Over-the-counter COVID-19 test coverage information

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The Department of Employee Trust Funds works with state health officials and health plans participating in the Wisconsin State Group Health Insurance Program to ensure you receive the care you and/or your covered dependents need during the COVID-19 pandemic. For more information on group health insurance benefits and coverage related to the COVID-19 pandemic, visit Your health benefits and COVID-19.

Below is important information and resources about federally regulated COVID-19 home testing kit coverage as of January 15, 2022.

Coverage for non-Medicare members

If you are enrolled in the Group Health Insurance Program and not yet insured by Medicare, you have coverage for eight (8) individual at-home COVID-19 tests every 30 days. Tests can be purchased at pharmacies, retail outlets, or online. Only tests approved by the Federal Food and Drug Administration, or FDA, will be covered. To check if a test is FDA approved, see this list of approved home test kits and scroll down to view a searchable table of approved tests.

  • Trial limits: You are covered for eight (8) individual home COVID-19 tests every 30 days starting January 15, 2022.
    • Tests are counted individually, not per box – i.e. four (4) boxes with two (2) tests each equals eight (8) tests.
  • Pharmacy coverage: If you purchase your test from a pharmacy, coverage will be handled by Navitus. Purchase tests over the counter from the pharmacy to ensure that the Navitus Pharmaceutical Advantage is applied correctly.
    • The tests will be covered free of charge at in network pharmacy chains and groups.
      • To see network pharmacies near you across the United States, including local pharmacies in Wisconsin, go to www.etf.benefits.navitus.com, click on your plan type (blue boxes) and click on it. pharmacy search option will appear in the right menu.
    • Tests purchased from a off grid pharmacy can be reimbursed up to $12 per test by submitting a reimbursement request form and any required documentation to Navitus.
    • If you wish to purchase more than 8 individual tests over a 30 day period (i.e. 5 boxes of 2 tests each), additional tests will be charged at $12 per in-network test and $48 per out-of-network test . .
  • Medical cover : If you purchase your tests at a retail store, online, or at a provider’s office, coverage may be available through your health plan. Health plans are currently rolling out coverage, so you should consider a network pharmacy chain for the smoothest customer experience.
    • Check with your health map before buying tests to check if the point of sale is part of the plan network and how to reimburse the costs after the purchase.
    • If your health plan does not provide testing coverage, you can submit a reimbursement request form and any required documentation to Navitus.
    • Your health plan may contact you directly by mail, email, or text with additional details about home testing kit coverage.

Coverage for Medicare Members

The Centers for Medicare & Medicaid Services (CMS) not currently reimburse Medicare members for over-the-counter test kit purchases.

  • Original health insurance can not pay for home testing through this program right now. Medicare programs offered by the ETF, including Medicare Advantage, Medicare Plus, and Medicare Coordinated plans, not reimburse over-the-counter tests.

Medicare members have several resources to receive free home tests, including:

  • collection kits provided by the State of Wisconsin and Vault Medical Services
  • HHS-provided test kits available at community health centers and Medicare-certified clinics. Learn more about this program here.

Types of COVID-19 tests excluded

Only COVID-19 home tests purchased for personal use on or after January 15, 2022 will be covered.

The following tests are excluded of the cover:

  • Testing to meet employer requirements, such as testing in lieu of vaccination.
  • Tests for public health surveillance (i.e., not to diagnose a specific condition).
  • Tests that are not specifically for you or a covered dependent.

Laboratory diagnostics (sometimes called PCR tests) and antibody tests still require prescriptions from a doctor to be covered.

Pre-tax savings account coverage

Home COVID-19 test kits will continue to be a eligible expense for Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA).

  • Your FSA/HSA funds can be used to purchase additional tests during each 30 day period covered by drug and medical benefits.
  • You can pay for COVID-19 testing using your FSA/HSA payment card, or pay for the test out of pocket and submit a claim through Optum Financial member portal, mobile app or Claim Form.

Resources on COVID-19 test kit coverage

For more information on COVID-19 home test kit coverage, visit:

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