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Wellmark’s COVID-19 response update

What's happening now

During the COVID-19 Public Health Emergency (PHE), Wellmark enhanced benefit coverage to ensure members had access to COVID-related services. The Biden administration announced the end of the COVID-19 national emergency on April 10, 2023, and ended the HHS-declared COVID-19 Public Health Emergency (PHE) on May 11, 2023.

Coverage for COVID-19 vaccines, over-the-counter tests, and COVID-19 testing and testing-related services may have changed as a result of the end of the PHE.

  • COVID-19 vaccines that are authorized or approved by the FDA are covered, at no cost to the majority of Wellmark members, as a preventive service. Please visit myWellmark to confirm you specific plan details.
  • Members will pay necessary costs out-of-pocket for COVID-19 testing and testing-related services that are administered by a physician, as outlined in benefit documents, after May 11, 2023.
  • Coverage of over-the-counter COVID-19 tests is no longer required by the federal government. Members will experience out-of-pocket costs for over-the-counter COVID-19 tests beginning May 12, 2023.

Please visit myWellmark Secure Site® for your specific plan details and coverage information.

Wellmark Resources

Learn more about the impacts the pandemic left on our overall health and well-being, and find ways to get and stay healthy with Blue.

Providers can find the latest information related to benefit updates within Wellmark’s provider resources.

An FAQ for employers is also available.

Your questions, answered

We've also put together the following information to answer questions you might have. If you need more help, please don't hesitate to call us at the number on the back of your Wellmark ID card. You can access your plan information, like coverage and claims, anytime. Just log in to myWellmark.

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.

Find a doctor

Search for a health care provider, hospital or clinic External Site for you or your family member. Log in to myWellmark to make sure the doctor and facility is in your network.

BeWell 24/7

BeWell 24/7 connects Wellmark customers with real people who can help with a variety of health-related concerns no matter the time or day. Just call Eight, Four, Four, Eight, Four, Be Well 24 hours a day, 7 days a week.

Get insights from BlueSM on coping with work and lifestyle changes, plus tips for staying healthy.

Doctor On Demand

Doctor On Demand External Site offers virtual visits with board-certified physicians for a number of minor issues, from a run-of-the-mill cold or flu to headaches, skin conditions or bronchitis. Physicians can even prescribe medication, if needed.

Doctor On Demand is a separate company providing an online telehealth solution for Wellmark members. Doctor On Demand® is a registered mark of Doctor On Demand, Inc.

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