OPM has expanded on recent guidance to FEHB carriers regarding coverage for over-the-counter Coronavirus test kits, telling them they may set limits on how many such kits they will cover at no charge unless the tests are medically ordered.
It said that plans may limit no-cost coverage to eight discretionary test kits per individual on an enrollment per month—meaning 32 for a covered family of four, for example. However, there generally is to be“no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions.”
“Plans may, but are not required to, provide such coverage for at-home OTC COVID-19 tests purchased before January 15. In addition, FEHB plans are not required to provide coverage of testing (including an OTC COVID-19 test) that is for employment purposes,” it said in a benefits administration letter.
Also at their discretion plans may set up programs that allow covered individuals to get the test kits directly through preferred pharmacies, retailers or other entities with no out-of-pocket costs, eliminating the need for enrollees to submit a claim for reimbursement. If they do so, plans still must reimburse enrollees for tests they purchase outside of that network up to $12 per kit.
As it had said in the earlier guidance—which also covered coverage issues regarding vaccines and therapeutics—OPM said that kits must be covered without a requirement for prior medical authorization and that carriers are to provide plain-language information to enrollees about the coverage through online postings or other regularly used communications channels.