Over the past few months, the highly transmittable and infectious omicron variant of COVID-19 has significantly increased the demand for testing in Kansas state. The Kansas Department of Health and Environment (KDHE) will continue to monitor the impact and spread of the virus. Throughout increased omicron variant cases, KDHE saw an increase in testing rates. The increase in demand for COVID-19 testing led to delays in a turnaround of test results, longer wait times, and decreased availability of over-the-counter (OTC) rapid tests.
In addition to the steps undertaken by KDHE to reduce delays and increase COVID-19 testing, at-home rapid antigen tests are available for free at COVIDtests.gov to all households. Every household is eligible to order four tests. In addition, OTC antigen tests for Kansas residents with health insurance plans are available for purchase at no cost or they can be reimbursed for the amount used through their health plans as of January 15, 2022 (KDHE, 2022). Also, Kansas state government will require individuals, employers, and health insurance companies to pay costs associated with COVID-19 tests. However, the changes will mainly affect employers’ programs to regularly test their 10% of workers. The policy will also affect community organizations to offer free rapid tests to residents.
Beginning March 2022, the State Department of Health and Environment will start phasing out free screening COVID-19 tests for people who are not showing the virus symptoms or those who are not potentially exposed. The department, however, noted that it could not sustain having these health agencies cover all testing costs indefinitely. This report will discuss COVID-19 tests reimbursement by different insurers in Kansas state.
How To Get Reimbursement
Blue Cross and Blue Shield of Kansas
Starting January 15, as per the federal requirement Blue Cross and Blue Shield of Kansas (BCBSKS) is covering the cost of up to eight at-home rapid tests every 30 days for its members. Therefore, BCBSKS members can go to any pharmacy counter and request a COVID-19 test. Members should present their BCBSKS ID cards at the representative pharmacy. Depending on your plan coverage, a member will receive a test at no cost or pay for the test and submit a reimbursement with a copy of the purchase receipt (BCBSKS, 2022).
It is important to note that PCR tests that require sending off to a lab are not covered at home. The test should not cost more than $12, as the maximum amount to be reimbursed is $12 per test. Also, the reimbursement is not valid for employment purposes or resale, and coverage is limited to tests that have the FDA emergency use authorization (BCBSKS, 2022).
CVS Caremark
The federal government announced on January 10, directing insurance health plans to cover the cost of specific OTC antigen tests. Accordingly, the CVS Caremark started covering specific OTC tests bought from January 15 through the duration of a public health emergency. Under this plan, OTC at-home tests are covered only through CVS Caremark and not medical insurance carriers like Aetna and Blue Cross Blue Shield of Kansas (Kansas State University, 2022).
Members do not require a prescription to buy and receive benefits for OTC COVID-19 tests. Some pharmacies will file and process claims directly; therefore, members’ costs will be $0. OTC tests purchased at a retail counter may require members to submit a reimbursement request even though the pharmacy is considered in-network. Only selected tests such as Flowflex COVID-19 Antigen Home Test, Access Bio On/Go COVID-19 Antigen Self-Test, InteliSwab Covid-19 Rapid Test, QuickVue At-Home COVID-19 Test (2-pack), and QuickVue At-Home COVID-19 Test (5-pack) are covered under the direct pharmacy benefit (Kansas State University, 2022).
The coverage plan is limited to eight tests per member per 30 days. Therefore, the maximum reimbursement to be provided is $12 per test, and a receipt must be included with claim submission. Reimbursement requests can be via paper form or filed online in the members portal. It takes 30 days for members to receive payment. The network pharmacies can be located at the CVS Caremark member portal (Kansas State University, 2022).
Cigna
The Cigna plan covers the cost of FDA emergency use authorization OTC COVID-19 tests beginning January 15. Members charged for test purchases online or at a pharmacy or retail store should keep their receipt and claim to Cigna for reimbursement. The company will reimburse the cost of the OTC test regardless of whether the test was purchased in or out of network. A copy of the purchase receipt or UPC barcode should be provided and submitted along with the form via mail or fax using the instructions on the form (Cigna, 2022).
The eight tests limit only applies to the tests purchased without the involvement of a health care professional, and additional tests required by the health professional will be covered. In addition, for members who are not original Medicare or Medicare Advantage Plan, the plan can cover a limit of eight tests per month (Cigna, 2022).
Summary
The KDHE has undertaken various actions to increase testing and reduce turnaround waiting time in the Kansas state. Therefore, Kansas residents with health insurance can obtain at-home OTC tests and the cost covered by their plan. Plans like BCBSKS, Cigna, and CVS Caremark provide coverage to FDA-approved tests. The maximum number of tests covered is eight tests under BCBSKS and CVS Caremark. Cigna also covers eight tests per 30 days, but they will be covered if the medical provider orders additional tests.
Moreover, Cigna reimburses its members the full amount whether the tests were purchased in or out of network. BCBSKS and CVS Caremark, on the other hand, reimburse a maximum of $12 per individual test. Residents should, however, check with their health care insurers to verify if the at-home self-administered tests are covered.
References
BCBSKS. (2022). At-home COVID-19 test reimbursement. Retrieved February 8, 2022, from https://blog.bcbsks.com/2022/01/26/at-home-COVID-19-test-reimbursement/.
Cigna. (2022). Coronavirus (COVID-19) Resource Center | Cigna. Cigna.com. Retrieved 8 February 2022, from https://www.cigna.com/coronavirus/.
KDHE. (2022). KDHE Takes Steps to Improve Access to and Speed of COVID-19 Testing. KDHE, KS. Retrieved February 8, 2022, from
Kansas State University. (2022). At-home COVID-19 testing updates. K-state.edu. Retrieved February 8, 2022, from
