As part of its ongoing efforts to expand Americans’ access to free COVID-19 testing, the Biden-Harris Administration requires insurance institutions and group health plans to cover the cost of at-home COVID-19 tests. The new coverage requirements mean that consumers with private health coverage can go to a pharmacy or online buy a test and get reimbursement by submitting a claim to their plan or paying it upfront by their health plan. This coverage plan is part of the Biden-Harris administration strategy to ramp up access to easy-to-use at-home COVID-19 testing kits at no cost (HHS, 2022). Here, we will focus on the State of Vermont and how the decree by President Biden applies to the state.
The state of Vermont adopted the emergency rule requiring insurance companies to cover COVID-19 at-home tests. The state’s governor and the department of a financial regulation commissioner in December 2021 announced an emergency regulation issued by the Vermont department requiring that health insurers cover all the cost of COVID-19 antigen at-home tests.
The emergency rule covers about 140000 Vermonters who purchase commercial insurance in small and large group markets, Vermont education health initiatives, and Vermont’s individual. When the rule is fully implemented, all those covered by the emergency rule will be eligible to obtain an at-home test through a pharmacy without an upfront cost. The at-home tests will be processed under the individual’s pharmacy benefit, and the pharmacy will seek reimbursement. Those, however, who purchase the at-home tests outside a pharmacy setting will be required to submit a claim to their insurer for reimbursement (State of Vermont, 2021).
Vermont stated that it lacks authority to extend the emergency rule to self-insured plans through the governor’s office. However, the governor encouraged such plans to voluntarily follow the direction in anticipation of new federal regulations. In a press conference, Governor Phil Scott also stated that private insurers must reimburse Vermonters for at-home COVID-19 test kits. The governor also said that he hopes to expand reimbursement to people without private insurance in the coming future. This, therefore, means that only private insurers and not public insurers are eligible for reimbursement (Petenko et al., 2022).
How To Get Reimbursed for your At-Home Covid Tests in Vermont
The Biden-Harris administration required the insurance companies to cover the cost of at-home rapid tests to expand access to COVID-19 testing. Vermont state also adopted the emergency rule to help them manage the virus and eliminate financial barriers to COVID treatment. Private insurers are to provide at-home reimbursement plans to include those not covered by private insurers are underway.
Those covered to provide reimbursement include MVP healthcare, Cigna, and Blue Cross Blue Shield Vermont. Only a limit of 8 kits per person per month is covered, and the amount to be reimbursed is $12 per kit. Both those kits purchased before, on, or after January 15, 2022, can be reimbursed as long as they are FDA-authorized.
Here’s how to apply for a reimbursement for Covid tests in Vermont by provider:
Blue Cross Blue Shield of Vermont Test Reimbursement
Members who have the pharmacy benefit through the Vermont blue RX can visit their in-network pharmacy, present their member cards, and request a take-home rapid COVID-19 test, and the pharmacy seeks reimbursement on their behalf. If an individual purchased a COVID-19 test on or after January 15, 2022, and is seeking reimbursement, they must follow the following steps.
Complete the member medical claim form. The information to be used include providing the name and address of the vendor or shop that sold you the kit, describing the service provided, for instance, at-home test, the procedure code, modifier, diagnosis code, charges where you list the amount paid excluding additional charges like tax, and finally the units purchased.
The member can then submit a claim by mail or fax, or through the member resource center (Blue Cross, 2022).
Finally, include a copy of the receipt with the claim form.
The covered tests under the Blue Cross Blue Shield of Vermont are the rapid tests with Emergency Use Authorization from the Food and Drug Administration. However, tests purchased for return-to-work will not be covered per federal regulations.
Cigna Test Reimbursement
One can claim reimbursement through the Cigna insurance company by first completing a conid-19 over-the-counter test kit claim form. The information included in the document is: describing the test kit, providing customers attention information, i.e., whether the kit was purchased by the customer for personal use or employment purposes, providing primary customer details, then patient information, and finally other or family coverage detail.
The claim form should then be submitted through the mail or faxed. To be attached are required documents, including a receipt stating clearly the date of purchase.
Those seeking reimbursement for at-home COVID-19 test kits bought before January 15, 2022, can only claim their money if the rapid tests have Emergency Use Authorization from the Food and Drug Administration. Tests kits that do not have the EUA or are otherwise taken at home but sent to the lab for processing are not eligible for reimbursement (Blue Cross, 2022).
Before January 15, 2022, an individual may purchase a limit of 8 testing kits due to limited supply in most pharmacies. If the pharmacy has not covered the test in stock, one will be forced to pay out of pocket and claim reimbursement. However, the insurers are only allowed to reimburse an amount of up to $12 per test kit if an individual pays out of pocket and even when the insurance provider prefers a specific type of test or pharmacy (Buchwald, 2022).
Vermont education health initiative, Vermont Medicaid, blue cross blue shield, Cigna, and MVP healthcare are covered to reimburse the at-home tests. However, not all their plans are covered, and this is because some of these companies have plans regulated by the federal government. Also, not all tests are covered, as some antigen tests are not included in the Vermont rule (Cutler, 2021).
While the FDA-authorized rapid tests are covered, only specific tests are likely to process through the pharmacy claims, including BinaxNow COVID-19 AG Card, Quickvue at-home COVID-19, On/Go COVID rapid test, and Intelliswab COVID-19 quick test (State of Vermont, 2021).
The Centers for Disease Control and Prevention (CDC) and the Center for Medicare and Medicaid Services (CMS) announced that payments would be available to healthcare providers and physicians to counsel patients at the time of COVID-19 testing concerning the importance of self-isolation after testing positive (CDC, 2020).
The optimal reason why the Vermont state adopted the emergency rule is to use the home testing tool to manage the virus and expand health access for its citizens. Also, the state aims at eliminating financial barriers to COVID-19 treatment and testing (State of Vermont, 2021).
References
Blue Cross. (2022). Blue Cross Blue Shield of Vermont to Cover Certain Take Home Rapid COVID Tests. Bluecrossvt.org. Retrieved January 18, 2022, from
Buchwald, E. (2022). Insurers are supposed to pay for COVID-19 tests starting January 15. So why are so many confused? MarketWatch. Retrieved January 18, 2022, from
CDC. (2020). Coronavirus Disease 2019. Centers for Disease Control and Prevention. Retrieved January 18, 2022, from https://www.cdc.gov/media/releases/2020/p0730-cms-cdc-provider-reimbursement-available-COVID-19.html.
Cutler, C. (2021). Vermont’s rollout of no-cost antigen tests causes some confusion. WCAX. Retrieved January 18, 2022, from
HHS. (2022). Biden-Harris Administration Requires Insurance Companies and Group Health Plans to Cover the Cost of At-Home COVID-19 Tests, Increasing Access to Free Tests. HHS.gov. Retrieved January 18, 2022, from
Petenko, E., Heintz, P., Robinson, R., & Tan, T. (2022). Vermont rolls out reimbursements for at-home COVID-19 antigen test kits. VTDigger. Retrieved January 18, 2022, from https://vtdigger.org/2021/12/07/vermont-rolls-out-reimbursements-for-at-home-COVID-19-antigen-test-kits/.
State of Vermont. (2021). At-Home COVID Tests | Department of Financial Regulation. Dfr.vermont.gov. Retrieved January 18, 2022, from https://dfr.vermont.gov/at-home-COVID-tests.
State of Vermont. (2021). Vermont Adopts Emergency Rule Expanding Insurance Coverage for COVID-19 Rapid At-Home Tests | Office of Governor Phil Scott. Governor.vermont.gov. Retrieved January 18, 2022, from https://governor.vermont.gov/press-release/vermont-adopts-emergency-rule-expanding-insurance-coverage-COVID-19-rapid-home-tests.
