The federal government issued a public notice in January which requires health insurance plans to cover over-the-counter (OTC) COVID-19 testing kits for our members and covered dependents. The effective date of this coverage begins January 15, 2022. Please read the details below for more information on this coverage and how if affects you.

What’s covered?

Each member and covered dependent may purchase up to eight (8) test kits out-of-pocket per month. Kits often come in packages of two or more. In this case, the amount of tests in the package will count toward your monthly total. For example, a package of two (2) tests will be two (2) purchases for the month.

How do I take advantage of this benefit?

Beginning January 15, Carpenters Health Plan began to cover OTC covid test kits, but all purchases required claim forms to be completed and submitted for reimbursement. Reimbursements need to be filed with an Express Scripts Direct Claim form, available on the Express-Scripts website here when you first set up an online member account. You may also access the Direct Claim form on the carpdc.org website here.

Currently at-home COVID-19 test kits are available to purchase at $0 copay through any Express Scripts retail pharmacy or home delivery through Express Scripts. Simply purchase your over-the-counter covid tests from the pharmacy counter with $0 copay. 

What’s NOT covered?

You may not purchase more than eight (8) COVID-19 testing kits per month per member and covered dependent or you will pay full price for the testing kit. if you purchase covid testing kits somewhere other than an Express Scripts pharmacy, you will be reimbursed $12. For example, if you buy testing kits on Amazon and submit your Amazon receipt for reimbursement to ESI, you will be reimbursed up to $12 for each kit, regardless if you spent more for the kits. Costs exceeding $12 will not be covered.

What else should I know?

OTC COVID-19 testing kits are significantly more cost-effective than office visits and PCR testing. You will save the both yourself and the health plan money by utilizing OTC testing kits when testing is necessary. Testing kits may be used due to COVID-19 exposure or concern.

More details may be found on our website at carpdc.org/covid19 regarding test kit coverage and how to take advantage of this benefit.