The Omicron variant continues to fuel the COVID-19 surge, resulting in high daily cases and hospitalization, increasing demand for COVID-19 tests across the US. Unfortunately, both at-home rapid and PCR (Polymerase Chain Reaction) test kits have been out of stock and were unavailable for shipping through CVS and Walgreens websites. Starting January 15, 2022, Americans with private health insurance have been getting the at-home COVID-19 tests at no cost. Therefore, citizens in Iowa state should contact their insurance companies to see what they must do to be reimbursed. For instance, they should keep their receipts and fill out paperwork for reimbursement (Webber, 2022).
In addition, Iowans can request free at-home PCR tests through the Test Iowa program at the testiowa.com website (Webber, 2022). Citizens have an option of requesting the test be shipped to their address or picked up at locations listed on the program website. Once the tests are returned to drop-off locations or the State Hygiene Laboratory through UPS, the results of the tests will be available within the next 24 hours. There are two primary types of tests. The PCR tests search for genetic materials of the virus and the rapid antigen tests that look for protein fragments from the coronavirus. The antigen rapid tests produce a quicker result than PCR tests. In this report, we will discuss how different private insurers provide reimbursement for at-home rapid COVID-19 tests in the state of Iowa.
How to Get Reimbursement
Wellmark Health Plan (Plan members with UISelect, SHIP, UIChoice, and UIGRADCare)
All self-funded health plans will cover over-the-counter (OTC), at-home COVID-19 tests during the national public health emergency period. As a result, Wellmark members and their eligible covered dependents can receive at-home tests at no cost or be reimbursed by CVS/Caremark. In addition, OTC at-home tests approved by the United States Food and drug administration are covered under the plan. On the other hand, the plan will not cover OTC tests used for employment or travel purposes (Iowa University Human Resources, 2022).
Plan members can buy an OTC at-home test at an in-network pharmacy counter, and the test kit will be covered with no out-of-pocket costs. However, if plan members purchased the test kit at a national retail store, the member would be required to pay out of pocket at a retailer’s price and submit a claim to CVS Caremark for reimbursement. Plans members can still buy OTC test kits from out-of-network pharmacies and be reimbursed. But members’ reimbursement will be limited to $12 per test or $24 for a box of two tests. In addition, the claim process applies a limit of eight OTC at-home tests per member per month (Iowa University Human Resources, 2022).
How to submit for reimbursement
Plan members who pay out of pocket will need to submit a claim form for eligible tests purchased online to CVS Caremark to start the reimbursement process. To access the online platform, members should register an account. After account registration, members should log in to access different services (Iowa University Human Resources, 2022).
Once logged in, members should visit the Plan and Benefits tab and submit a prescription claim. If a member is eligible, they will see a link to submit an at-home reimbursement claim. CVS Caremark will process and pay claims for eligible tests purchased on or after January 15 (Iowa University Human Resources, 2022).
Iowa State University
Employees under the Iowa State University health plan can secure OTC COVID-19 tests. Therefore, members can use their Express Script pharmacy benefit to obtain a maximum of eight tests per member per month with no cost-sharing. Members should thus visit participating pharmacies, select the test, bring it to the pharmacy counter, and present their prescription benefit card. The pharmacy will process the payment for members (Iowa State University, 2022).
Members can also submit a manual claim for reimbursement to test purchased on or after January 15. Members should visit the Express Script website and download the form. Then, they should complete the form and submit it with the pharmacy receipt. If a member has exceeded their allotment of free at-home tests and participated in the health flex program, the additional OTC tests may be eligible for reimbursement (Iowa State University, 2022).
Aetna Health of Iowa
The employer-sponsored, private, and individual health commercial insurance plans under Aetna will cover up to eight FDA authorized OTC tests per member per month. This mandate will be effective until the end of the health emergency period issued by the federal government. Members with Aetna pharmacy benefits can submit a claim form through the members’ website. Members with CVS Caremark pharmacy benefits should expect a response within 30 days (Aetna, 2022).
When submitting reimbursement claims, members should include:
- Date of purchase,
- What the tests are for,
- The number and type of tests,
- Tests price, and a copy of the receipt.
Members will be asked to attest whether the OTC test is for self or employment use. The attestation is required because the eligible tests for reimbursement are those purchased for personal use. Members also need to note that some pharmacies may not process claims. Thus, members will be required to submit a request for reimbursement on their own (Aetna, 2022).
Sanford Health Plan
Sanford Health Plan members are eligible to purchase FDA authorized at any location where the tests are sold and submit a form to Sanford Health Plan for reimbursement. Members can, however, submit claims for up to eight OTC COVID-19 tests per member per month. Members should download the form at the Sanford Health Plan website and fill out the form and include proper documentation before mailing the form to them (Sanford Health Plan, 2022).
Conclusion
Increased demand for at-home rapid tests in Iowa state was due to the continued Omicron variant surge cases. Therefore, private insurers like Sanford Health, Wellmark, ISU, and Aetna of Iowa have provided guidelines on how members can get reimbursement for tests purchased on or after January 15. The FDA should approve the tests covered under these plans. All plans provide coverage for a maximum of eight at-home tests per member per month. The reimbursement claim form should be filled out and sent to specific insurers as stated above. Most of the discussed insurers only reimburse a maximum of $12 per individual test.
References
Aetna. (2022). COVID-19 Patient coverage FAQs for Aetna providers. Aetna. Retrieved February 7, 2022, from https://www.aetna.com/health-care-professionals/covid-faq/patient-coverage.html.
Iowa University Human Resources. (2022). Wellmark Health Plan Updates. Retrieved February 7, 2022, from https://hr.uiowa.edu/benefits/health-insurance/wellmark-health-plan-updates.
Iowa State University. (2022). COVID-19 Testing Options and Insurance Reimbursement Procedures. Hr.iastate.edu. Retrieved February 7, 2022, from
Sanford Health Plan. (2022). Reimbursement Information for COVID-19 At-Home Tests. Retrieved February 7, 2022, from https://www.sanfordhealthplan.com/covid-19/reimbursement-information.
Webber, T. (2022). At-home COVID tests are hard to find in Iowa. But, here’s a guide on where you can get a test. Desmoinesregister.com. Retrieved February 7, 2022, from https://www.desmoinesregister.com/story/news/health/2022/01/11/covid-19-iowa-where-find-in-person-take-home-pcr-antigen-tests-des-moines-omicron-variant/9160419002/.
