COVID-19 Updates

Yes, Wellmark covers medically necessary COVID-19 tests ordered by a health care provider. Your health plan does not cover return to work/return to school/return to other activity testing. Additionally, COVID-19 testing performed so a member can travel, including but not limited to flying internationally or boarding a cruise, is not a covered health plan benefit.

For most members, member cost-shares for these services will apply again for dates of service May 12, 2023 and after. Please visit myWellmark Secure Site® for your specific plan details and coverage information.

Wellmark will cover OTC COVID-19 tests when the tests were purchased between January 15, 2022, and May 11, 2023 (the end of the public health emergency as declared by the federal government), subject to certain limitations:

• The OTC COVID-19 test must be approved by or have an emergency use authorization from the FDA. Visit the FDA's website (External Link) to make sure the test you are planning to purchase qualifies for coverage. Enter "OTC" in the search box to see the list of 13 tests that qualify.
• The OTC COVID-19 test must have been 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.
• Members will only be reimbursed for up to eight OTC COVID-19 tests per member (including dependents on the same health plan) every 30 days. As an example, if a family has five members on the same health plan, the family is eligible to be reimbursed for up to 40 OTC COVID-19 tests every 30 days.
• OTC COVID-19 tests must have been purchased from the pharmacy counter of an in-network pharmacy 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 for reimbursement.
• OTC COVID-19 tests covered by your health plan are for the personal use of the member requesting reimbursement from the health plan and their dependents on the same health plan. These tests should only be used by that member and their dependents.

If you have pharmacy benefits through Wellmark:

Members who purchased a qualifying OTC COVID-19 test between January 15, 2022, and May 11, 2023 (the end of the public health emergency as declared by the federal government) must submit claims for OTC COVID-19 tests through CVS Caremark External Link.

• If starting from myWellmark Secure Site®:
• Log in
• Once you are in myWellmark, click "Find a Pharmacy"
• If you already have an account with CVS Caremark, clicking on "Find a Pharmacy" will take you straight to your CVS Caremark portal
• If you do not have an account with CVS Caremark, clicking on "Find a Pharmacy" will take you straight to the CVS Caremark website where you will need to create a CVS Caremark account
• Once on the CVS Caremark External Link website:
• Log into your CVS Caremark account
• Once you are in the CVS Caremark portal, go to Plan and Benefits and click "Submit Prescription Claim"
• Click "Submit at-home COVID-19 test reimbursement claim". The form will walk you through the claim submission process step-by-step.
• After you complete the form, you can upload a picture of your receipt electronically. Note: Do not write on the receipt or cross items off the receipt.
• Submit the form to process the claim.

If you purchased an OTC COVID-19 test at an out-of-network pharmacy or a non-network retailer, your reimbursement may be limited to $12 per test (or $24 for a box of two tests).

If you don’t have pharmacy benefits through Wellmark:

During the public health emergency as declared by the federal government, many plans whose pharmacy benefits claims are processed by someone other than CVS Caremark External Link (through Wellmark) decided to cover OTC COVID-19 tests through the pharmacy benefit instead of the medical benefit. If your plan does not have pharmacy benefits with Wellmark through CVS Caremark, you should contact your employee benefits department for information on how and when you can submit claims for reimbursement of these tests.

Once a COVID-19 vaccine is authorized or approved by the FDA and receives an Advisory Committee on Immunization Practices (ACIP) recommendation on its vaccination index, it will be covered as a preventive service through the Affordable Care Act (ACA) Preventive services benefit.

For most members, member cost-shares for the COVID-19 vaccine will continue to be waived, as the COVID-19 vaccine is treated an ACA Preventive service. Please visit myWellmark Secure Site® for your specific plan details and coverage information.