COVID-19 test coverage – Federal health plans expand benefits

The Office of Personnel Management has directed Federal Employees Health Benefits Program plans to offer expanded coverage for over-the-counter COVID-19 test kits.

This coverage must be provided without adding any cost-sharing requirements or prior authorization. In addition, plans are required to reimburse out-of-network costs up to $12 per test.

Plans have the right to limit tests to eight per individual per month, but in general there is no limit on tests of any kind — in office or at home — if ordered by a health care provider after a clinical assessment. This includes those who may need the tests because of an underlying medical condition.

The Office of Personnel Management, also known as OPM, is directing plans to support enrolled employees with information on where to obtain tests and how to submit claims for reimbursement.

The USPS Health Benefits Plan, a self-funded plan for noncareer employees, will follow OPM’s COVID-19 test policy.

Contact your health plan for more information.


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