TO: Fresno Unified School District Employee Health Care Plan Participants
DATE: February 4, 2022
You may have recently heard that the federal government issued new requirements for group health plans to cover (per 30-day period or calendar month) up to a total of eight (8) FDA-approved over-the-counter (OTC) COVID-19 tests at no cost for plan participants (not including Medicare beneficiaries – see “What’s Covered” section below). These requirements are effective as of January 15, 2022, and will continue until the end of the COVID public health emergency.
From the time these requirements were issued the Joint Health Management Board (JHMB) has been working with our partners to establish an efficient process to cover the eligible OTC COVID tests for our plan participants at no cost. At the present time, we are still working diligently behind-the-scenes to solidify the processes for both no-cost acquisition at the point-of-sale and reimbursements with the appropriate receipts.
What’s Covered
As noted above, the Plan must cover up to a total of eight (8) OTC COVID-19 tests per 30-day period or calendar monthat no cost for each covered plan participant, excluding Medicare beneficiaries.* The eight (8) free tests covered only apply to FDA-approved OTC COVID-19 tests purchased for at-home testing purposes. Tests can be purchased all in one day or over the course of a 30-day period or calendar month. This limit does not apply to FDA-approved COVID-19 tests obtained with an order or assessment from a health care professional.
It is important to note that if you purchase a box with more than one test inside, each test will count toward the 8-test limit. For example, if you purchase a box with two (2) COVID-19 tests inside you will only be eligible for six (6) additional plan-covered tests during the same 30-day period or calendar month.
- * Medicare Beneficiaries: Those enrolled in the District’s Medicare Part D Plan through Elixir RxPlus are not eligible for this covered benefit. Instead, we recommend that you contact Medicare at www.Medicare.gov or by phone at (800)-MEDICARE for information about benefits available to you.
Two Ways to Get FREE FDA-Approved OTC COVID-19 Tests
First, it’s important to know that as of January 19, 2022, every home in the U.S. is eligible to order 4 free at-home COVID-19 tests directly from the federal government. The tests are completely free and orders will usually ship in 7-12 days – per the government website. For more information about this offer, visit www.covidtests.gov.
Secondly, while the JHMB and its partners are still working through the processes and details for our plan participants to efficiently acquire their free OTC COVID-19 tests through the District plan, here’s what we have established so far:
PPO Plan A & B (Aetna) Participants
- No-Cost Pharmacies: At present, you may acquire your free OTC COVID-19 tests at the pharmacy counter at Walmart, Sam’s Club, or Rite Aid by presenting your Medical ID card. Currently, these are the only three retailers within the Elixir network committed to providing no-cost acquisition of these tests. But, remember, you must acquire the tests at the pharmacy counter and not the main retail counter, as your Medical ID card will only be processed at the pharmacy counter. You will not have any additional payment for covered tests if acquired at the pharmacy counter at these three retailers. For the purposes of no-cost acquisition at the pharmacies noted above, the coverage period is per 30 days (i.e., not specific to a calendar month).
- Reimbursement: The JHMB and its partners are still working to establish the processes for reimbursing plan participants for FDA-approved OTC COVID-19 tests purchased at other locations. That said, we strongly advise that you retain any receipts for OTC COVID-19 tests purchased on or after January 15, 2022. As soon as we solidify the process for reimbursement, we will notify our plan participants.
HMO Plan C (Kaiser) Participants
- Kaiser will reimburse HMO Plan C participants for FDA-approved OTC COVID-19 tests purchased at non-Kaiser pharmacies and retailers. Participants should submit reimbursement requests through www.kp.org using the form specified on the website.
We Appreciate Your Patience and Understanding
The Joint Health Management Board continues to work with our partners to ensure that we develop the most efficient processes to support this recent federal mandate. We will inform you as more information becomes available and the appropriate processes are put in place.
We appreciate your continued support in helping us manage and maintain the highest quality health and wellness benefits on behalf of the District’s employees, retirees, and their families.
