All three medical options (PPO, EPO, and HDHP) and the Medicare Supplement Plan cover over-the-counter home tests for COVID-19 for $0 copay through December 31, 2023.
Through December 31, 2023, the Medical Plan covers up to eight over-the-counter (OTC) home COVID-19 tests for a covered member in a 30-day period, provided the test is approved by the U.S. Food and Drug Administration (FDA). You and your covered family members can get these tests at Express Scripts pharmacies or through Express Scripts Pharmacy home delivery service, and no copay, deductible, or coinsurance will apply.
Members enrolled in Triple-S also have no-cost coverage for OTC home COVID-19 tests, but the reimbursement process is different.
The plan does not cover COVID-19 testing for employment purposes; for example, an employer screens all employees before they return to the workplace.
Simply present your prescription drug ID card when buying FDA-approved OTC home COVID-19 tests at the pharmacy counter of a participating Express Scripts pharmacy, and you won't be charged a copay. You and your covered family members can each get up to eight OTC tests in a 30-day period for $0 copay. If a package includes two or more tests, each individual test will count toward the eight-test maximum. In other words, if you buy two packages that each contain two tests, it counts as four tests.
You can also use Express Scripts Pharmacy home delivery service to get your eight tests with no copay. To order your tests for home delivery, log on to the Express Scripts website and click Order At-home COVID-19 Tests under Quick links on the homepage. If ordering through home delivery, you will receive eight OTC home COVID-19 tests. You cannot order fewer than eight tests through mail order. Therefore, if you get tests at a participating pharmacy, you should not use home delivery during the same 30-day period.
Note: While the Medical Plan covers up to eight OTC home COVID-19 tests per member in a 30-day period, keep in mind that these tests have a limited shelf life, so you should only purchase what you need. Being thoughtful about this number also helps to ensure access for everyone.
If you purchase an FDA-approved OTC home COVID-19 test at an out-of-network pharmacy, or online retailer such as Amazon, between January 15, 2022, and December 31, 2023, and pay for the test out of pocket, you may submit a request for reimbursement from Express Scripts.
You (and each covered family member) can be reimbursed for up to $12 per test, subject to the eight-test limit in a 30-day period.
To file for reimbursement by mail
Attn: Commercial Claims
P.O. Box 14711
Lexington, KY 40612-4711
Important: You can submit requests for reimbursement online only if you have national drug code (NDC) number for the test(s) purchased (typically found on your pharmacy receipt). If you do not have this number, you will need to submit your request by mail.
To file for reimbursement online
Note: If you are enrolled in the PPO, EPO, or HDHP and need help filing a request for reimbursement from Express Scripts or ordering OTC home COVID-19 tests through home delivery, call Quantum Health at 855-497-1237 and a Care Coordinator will assist you.