Coverage for over-the-counter home COVID tests under the HealthSelectSM Prescription Drug Program
PLEASE NOTE: The following information applies only to health plan participants who are not enrolled in Medicare. If you’re enrolled in Medicare and have prescription drug coverage through HealthSelect Medicare Rx, please contact UnitedHealthcare for information on coverage of COVID-19 tests.
Effective January 15, 2022, the federal government is requiring most group health plans to cover a quantity of eight over-the-counter (OTC) at-home COVID-19 tests for participants each month. The following information applies only to certain at-home COVID-19 tests (details below) for participants enrolled in the HealthSelect of Texas® Prescription Drug Program and Consumer Directed HealthSelectSM Prescription Drug Program offered through the Employees Retirement System of Texas (ERS).
The tests will be covered under your pharmacy benefit. To get these tests at no cost to you, you must use your prescription insurance card at a preferred in-network pharmacy. You don’t need a prescription for these tests at the covered limit. Just go to a preferred in-network pharmacy and present your prescription insurance card along with the tests you are purchasing. The list of preferred network pharmacies is subject to change and is different from the broad network of pharmacies participating in the HealthSelect prescription drug program. To get the latest list of preferred in-network pharmacies, please call OptumRx customer service toll-free at (855) 828-9834 (TYY:711) or see the COVID-19 test kits FAQs for the most up to date list of preferred network pharmacies.
If you buy a test from a retailer—either online or in person—that is not providing OTC at-home COVID-19 tests as part of the OptumRx preferred pharmacy network, you are responsible for paying the total cost out of pocket and seeking direct reimbursement from the HealthSelect Prescription Drug Program. HealthSelect will reimburse you up to $12 for each test (not each box). To submit an online reimbursement request, please complete the COVID-19 Over-the-Counter Test Reimbursement Form and attach a copy of your receipt. You can find a printable version of the COVID-19 Over-the-Counter Test Reimbursement Form on the OptumRx website. You can print and mail the completed form, along with the purchase receipt(s) to: OptumRx Claims Department, P.O. Box 650334, Dallas, TX 75265-0334.
Note: To avoid processing delays for reimbursement, enter the ID number on your prescription insurance card (see the image below), not your medical insurance card.
You can also buy test kits online through the Optum Store at no out of pocket cost to you*. Sign in to your account at www.optumrx.com to access the Optum Store link.
- Coverage allows for up to eight tests per plan participant per calendar month. For example, if your HealthSelect coverage includes yourself, your spouse and three children, each calendar month, your household can get up to 40 tests—eight tests for each person participating in the plan—at no cost to you.
- Under federal guidelines, the plan covers only specific tests. Please call OptumRx customer service toll-free at (855) 828-9834 (TTY:711) or see the COVID-19 test kit FAQ under “Which tests are covered” for the most up to date list of covered tests. The list will be updated as new FDA-authorized tests become available.
- Some OTC at-home COVID-19 test kit packages contain more than one test. Your covered calendar-month limit is based on the number of tests, not the number of boxes.
- For example, if you have individual coverage and purchase boxes that contain two tests in each box, your insurance will cover four boxes (with a total of eight tests) in a calendar month.
- If you buy a test from a retailer – either online or in person – that is not providing OTC at-home COVID-19 tests as part of the OptumRx preferred pharmacy network or without your prescription ID card, you are responsible for paying the total cost out of pocket and seeking direct reimbursement from the HealthSelect Prescription Drug Program. The online and mail-in reimbursement processes are detailed above.
- If you submit for direct reimbursement, your coverage is still limited to the approved tests listed here under "Which tests are covered", up to eight tests per insured participant each calendar month.
- If you submit for direct reimbursement (with a purchase receipt), you are eligible for payment of up to $12 for each test (not each box).
- Your medical benefits will continue to cover other clinician-administered COVID-19 tests, such as PCR tests at doctors’ offices and other testing sites.
You can find more information about your coverage and reimbursement for OTC at-home COVID-19 tests on the OptumRx website. The Centers for Medicare and Medicaid Services (CMS) website has information on general access to OTC at-home COVID-19 tests. Anyone may order OTC at-home COVID-19 tests at no cost to them from the federal government by visiting www.covidtests.gov.
*Shipping costs may apply depending on the number of test kits in your order. See www.optumrx.com for details on shipping costs.