On Jan. 10, 2022, the Depts. of Labor (DOL), Health and Human Services (HHS), and the Treasury issued FAQ guidance regarding the requirements for group health plans and health insurance issuers to cover over-the-counter (OTC) COVID-19 diagnostic tests.
Legal Requirements Plans and issuers must cover the costs of COVID-19 tests during the COVID-19 public health emergency without imposing costsharing requirements, prior authorization or other medical management requirements.
As of Jan. 15, 2022, the cost of these tests must be covered, even if they are obtained without the involvement of a health care provider.
However, the FAQs do not require tests to be covered if they are not for individualized diagnosis (such as tests for employment purposes).
Plan Options Plans and insurance issuers may place some limits on coverage, such as:
- Requiring individuals to purchase a test and submit a claim for reimbursement.
- Providing direct coverage through pharmacy networks or direct-to consumer shipping programs.
- Limiting the number or frequency of OTC COVID-19 tests that are covered.
- Taking steps to prevent, detect and address fraud and abuse.
If you have questions call your benefits department or the number on your insurance card.