The Health Plan Will Cover At-Home COVID Tests for Covered Participants and Dependents with No Cost-Sharing Beginning January 15, 2022

The Federal government recently released new rules requiring insurers, including the DGA Health Plan, to cover, with no cost-sharing, at-home COVID-19 tests purchased without a doctor’s order or individual health assessment for covered participants and their eligible dependents, beginning January 15, 2022 and throughout the National Emergency Period. The Health Plan will implement this change through its prescription benefit manager, CVS Caremark. 

Additionally, beginning January 19, 2022, anyone, regardless of coverage status, may order up to four free at-home tests per household directly from the Federal government at www.COVIDTests.gov. 

This article provides important details about the new requirement, including instructions on how to get your free tests using participating pharmacies in CVS Caremark’s broad national pharmacy network and how to request reimbursement for tests purchased through other means.  This information and the limitations described below apply only to tests performed without the order or involvement of a health care provider. 

Important details regarding coverage of at-home COVID tests 

  • The Health Plan will cover only FDA-approved at-home use tests purchased on and after the required January 15, 2022 effective date. 
  • The Health Plan has implemented a “direct coverage option” with CVS Caremark that will allow participants and dependents to obtain test kits from any participating CVS network pharmacy location with no upfront out-of-pocket costs and without having to seek reimbursement. This option will not include tests purchased from CVS online, which will require you to request reimbursement after your purchase. 
  • The Health Plan will limit the number of covered tests to 8 per covered individual per 30 calendar days, which is the lowest allowable limit.  
  • The new rule does not supersede the previous rule requiring coverage of COVID testing at 100% when ordered by your healthcare provider. 

What you need to do to seek reimbursement 

  • If you purchase your at-home tests at a participating CVS network pharmacy (not including CVS online), you will need to present your prescription benefit ID card at the point of purchase to receive your tests with no upfront out-of-pocket costs, as your claim will be processed electronically. No claim form or request for reimbursement will be necessary. PLEASE NOTE: Some pharmacies in the network may not have the capacity or the capability to process the claim electronically using your prescription benefit ID card. If that is the case, purchase the test kits and submit for reimbursement following the steps outlined below.
  • Click the image above for step-by-step instructions on how to request reimbursement for at-home COVID-19 tests

  • If you purchase your at-home tests at a non-CVS-network pharmacy location, non-participating CVS pharmacy network location or through any online retailer (including CVS online), you will need to pay for your tests upfront and submit a claim for reimbursement to CVS Caremark. All claims for reimbursement will require a receipt as proof of purchase. Additionally, participants seeking reimbursement will be required to attest that the at-home tests were purchased for personal use, not employment, that they have not been reimbursed by another source, and were not purchased for resale. 

Claims for reimbursement can be submitted by:

Please note that aforementioned information may change. We will continue to notify you of such changes on the website at dgaplans.org, through email and/or in the Spotlight on Benefits newsletter. 

Questions about coverage of at-home tests through CVS Caremark? 

Click the button below to learn more information about Health Plan coverage of at-home COVID-19 tests through CVS Caremark, including Frequently Asked Questions about the reimbursement process. 

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