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February 2, 2022
Beginning Jan. 15, 2022, employers are covering over-the-counter COVID-19 diagnostic tests authorized by the U.S. Food and Drug Administration. Your employer may choose to cover these tests through your BlueCross medical benefit, through your pharmacy benefit, or both. Please consult your employer or call BlueCross customer service to confirm your coverage.
For members with coverage through BlueCross BlueShield of Tennessee, please review the FAQs below for more information on which purchases are eligible and how to get reimbursed.
If you would like to file for reimbursement for the purchase of over-the-counter COVID-19 tests, download the BlueCross reimbursement form.
For members with pharmacy benefits through OptumRx, please visit OptumRx Test Information to learn more about coverage.
Who should take a COVID-19 test?
Anyone who may have had exposure to COVID-19 or who has COVID-19 symptoms should take a test.
Where can I purchase eligible over-the-counter COVID-19 tests?
You can purchase tests at local retailers or online.
Do I need to buy a certain type of test?
Tests must be authorized, cleared or approved by the U.S. Food and Drug Administration. See the list of qualifying tests.
Will there be any out-of-pocket costs?
Members will pay for their tests out of pocket and file for reimbursement. With proper documentation, we will reimburse you for the tests.
The amount reimbursed depends on your plan:
- If your pharmacy coverage offers a retail network where you can get tests at no upfront cost, BlueCross must limit reimbursement of tests purchased out-of-network to $12 per test.
- If your pharmacy coverage does not offer a retail network, or if your plan only covers tests through the medical benefit, BlueCross will reimburse you in full for the amount you paid.
How can I file a claim for reimbursement?
Here's the reimbursement process:
- Save the purchase receipt and cut out the UPC code on the test box.
- Download and print the reimbursement form(s).You will need one form for each plan-covered individual who will be using the test.
- Mail the form(s), along with the UPC code(s) and receipt(s), to the address on the form.
If you don’t send in complete documentation, we will return the form with a request for additional information. To process the claim, the physical copy of the product barcode is required. You must mail in the required documentation.
When should I expect to receive payment? Is there a way to check on the status of a claim?
The processing standard for claims is 30 days. You can log into My Health Toolkit® to see the status of your claims. We will send out reimbursements in the form of checks.
Will BlueCross reimburse me for sales tax and shipping costs?
Possibly, depending on your plan; be sure to include these expenses with your documentation.
- If your pharmacy coverage offers a retail network where you can get tests at no upfront cost, BlueCross will reimburse you up to $12 per test inclusive of tax and shipping. Taxes and shipping costs may be reimbursed depending on the total cost of the test.
- If your pharmacy coverage does not offer a retail network, or if your plan only covers tests through the medical benefit, BlueCross will reimburse you in full for the amount you paid, including sales tax and shipping costs.
Will BlueCross reimburse me for over-the-counter COVID-19 tests they bought before Jan. 15, 2022?
No. We will reimburse you for over-the-counter COVID-19 tests you purchased on or after Jan. 15, 2022, only.
What if I can’t afford the upfront cost of purchasing an over-the-counter COVID-19 test?
- Many communities offer free COVID-19 testing. Here is a list of sites.
- Also, please check your pharmacy coverage for COVID-19 at-home tests. Many plans offer a retail network where you can get tests at no upfront cost.
Do I need to see a doctor to qualify for a covered over-the-counter test?
No. BlueCross will provide reimbursement for eight over-the-counter, self-administered tests per 30-day period for each covered individual on the plan. COVID-19 tests ordered or given by health care providers do not count against the monthly maximum of eight tests per member.
Is there a limit to how many over-the-counter tests the member’s insurance will cover?
We will provide reimbursement for eight over-the-counter tests per 30-day period for each covered individual on the plan.
How will BlueCross count multiple tests sold together in one package?
BlueCross will count each test separately, even if tests are sold together in one package. For example, a package containing eight tests would count as eight tests, not one.
Will BlueCross cover tests for members whose employers require them to be tested?
BlueCross will not cover tests purchased for this reason. Members who need tests to comply with workplace requirements can take advantage of free COVID-19 testing in their communities. Here is a list of sites.