Effective Jan. 15, 2022, new federal regulatory guidance requires that medical plans must provide coverage for the cost of over-the-counter (OTC) at-home COVID-19 antigen tests, including tests obtained without a healthcare provider’s order or authorization.
There are three options for coverage of OTC at-home COVID-19 test kits:
- Pay $0 at a preferred network pharmacy: Visit a Walmart, Sam’s Club, or Rite Aid pharmacy and simply go to the pharmacy counter, present your Optum prescription drug ID card, and ask to have your OTC at-home COVID-19 test kits submitted to your plan for coverage. Optum anticipates adding other pharmacies as they become operationally ready.
- Purchase a kit and then submit an electronic form for reimbursement: You can also purchase an OTC at-home COVID-19 test kit at other stores or online retailers. Keep your purchase receipt(s) to submit for reimbursement. To receive the quickest possible reimbursement of up to $12 per test*, submit an electronic claim form by visiting optumrx.com/testinfo.
- Purchase a kit and then print and mail in a paper reimbursement form: If you prefer to submit your claim by mail, you can print a form at optumrx.com/testinfo and then mail it in. Reimbursement applies up to $12 per test*. Please note: you will receive reimbursement more quickly if you submit an electronic claim.
*The reimbursement is for each test, not per box purchased. For example, if the box contains two test kits, the reimbursement will be up to $24.
Which COVID-19 tests are covered?
Coverage includes OTC at-home COVID-19 test kits authorized by the Food and Drug Administration (FDA). The most common tests are BinaxNOW™, Flowflex™, InteliSwab™, On/Go™ and QuickVue®.
Currently, the Carestart home test kits sold at Dougherty Pharmacy are not covered by Optum. This will change as carriers update their systems. If you purchase a kit that is not currently covered by our plan, save your receipts so that you can submit for reimbursement if the test kits get approved for reimbursement.
Is there a limit to how many tests will be covered?
Yes. Covered members can get up to eight individual tests per month, e.g., a family of four would be eligible for 32 tests a month. Visit optumrx.com/testinfo or call OptumRx at 1-855-227-8568 for the latest updates and information.
Can I use my flex card to make purchases?
The cost of OTC antigen test kits can be reimbursed through your flexible spending account if the cost of the test kit is greater than the reimbursement from the insurance carrier or if you do not request reimbursement from the insurance carrier. As a reminder, save all receipts. If you have questions, contact Lifetime Benefit Solutions at 800-327-7130 or LBS.CustomerService@LifetimeBenefitSolutions.com.
I don’t have an Optum ID card, how do I get a new one?
Contact Relph Benefit Advisors/Alera at 1-800-836-0026 x 7400 to order a new id card.