 Test

Individuals may order free at-home Over-the-Counter COVID-19 tests through the Federal Government at covidtests.gov without having to pay upfront and wait to be reimbursed.

Starting January 15, 2022, Independent Health commercial and self-funded plan members can go to their pharmacy, a store or online to obtain an at-home over-the-counter (OTC) COVID-19 diagnostic test authorized by the U.S. Food and Drug Administration (FDA).

View Questions and Answers here

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

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. Any claims for more than 2 tests per week will require additional documentation in order to prevent fraud and abuse.

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.

Cost of Tests

If individuals obtain tests through the Federal Government website, covidtests.gov, they get the test for free and will not have to pay any costs upfront and request reimbursement.

If members obtain the tests through a pharmacy or other retailer and use their Independent Health coverage, the Federal Government authorizes health plans to reimburse members up to $12 per test. (If the test kit contains two tests, members will be reimbursed up to $24). Please note, shipping costs are not reimbursable.

Members may have to submit a claim for reimbursement.

We are working with our participating pharmacy network to set up a process to bill us directly so members won’t have to pay out-of-pocket and submit a claim form for reimbursement, but this may take time to develop.  You can check with the pharmacy where you get your medications to see if they can process it in this way, but you may have to pay upfront and submit the claim form to request reimbursement.   

Reimbursement Process

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 you may be responsible for shipping costs, and 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.

Common Questions

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.

Starting January 15, Independent Health commercial members can go to their pharmacy, a store or online to obtain an at-home over-the-counter (OTC) COVID-19 diagnostic test listed on the  U.S. Food and Drug Administration (FDA) website. Only OTC tests on this list will be covered by Independent Health, so please review list prior to purchase. This applies to members of our commercial group and individual plans, as well as self-funded plans.

However, as of January 19, individuals can order free tests through a Federal government website, covidtests.gov, without paying upfront.

We are working with our participating pharmacy network to set up a process to bill us directly so members won’t have to pay out-of-pocket submit a claim form for reimbursement, but this may take time to develop. If you buy 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. (A test kit that contains two tests is reimbursable up to $24. Shipping costs are not reimbursable.)

However, as of January 19, individuals can order free tests through a Federal government website, covidtests.gov, without paying upfront.

The FDA has a list of OTC tests that you may obtain. These are tests that do not require a health care provider’s order or clinical assessment, and are those that individuals do on their own, and read the results without sending them to a lab for processing. 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. 

You may have to pay for the test up front if you obtain them at a pharmacy or other retailer.. We are working with our participating pharmacy network to set up a process to bill us directly so members won’t have to pay out-of-pocket and submit a claim form for reimbursement, but this may take time. 

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.). Shipping costs are not reimbursable.

Members can log in to their secure MyIH account and fill out a claims form online. If you do not have an account, you can register for one here.

Alternately, members can download the claim form and submit it with an itemized receipt to Independent Health to get reimbursed.

No. The Federal Government’s regulation applies to at-home over-the-counter COVID-19 tests purchased on or after January 15, 2022.

It may take up to 30 days to receive your reimbursement for the test. 

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. Any claims for more than 2 tests per week will require additional documentation in order to prevent fraud and abuse.  This limit does not include at-home tests ordered or administered by a health care provider.

Check with your local pharmacy where you get your prescriptions, or any store or online retailer that provides the FDA-authorized tests. 

Tests are in short supply and high demand.  Keep in mind you can get free testing at a community testing site. Diagnostic COVID-19 tests are available without cost-sharing when administered by a health care provider like a nurse, doctor, or pharmacist, without limitation.

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.

Wellness Resources

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.

Community Events

Community Events

Check out some of the ways we are working with our partners to help the Western New York community stay active and connected during this unprecedented situation.

Brook

Brook

Your personal health companion app – supporting your daily health decisions with trusted expertise.

Work Out from Home Videos

Work Out from Home Videos

Interested in staying healthy and active at home? Try our series of instructional videos on health and fitness topics to show how exercising at home can be both easy and fun to do.

Foodsmart

Foodsmart

Eating well just got simpler with instant personalized meal plans, digital grocery lists, nutrition guidance and more.

Community Services

Looking for additional information? These local resources may help.

Crisis Services Hotlines

Erie County Senior Services

WNY Childcare Resource Network

NYS Coronavirus Emotional Support Line

Stay Informed

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.