The State Employee and Retiree Health and Welfare Benefits Program (the Program) is required by federal law to cover certain over-the-counter (OTC) COVID-19 tests for eligible plan participants. A summary of the rules currently in effect for reimbursement of these tests is included below. We will provide an update to the rules as additional guidance is released.
What is covered?
- Participants may purchase up to eight COVID-19 tests per covered family member per month. Note: Tests performed at a doctor’s office or hospital do not count toward the eight-test maximum for reimbursement.
- If COVID-19 tests are purchased, with your prescription drug ID Card, at a retail or mail-order pharmacy, they will be fully covered at the point-of-sale. Copays do not apply.
- If the tests are purchased outside of the prescription drug plan, they may be eligible for reimbursement under your medical plan. Reimbursement is limited to $12, and you must submit a claim form including appropriate receipts to receive reimbursement.
When will the Program start covering COVID-19 tests?
Over-the-counter or doctor-ordered COVID-19 tests are eligible for reimbursement from January 15, 2022, through the end of the public health emergency. Note: Tests purchased for employment purposes are not covered.
Where can I purchase a COVID-19 test?
Purchasing COVID-19 tests, either in person or online, from a network pharmacy that participates is your best option. You can find a network pharmacy near you at Pharmacy Locato
r. If you purchase a COVID-19 test from an out-of-network retailer, the Program will cover either the full cost of the test or $12 – which amount is lower.
Tests are also available through the federal government at COVIDtests.gov, which offers every home in the U.S. four free at-home tests.
How am I reimbursed for a COVID-19 test?
COVID-19 tests purchased at a network pharmacy are covered 100% when using your CVS/Caremark prescription drug benefits.
For tests purchased from out-of-network retailers you must submit a claim to your medical plan carrier for reimbursement along with a copy of the receipt and the UPC code from your COVID-19 test’s box. You’ll be reimbursed for either the full cost of the test or $12-whichever amount is lower.
We will continue to share timely updates with you as the situation evolves. We will also be updating our website with specific carrier information as it is made available.