This article was last updated in January 2022.
Testing for the coronavirus continues to be an important tool in understanding the pandemic and the amount of COVID-19 that's in our communities. That's why it's important for you and your employees to understand the testing options available and how they're covered by health insurance. Wellmark Blue Cross and Blue Shield is offering guidance on where your employees can go if they need COVID-19 testing, and what they can expect from their Wellmark coverage.
Here are three ways for your employees to get tested:
- Community-based testing. Throughout the U.S., COVID-19 tests are available at no cost at health centers, select pharmacies and other established locations. Testing sites for each state can be found here External Site. Iowa’s program, called Test Iowa External Site, has drive-up locations throughout the state. It includes an online assessment that was developed in coordination with the Iowa Department of Public Health. South Dakota has a similar public testing program External Site through the South Dakota Department of Public Health. These programs do not submit health insurance claims and are free of charge.
- Health care provider testing. Hospitals, clinics, urgent care centers and other health care providers all have their own processes in place for COVID-19 testing. Employees who are experiencing COVID-19 symptoms External Site, or have been in close contact with someone who has tested positive for COVID-19, should call their health care provider before going to a doctor's office, clinic, urgent care or emergency department. The health care provider will assess symptoms and direct your employee to the appropriate care. COVID-19 tests provided through the doctor or hospital will be processed through insurance and covered in full.
- Over-the-counter (OTC) tests. There may be situations where an employee needs the results of a COVID-19 test quickly, but may be unable to schedule the test through a community testing site or through their doctor. On Jan. 15, 2022, Wellmark began covering OTC COVID-19 tests with no member cost share during the national public health emergency. The OTC COVID-19 tests for which members are reimbursed must be approved by the Food and Drug Administration (FDA) and should only be used by the policy holder and their dependents on the same health plan. Free at-home tests External Link are now available for ordering from the United States government.
What OTC tests aren't covered by Wellmark?
Wellmark will not cover OTC COVID-19 tests used for employment purposes, meaning that if you require employees to test for COVID-19 weekly or other routine basis, employees should not be purchasing those and submitting them to Wellmark for reimbursement. Coverage and reimbursement of OTC COVID-19 tests is limited to eight OTC COVID-19 tests per member per month, claims totaling more than that will not be reimbursed by Wellmark. OTC COVID-19 tests must be one for which you collect your own specimen and read the test at home. OTC COVID-19 tests that require you to drop off or mail your specimen to a laboratory are not covered under the OTC COVID-19 test coverage.
There are companies out there that are capitalizing on the need for testing. While some may be legitimate, others may be fraudulent External Site. So before directing your employees to an independent testing site, be sure to check the FDA's website External Link. Once on that page, find the search box and enter "OTC" in the search field to view the tests that qualify.
How does reimbursement work?
The easiest way to get reimbursed for a test is to encourage your employees to obtain an OTC COVID-19 test without paying money upfront! The federal government has made free at-home COVID-19 tests External Link available for ordering. If purchasing OTC tests, they must be purchased from the pharmacy counter of an in-network pharmacy External Link to receive direct coverage. If purchased from any retailer at a regular check-out, you will need to pay retail price and submit a claim to CVS Caremark® External Linkfor reimbursement.
Direct employees to Wellmark.com/Coronavirus to see the details on how to submit a claim for reimbursement.
Help your employees know what to do if they need a COVID-19 test.
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For more information about COVID-19 testing and to learn about other benefits that related to COVID-19, visit Wellmark.com/Coronavirus Opens in a new window. You can also encourage your employees to check out our coronavirus articles Opens in a new window at Wellmark.com/Blue.
Questions? Contact your authorized Wellmark account representative, or email us at firstname.lastname@example.org Send Email.