Over the Counter COVID Tests and Antiviral Therapy Coverage
On January 10, the U.S. departments of Health and Human Services, Labor and Treasury issued guidance requiring group health plans, like the NRECA Medical Plan, to cover over the counter COVID-19 tests that are approved by the Food & Drug Administration.
This requirement goes into effect on January 15, 2022. NRECA is working with our vendor partners, UnitedHealthcare and CVS Caremark, to determine a clear and consistent implementation that ensures plan participants are able to seek reimbursement for these tests in accordance to the guidance. Tests purchased on or after January 15 will be eligible for reimbursement from the plan.
We expect implementation of these requirements to be completed shortly and will provide additional information and resources. This will include details on the number of tests eligible for reimbursement and any dollar limits on reimbursable test costs to ensure the NRECA Medical Plan complies with the agencies’ guidance.
The requirement only applies to over the counter testing for diagnosis and treatment for COVID-19. Testing for employment purposes is not considered diagnostic. Tests for employment purposes do not fall under this new requirement.
New antiviral coverage
In December, both Pfizer and Merck received Emergency Use Authorizations (EUA) from the Food and Drug Administration for their respective COVID-19 oral antiviral therapy. As with COVID-19 vaccines, there will be no cost share obligation for participants covered by the NRECA Medical Plan. Participants can obtain the therapy through any pharmacy that offers it. The effective date was December 22, 2021; claims incurred after this date will be covered and eligible for reimbursement.
Participants will be able to receive one course of therapy of the oral antiviral products within a 30-day window. Participants age 12 and over are eligible for the Pfizer oral antiviral therapy and must be age 18 and over for the Merck therapy.
The antiviral therapy coverage information has been added to the benefits administrator and participant COVID-19 resources pages on the NRECA Employee Benefits website.
Questions
For questions regarding over the counter COVID-19 testing coverage, please reach out to NRECA’s Member Contact Center at 866.673.2299, option 1. For questions regarding COVID-19 oral antiviral therapy coverage, please reach out to CVS Customer Care at 888.796.7322.