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Over-the-Counter Home COVID-19 Tests Now Covered by the Federal Government, McLaren Health Plan

Jan. 15, 2022 – The Biden Administration announced today Americans will be able to order free coronavirus tests at www.COVIDTests.gov beginning Wednesday, Jan. 19. There is a limit of four rapid tests per household. Tests will ship within seven to 12 days. To ensure equity and access for all Americans, there will also be a call line to help those unable to access the website to place orders.

Public health experts recommend Americans use at-home tests if they begin to have symptoms within five days after coming in close contact with someone who has COVID-19, or are gathering indoors with a group of people who are at risk of severe disease or unvaccinated.

American Rescue Plan (ARP) funding has provided schools with $10 billion to get tests to K-12 districts; $6 billion to cover free testing for uninsured individuals, those in correctional facilities, in shelters and mental health facilities.

To ensure anyone can get a test who needs it, the Biden Administration also announced that private insurers, like McLaren Health Plan, will cover the cost of over-the-counter (OTC) home COVID-19 tests for members in group health plans during the public health emergency. This does not apply to Medicaid or Medicare. Existing guidance remains in effect for COVID-19 testing for Medicaid and Medicare.

Starting Jan. 15, 2022, private insurers and group health plans must cover up to eight FDA-authorized tests per covered person per 30 days. This means a family of four can be reimbursed for 32 tests per month. This guidance applies to COVID-19 OTC diagnostic tests that have been authorized, cleared or approved by the U.S. Food and Drug Administration (FDA).

If McLaren Health Plan group members choose to purchase an OTC home COVID-19 test, the cost will be reimbursed without cost-sharing. There are no deductibles, copayments or coinsurance, prior authorization, or other medical management requirements. People should only buy tests through authorized retailers to ensure the integrity of the test. Many retailers are currently experiencing shortages of tests and limiting the number that may be purchased per household. McLaren Health Plan will continue to provide coverage for COVID-19 tests that are ordered or administered by a health care provider.

The reimbursement for an OTC test for McLaren Health Plan is $12 per test, pending program implementation. This only applies to tests purchased on or after Jan. 15, 2022. This does not apply to Medicare or Medicaid. People covered under those plans should follow existing guidance. McLaren Health Plan will reimburse for up to eight tests per covered person per month or 32 tests per month for a family of four. To get reimbursed, members will need to submit a Direct Member Reimbursement (DMR) form that includes proof of purchase, such as a prescription receipt and UPC code from the package.

Please refer to the following for answers to questions about coverage for COVID-19 testing. Please call customer service at 888-327-0671 (TTY: 711) if you need additional assistance.

 

Questions and Answers about OTC at-home COVID-19 tests

WHERE DO I GET THE OTC AT-HOME COVID-19 TESTS?

Beginning Jan. 19, go to www.COVIDTests.gov to order up to four tests per household. Tests will typically ship within seven to 12 days of ordering. If you are a McLaren Health Plan group member, you can choose to go to a pharmacy or store to purchase the tests and get reimbursed. You must purchase a test that is authorized, cleared or approved by the U.S. Food and Drug Administration (FDA). Please know that supplies are limited.

 

WHO IS ELIGIBLE TO RECEIVE REIMBURSEMENT FOR OTC AT-HOME COVID-19 TESTS?

People who are in a private group health plan or purchase individual health insurance are eligible for reimbursement.

 

ARE THERE LIMITS ON THE AMOUNT OF TESTS FOR WHICH I CAN GET REIMBURSED?

Yes. A covered person can purchase and get reimbursed for eight FDA-authorized tests per 30 days. This means a family of four can be reimbursed for 32 tests per month.

 

DO I HAVE TO PAY FOR THE TEST UP FRONT?

Currently, yes. If you choose the health plan option, you pay for the test, then submit a Direct Member Reimbursement (DMR) form to McLaren Health Plan. If you order online at COVIDTests.gov, the tests will be mailed to you with no up-front payment required.

 

WHAT IF I CAN’T AFFORD TO PAY FOR THE TEST UP FRONT?

You have options other than to purchase a test and get reimbursed. As of Jan. 19, you can go to COVIDTests.gov and order tests with no up-front payment required. There are many free testing sites in Michigan where you can get a test. A list of community-based sites can be found at https://www.hhs.gov/coronavirus/community-based-testing-sites/index.html Tests also are available without cost-share to covered persons when given by a health care provider, like a nurse, doctor or pharmacist.

 

HOW MUCH WILL I GET REIMBURSED PER TEST IF I DECIDE TO PURCHASE ONE?

Pending program implementation, you will get reimbursed $12 per test or the amount of your actual purchase price, up to $12.

 

I HAVE MEDICAID. AM I ELIGIBLE FOR REIMBURSEMENT?

No. This reimbursement process is available only for those who are in a private group health plan or who have purchased an individual policy. You can still get a COVID-19 test at no cost-share from www.COVIDTests.com or when ordered or administered by a health care provider, like a nurse, doctor or pharmacist.

 

IS REIMBURSEMENT AVAILABLE FOR OTC AT-HOME COVID-19 TESTS I PURCHASED BEFORE JAN. 15, 2022?

No. Reimbursement for OTC at-home COVID-19 tests is only available for those tests purchased on or after Jan. 15, 2022.

 

I HAVE A HIGH DEDUCTIBLE HEALTH PLAN (HDHP). AM I ELIGIBLE FOR REIMBURSEMENT IF I PURCHASE AN OTC AT-HOME COVID-19 TEST?

Yes. Please follow the reimbursement instructions listed below.

 

HOW DO I GET REIMBURSED FOR PURCHASING AN OTC AT-HOME COVID-19 TEST?

Members can submit a Direct Member Reimbursement (DMR) form found here: https://www.mclarenhealthplan.org/community-member/materials-mhp/direct-member-reimbursement-7049. Claims for reimbursement must include proof of purchase, such as a prescription receipt and the UPC Code from the package.

 

WHAT IF I HAVE ADDITIONAL QUESTIONS?

Please call our customer service team at 888-327-0671 (TTY: 711).

 

     
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    • Medicare Supplement
    • State of Michigan Employees                                                                                                                                                                                                                                                                          

    Electronic Premium Payments Now Available

    McLaren Health Plan Community and McLaren Health Advantage has upgraded its payment systems. Effective immediately, you can now make your premium payments by credit/debit card or by e-check.

    Individuals (on and off the Exchange) and Medicare supplement members, click here:

    www.pay.instamed.com/mclaren.comm  

    Health Advantage members, click here:

    www.pay.instamed.com/mclaren.ha

    It’s fast, easy and secure and you can make a payment anytime. You will continue to receive a monthly invoice by mail.

    Please call customer service at 888-327-0671 (TTY: 711) if you have any questions.