Anthem COVID-19 Test Reimbursement

 

Participants in our CW/Anthem health plans are eligible for reimbursement of over-the-counter (OTC) COVID tests. Anthem will cover 8 total OTC COVID-19 tests per month, per covered individual. A box containing two tests would count as 2 tests. The tests must be authorized for emergency use by the FDA as a self-administered and self-read test in order to be within the scope of this guidance. 

Plan members can purchase up to 8 OTC COVID-19 tests per month via their preferred method (local pharmacy, grocery store, Amazon, etc.). The member would then submit the receipt(s) along with Anthem’s standard out-of-network member claim form (attached) for reimbursement.  

Anthem will reimburse member costs for up to 8 OTC COVID-19 tests per month, including sales tax. Shipping charges are not reimbursable. Members may purchase and submit all 8 OTC COVID-19 tests at one time for reimbursement or submit one OTC COVID-19 test claim at a time.

OTC Member Reimbursement Process and Requirements

  • How does a member get reimbursed for an at-home COVID-19 diagnostic test?

    • Members can purchase the OTC tests and follow usual and standard procedures to submit a claim or reimbursement at Anthem.com. When members use the online claim submission tool to request a reimbursement for the purchase of their OTC COVID-19 test, the portal will fail and not allow the member to complete the process. This is caused when the member enters an online retailer name with an ending like “.com” or “.org”. (Amazon.com, Walmart.com). As a workaround, members should remove the ending “.com” or “.org” from the retailer name before submitting. The member will be required to certify that the test was purchased for personal use, not for employment purposes, and will not be resold.

 

  • What is the maximum amount that Anthem will reimburse for an OTC COVID-19 test?

    • Anthem will reimburse the member based on what the member paid for the test. Anthem will actively monitor to determine if there is evidence of outlier/abusive pricing by retailers.

 

  • Will Anthem pay for shipping for online ordering? Will Anthem pay for sales tax?

    • Anthem will not pay for shipping charges of the OTC COVID-19 tests from retailers. Anthem will pay for member-submitted claims for the OTC COVID-19 tests and sales tax only.

 

  • What types of OTC COVID-19 tests are covered?

    • The test must be authorized for emergency use by the FDA as a self-administered and self-read test in order to be within the scope of this guidance. Tests purchased that require the involvement of health care professionals to administer or read the test are reimbursed consistent with previous federal guidance.

 

  • What is the limit of the required number of OTC COVID-19 tests to be covered at no cost to the member?

    • 8 total OTC COVID-19 tests per month per covered individual. For example, a box with two tests would count as two total tests.

 

  • Are there a maximum of OTC COVID-19 tests a member can purchase per day? Can they purchase all 8 for a month on 1 day?

    • A member can purchase all 8 of the OTC COVID-19 tests per covered individual per month at once and submit for reimbursement for the maximum monthly amount at once. The member can also buy them as needed and file separate claims for reimbursement.

 

  • What happens when a member reaches the 8 test per covered individual limit for the month of OTC COVID-19 tests?

    • Anthem will reimburse for up to 8 tests per covered individual. For additional tests, the member will be responsible for the costs of purchasing the test.

 

  • Is a care provider’s order required?

    • Prior to the new federal guidance, member-submitted claims for OTC COVID-19 tests required submission of evidence that the test was ordered by a care provider. Beginning on January 15th, Anthem will no longer require a care provider order, consistent with the requirements of the guidance, for up to 8 OTC COVID-19 a month per covered individual. In addition, there is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a care provider.

 

  • Is there an end date to the federal mandate for OTC COVID-19 test coverage?

    • The mandate is only effective during a public health emergency. The public health emergency was recently extended to April 17, 2022, but it could be further extended.

  • Does this mandate change in any way the limit on the number of OTC COVID-19 tests a member can get when ordered by a care provider?

    • There is no limit to the number of at-home tests that can be ordered by or administered by a care provider. This mandate applies to OTC COVID-19 tests not ordered by a care provider.