TO: Fresno Unified School District Employee Health Care Plan Participants
DATE: May 10, 2022
Earlier this year, the Joint Health Management Board provided an initial notice regarding federal government requirements for group health plans to cover over-the-counter (OTC) COVID-19 tests. The requirements, which went into effect on January 15, 2022, state that our plan must cover up to a total of eight (8) FDA-approved over-the-counter (OTC) COVID-19 tests per month at no cost for plan participants. This coverage will continue until the end of the COVID public health emergency.
We invite you to review the information below for details on how to acquire and receive reimbursement for your eligible FDA-approved over-the-counter (OTC) COVID-19 tests.
What’s Covered
As noted above, the Plan must cover up to a total of eight (8) OTC COVID-19 tests per month at no cost for each covered plan participant. 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 month.
Ways to Get FREE FDA-Approved OTC COVID-19 Tests
In March 2022, the federal government approved a second round of at-home COVID-19 test kits available through the US Postal Service (USPS). Even if you received an initial order of 4 free at-home COVID-19 tests, “U.S. households can place a second order for free, at-home COVID-19 rapid tests (4 tests per order); for a total of 2 orders containing 4 tests each. If an order was previously placed for your address, you can place a second order now.” (per the USPS website – https://faq.usps.com/s/article/At-Home-COVID-19-Test-Kits).
In addition, the JHMB and its partners have established the following processes for our plan participants to efficiently acquire their free OTC COVID-19 tests through the District plan:
PPO Plan A & B (Aetna) Participants (including Medicare Retirees)
Acquiring Your COVID-19 OTC Test Kits: You may continue to acquire your free OTC COVID-19 tests at the pharmacy counter at any in-network pharmacy by presenting your Medical ID card when making your purchase (Medicare retirees use your red, white, and blue Medicare Health Insurance card). You will not have any additional payment for covered tests if acquired at the pharmacy counter at any in-network retailer. You may also acquire your free OTC COVID-19 tests through Elixir Mail. For more information about this purchasing option, please call Elixir Mail at (866) 909.5170 (TTY: 711).
Reimbursement: You are eligible for reimbursement of FDA-approved OTC COVID-19 tests purchased during the COVID public health emergency period beginning on January 15, 2022. To request your reimbursement, submit a medical claim form to Delta Health Systems (available online at JHMBHealthConnect.com/your-benefits/benefit-forms). The claim form must be accompanied with the following information and details:
- The medical claim form must include the name of the eligible plan participant for whom the tests were purchased.
- A copy of the purchase receipt must be included with the medical claim form.
- A picture of the test kit(s) must include how many tests were enclosed in the package (usually on the front of the box).
- A legible picture of the UPC symbol (barcode) from the back of the test kit(s) package.
- The package of the OTC COVID-19 tests must include the words “FDA APPROVED.”
- The form must be mailed to Delta Health Systems at the following address:
- Delta Health Systems
PO Box 80
Stockton CA 95201-3080
- Delta Health Systems
Please note that FDA-approved OTC COVID-19 tests purchased at out-of-network pharmacies or by direct mail will only be reimbursed up to $12 per test kit. Also, you have up to one year from the date of purchase to submit your reimbursement. Contact Delta Health Systems at (800) 807-0820 if you have any additional questions.
HMO Plan C (Kaiser) Participants
Kaiser will continue to 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 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.
