University of Arkansas System Health Plan Coverage for At-home Testing
On January 10th federal guidelines addressing at-home COVID testing were issued. Beginning January 15th, the guidelines require health plans to cover the costs of approved at-home COVID self-testing at no cost to plan participants.
The information below is based upon the guidance available at this time. Updates will be provided as clarifications and changes are issued by the regulatory agencies involved.
Will our health plan cover the costs of at-home COVID tests?
- Yes. Within the federal guidelines established, beginning January 15th the University of Arkansas System (UAS) health plan will provide reimbursement for the full costs of at-home tests for plan participants.
- At-home tests provide for the sample collection, analysis, and testing results at home. The program does not cover testing in which the sample is collected at home and mailed/delivered to a testing facility.
Am I required to use at-home testing?
- No. At-home testing is available for your convenience and as another tool to assist in controlling the spread of COVID.
- The need for testing is dependent upon your individual situation. From the Arkansas Department of Health website:
- Why should I get tested?
- You should get tested because you may have been exposed to the virus that causes COVID-19 based on your signs and symptoms (e.g., fever, cough, difficulty breathing), and/or because:
- You live in or have recently traveled to a place where transmission of COVID-19 is known to occur, and/or
- You have been in close contact with an individual suspected of or confirmed to have COVID-19.
What should I know about home tests and which are best?
- Use only FDA emergency use/approved/authorized products, generally from established brands such as Binax, On/Go, iHealth and others as identified on the FDA website.
- Reimbursements will be available only for tests purchased through first-party vendors. Resale websites and similar vendor purchases are not eligible for reimbursement.
- Review the CDC guidance on home testing at https://www.cdc.gov/coronavirus/2019-ncov/testing/self-testing.html
- Review the FDA emergency use authorization tables for home test kits at https://www.fda.gov/consumers/consumer-updates/coronavirus-disease-2019-testing-basics
- Log-in at the UMR member portal umr.com for additional resources and information.
Are there limits or restrictions on the coverage?
- Test kits covered are only those FDA approved products purchased through first-party vendors.
- Reimbursement through the UAS health plan will apply for tests purchased on and after January 15, 2022, and will continue through the stated public health emergency period or until other guidance is issued.
- The federal guidelines limit the number of tests covered to eight tests per month for each eligible plan member. A family of four eligible participants in the health plan could receive reimbursement for up to 32 tests per month. Please note that additional testing may be covered by the UAS health plan when testing is directed by a health care provider.
- Reimbursement is based on the month-by-month standard.
- The tests are not covered for employment purposes.
- Coverage is available only for plan participants. Providing others not in the plan with tests paid for by the plan is prohibited.
Are there restrictions on the supply, brands, or types of home testing kits covered?
- Beyond covering only products approved by the FDA purchased only through first-party vendors, there are not restrictions on the brands of test covered or on the place of purchase.
- Kits not approved by the FDA, kits purchased through a resale site, and kits that provide for the home collection of the sample with mailing/delivery to a testing facility are not covered.
- Reimbursements are available for one month supply counts only.
- When purchasing and submitting reimbursement requests do not confuse the count of kits with the count of tests. Coverage is provided for up to eight tests per month. One kit containing two tests is counted as two tests.
- Reimbursements are available only for purchases from first-party vendors. Purchases through on-line resale sites or from individuals will not be reimbursed.
Is there a prior authorization process or prescription required for purchase of the at-home tests?
- No. Under this program the UAS health plan will reimburse your monthly costs of at-home tests without prior authorization or prescription and without need for authorization from your health care provider.
Why is the health plan covering the tests as reimbursements rather than processing under plan coverage similar to a prescription?
- The availability and distribution of kits varies widely today. In working within the guidelines and timeframes required in the new regulations and given the variety of vendors involved, reimbursement is the most appropriate and timely process to introduce the program.
- Reimbursement removes in-network/out-of-network restrictions at a time when test supplies may not be available through all traditional in-network providers.
- The University will monitor processing options and product availability with the goal of adding in-network coverage through existing in-network providers as available.
How do I receive my reimbursement for the tests?
- Complete the attached UMR Medical Claim Form for reimbursement and mail it to UMR, along with the UPC code from the kit and the complete receipt from the provider where purchased.
- UMR is developing an on-line claim submission process. Please continue to log-in at umr.com to check for updates and for additional testing information.
Are at-home tests eligible expenses for H.S.A. and F.S.A. accounts?
- Tests kits are eligible expenses in H.S.A. and F.S.A. accounts and either may be used to purchase the kits.
- If using your H.S.A. account, use the process outlined in the question above to receive reimbursement through the UAS health plan for the use of your H.S.A. funds.
- If using your F.S.A. account, use the process outlined in the question above to receive reimbursement for the use of your F.S.A. funds. Because many test vendors will not file medical claims, because tests may not be coded as F.S.A. eligible expenses with vendors (coding will vary by provider), and because there is no single uniform price for UMR to track as the test cost, you will also need to file the attached UMR Flexible Spending Claim form along with the itemized receipt to record the purchase as an eligible F.S.A. expense.
As CDC, Department of Health, or other federal or state guidelines and recommendations for COVID testing are revised the University will update the at-home testing information and procedures.