Coverage of At-Home/Over-The-Counter (OTC) COVID-19 Test Kits

Regardless of your coverage, every home in the U.S. is eligible to order 4 free at-⁠home COVID-⁠19 tests through www.covidtests.gov. Orders will usually ship in 7-12 days.

Employer Group or Individual & Family Plans

Effective January 15, 2022, Optima Health will offer coverage for over-the-counter (OTC) COVID-19 diagnostic tests for a limited time to commercial members of specific groups covered under our employer group or Individual & Family Plans. The test(s) must be used for personal use intended for individualized diagnosis or treatment of COVID-19, and not for employment, or other screening, or public health surveillance purposes. The test(s) may not be used for resale or be reimbursed by another source.

Each member will have coverage for a maximum of eight tests per 30-day period (or per calendar month). This limit applies across all below options cumulatively. Please note that many tests are packaged in pairs, so this may mean four kits of two tests per member.

How to Order an OTC COVID-19 Test Kit Online

Members who have symptoms of COVID-19 or who think they may have been exposed can order an OTC test kit, with no out-of-pocket costs, through our direct-to-consumer partner, NationsOTC. OTC COVID-19 test kits are available for ordering online or by calling 1-888-270-8292. Kits will be delivered within 7-10 days. Members should have their Optima Health member ID number handy when ordering.

How to Receive an OTC COVID-19 Test Kit from our Preferred Pharmacy Network

Effective January 30, 2022, Optima Health has established a preferred pharmacy network for members who have symptoms of COVID-19, or think they may have been exposed, to obtain OTC COVID-19 test kits at no out of pocket to them. To utilize this benefit, members with an Optima Health pharmacy benefit must obtain an eligible OTC COVID-19 test kit from one of our participating pharmacy counters: Kinney Drugs, Rite Aid (including Bartell Drugs), Sam’s Club, Walgreens, or Walmart. Additional pharmacies may be added at a later date.

How to Purchase OTC COVID-19 Test Kits at a Non-Participating Pharmacy

Members who purchase an OTC COVID-19 test kit from a non-participating pharmacy (any pharmacy other than those listed above) can file a claim with Optima Health. Reimbursement for tests purchased on or after February 3, 2022 will be limited to a maximum amount of $12 per test.

How to File an OTC COVID-19 Test Kit Claim to Optima Health for Reimbursement

Select members may be reimbursed for covered OTC COVID-19 diagnostic tests purchased on or after January 15, 2022. For kits purchased on or after February 3, 2022, members may be reimbursed up to $12 per test. Diagnostic tests are for people who have COVID-19 symptoms. They also are for people who have no symptoms but know or suspect that they have recently been exposed to someone who has COVID-19. You do not need a doctor’s order for the OTC diagnostic test. Reimbursement is available only during the COVID-19 public health emergency.

To apply for reimbursement, you must certify the following:

  • The test(s) for reimbursement is for my personal use intended for individualized diagnosis or treatment of COVID-19, and not for employment, or other screening, or public health surveillance purposes; and
  • The test is not for resale, and I have not (and will not be) reimbursed by another source for such test(s); and
  • I agree to provide any additional reasonable documentation that may be requested by Optima Health.

If you agree to the terms above, please complete this brief attestation document and submit it with your claim for reimbursement.

Remember to save your receipts when you purchase OTC COVID-19 diagnostic tests. You’ll need to submit them when you file a claim with us and apply for reimbursement. You will also need to tear off the UPC code from the test kit boxes and include that with your claim.

We will process your claim according to our normal timeframes. Please note, reimbursement is limited to eight tests per member per 30-day period and is limited to $12 per test for tests received from a non-plan pharmacy or other seller unless otherwise required by law.

Where to Send Your Claim and Proof of Loss or Proof of Purchase

To file a claim, please send all the information noted above to:

Medical Claims – OTC Claim
P.O. Box 5028
Troy, MI 48007-5028

Optima Health has a timely filing limit for claim submissions. Claims must be received within 365 days from the date of service.

Medicare

Medicare members have the ability to utilize their over-the-counter (OTC) allowance to purchase OTC COVID-19 tests. Medicare members can order COVID-19 test kits through our partner, NationsOTC. OTC COVID-19 test kits are available for ordering online or by calling 1-877-438-7521 (TTY: 711), 24 hours a day, 7 days a week, 365 days a year. Kits will be delivered within 7-10 days. Members should have their Optima Health member ID number and plan ID handy when ordering.

Medicaid

Effective February 7, 2022, Optima Health will cover Food and Drug Administration (FDA) approved COVID-19 OTC Antigen and Molecular Home Test kits from a network pharmacy with no out-of-pocket cost to the member. Test kits must have a national drug code (NDC) for the network pharmacy to submit a claim to Optima Health. Some test kits may have age restrictions and members requesting a test kit through Optima Health must meet the recommended age. A prescription may be required for the network pharmacy to submit a claim; members should contact their pharmacy or provider to obtain the necessary prescription when required.

Each member will have coverage of two (2) tests per day with a maximum of eight (8) tests every 30 days. (Please note that many tests are packaged in pairs, so this may mean four (4) kits of two tests per member.)

Learn more about how to avoid buying fake COVID-19 test kits.