COVID-19 home test kits
Updated on December 22, 2022
Home test kits can be an important and convenient tool for diagnosing COVID-19, and BCBSRI members have $0 coverage for these home test kits without a prescription. You can share information with your employees about this benefit by downloading a ready-to-use email from our Employer Toolkit or sending them the link to our home test kit page for members.
3 things to know about your employees’ $0 home test kit coverage
- Each person on your employees’ plan is covered for up to 8 individual home test kits every 30 days.
They don't need a prescription or order from a healthcare provider, and $0 coverage applies even for high-deductible plans. - If your employee buys the tests at a participating pharmacy (at the pharmacy counter), they will pay $0.
Like COVID-19 vaccines and lab tests, home test kits are covered under your employees’ medical benefit. They should use their BCBSRI member ID card at the pharmacy counter. (CVS, a participating pharmacy, has a different, online process for getting home test kits for $0 that is detailed on our home test kit page for members.) If a pharmacy can’t process the $0 coverage, your employees can buy the tests at the pharmacy store checkout, a retail store, or online and will be reimbursed up to $12 per individual test. If a test is sold in a package of two, that is considered two tests, and they will be reimbursed $24. - Our participating pharmacy network for COVID-19 home test kits has approximately 65,000 pharmacies nationwide, including CVS Pharmacy, Walgreens, Walmart, and Costco.
Please note that this network may be different than your plan’s standard pharmacy network. You can view a complete list of participating pharmacies in Rhode Island or search the national directory for participating pharmacies. You don’t need to sign in to search for a pharmacy. After choosing “BCBS Rhode Island” as your health plan, select the “Rhode Island Pharmacy Network” (which is a national network) and enter your ZIP code.
Your employees or retirees with Group Medicare or Group Plan 65 have different benefits than described above and in most of the FAQs below. For details on their coverage, please see the “How is the coverage different for my employees or retirees with Group Medicare or Group Plan 65?” FAQ below.
For all employers
Is the cost of the home test kits going toward my employees’ deductible?
No, the cost of the test does not apply to your employees’ deductibles, and $0 coverage applies even for high-deductible plans. This is true whether your employees receive the test for $0 at the counter of a participating pharmacy or is reimbursed (up to $12) for the test.
Will the tests be eligible for reimbursement if they are purchased at pharmacies at the regular store checkout instead of the pharmacy counter?
Yes. If your employees buy the tests at a retail store (including the regular store checkout at a pharmacy rather than the pharmacy counter) or online, they’ll be reimbursed up to $12 per individual test. If a test is sold in a package of two, that is considered two tests and they will be reimbursed $24. Please note that taxes and other fees are not covered.
Is there a national directory of participating pharmacies?
Yes. Our participating pharmacy network for COVID-19 home test kits includes approximately 65,000 pharmacies nationwide, including CVS Pharmacy, Walgreens, Walmart, and Costco. Please note that this network may be different than your plan’s standard pharmacy network. You can view a complete list of participating pharmacies in Rhode Island or search the national directory for participating pharmacies near you. You don’t need to sign in to search for a pharmacy. After choosing “BCBS Rhode Island” as your health plan, select the “Rhode Island Pharmacy Network” (which is a national network) and enter your ZIP code.
Do the home test kits provided by the federal government count toward my employees’ coverage through their BCBSRI health plan?
No. Those home test kits are independent of your employees’ BCBSRI health plan coverage, which is for 8 individual tests per member per 30 days.
How is the coverage different for my employees or retirees with Group Medicare or Group Plan 65?
As of April 4, 2022, members with Group Medicare and Group Plan 65 can now receive COVID-19 home test kits at no cost under their Part B benefit. They can get up to 8 individual tests per calendar month from participating pharmacies and healthcare providers during the COVID-19 public health emergency. See the list of participating pharmacies and healthcare providers.
At a participating pharmacy, members should go to the pharmacy counter (not the store checkout) and use their red, white, and blue Medicare card instead of their BCBSRI ID card. The $0 coverage only applies for home test kits received at participating pharmacies or through participating healthcare providers. Members can’t submit for reimbursement for a home test kit unless they have a doctor’s note or prescription.
For additional details, please see the member home test kit page.
Why are the home test kits being covered under the medical benefit?
We are covering the home test kits the same way we cover COVID-19 vaccines and tests, which are also administered at pharmacies but covered under the medical benefit.
Will BCBSRI provide reporting on the expenses associated with the home test kits?
Yes, we will provide reporting on these expenses.
Is getting a home test for $0 before the deductible is met allowed for HSA-qualified high-deductible health plans?
Yes, the IRS has indicated that $0 benefits for COVID-19 home test kits are allowed under the rules for HSA-qualified high-deductible health plan rules.
How is BCBSRI meeting the safe harbor requirements?
Through our pharmacy benefits manager (PBM), BCBSRI is offering a solution that meets the safe harbor requirements, as it includes both a retail pharmacy and direct-to-consumer option.
For employers with BCBSRI medical coverage ONLY (no pharmacy coverage)
If my employee presents their BCBSRI medical card to a pharmacist for a home test kit, will the claim still process?
Yes. Members of most plans with BCBSRI medical coverage only can use their card to receive COVID-19 home test kits for $0 at the pharmacy counter. They can also be reimbursed for home test kits (up to $12 per individual test) by submitting for reimbursement using this form. If a test is sold in a package of two, that is considered two tests and they will be reimbursed $24. Some employers are covering home test kits only through their pharmacy coverage, and for their employees, BCBSRI’s medical coverage will not apply.
If I want to cover this benefit under my employers’ pharmacy benefit only, can BCBSRI administer an exclusion under my employees’ medical plan?
Yes. With the very short lead time provided by the federal government, we focused on complying and processing test kits under the medical benefit as we do for other COVID-19 vaccines and tests. However, if you wish to have those claims go through your pharmacy benefits manager, BCBSRI can implement that exclusion. It will take at least 10 days, and we will need written direction that you accept responsibility for meeting the requirements of the mandate and that BCBSRI should exclude claims for home test kits. To start the process, please contact your account representative.
If BCBSRI and my pharmacy benefit manager (PBM) both administer coverage for home test kits, can BCBSRI provide data about home test kit purchases to my PBM?
We are not able to coordinate the number of home test kits purchased with a third-party PBM.
If a provider prescribes a home test kit, will that be covered under my employee’s BCBSRI medical coverage or their pharmacy coverage?
It will be covered under your employee’s BCBSRI health plan, as it is independent of the $0 home test kits coverage. Home test kits ordered by a provider will not count toward your employee’s coverage of up to 8 test kits every 30 days.
Looking for information for your employees? See the member home test kit page