Special Notice of Coverage of OTC COVID Test

Date:     January 14, 2022

To:         All Health Insurance Companies, Health Maintenance Organizations, PBMs and Other Interested Parties

From:    Glen Mulready, Commissioner

Re:        Special Notice Regarding Coverage for At-Home, Over-the-Counter COVID-19 Tests

On January 10, 2022, the Departments of Labor, Health and Human Services (“HHS”), and the Treasury (collectively, the “Departments”), announced that insurance companies and group health plans must cover the cost of at-home, over-the-counter (“OTC”) COVID-19 tests. The Oklahoma Insurance Department (“OID”) is releasing this Special Notice with the purpose of providing information and assisting with implementation of the requirement to cover at-home, OTC COVID-19 test purchases.

Beginning January 15, 2022, group health plans and health insurance issuers offering group or individual health insurance coverage must cover OTC COVID-19 tests that meet the statutory criteria under section 6001(a)(1) of the Families First Coronavirus Response Act (“FFCRA”), including tests obtained without the involvement of a health care provider. This coverage must be provided without imposing any cost-sharing requirements, prior authorization, or other medical management requirements.

Plans and issuers are strongly encouraged to provide direct coverage for the OTC tests through preferred pharmacies, retailers, or other entities with no out-of-pocket cost to prevent consumers from needing to submit a claim for reimbursement. To incentivize creating a preferred network to provide direct coverage, the Departments are allowing a safe harbor reimbursement limitation when a test is purchased at a non-preferred pharmacy or retailer at a rate of $12.00 per test or the cost of the test, whichever is less.

OID requests that all regulated insurance companies provide a description of how the administration of coverage for at-home OTC COVID-19 tests will be handled and communicated to their insureds and members. This description should include, but is not limited to, any applicable preferred network arrangements, point-of-sale purchase arrangements, procedures and provisions governing claim reimbursement, exclusions or limitations, and, if a preferred network is created, implementation of the safe harbor reimbursement limitation.

It is the intent of OID to make this information available to the public at the OID website. Please direct all submissions to Data.Call@oid.ok.gov no later than February 4, 2022.

Questions concerning this Notice should be directed to Data.Call@oid.ok.gov.