Agencies Issue Guidance on Coverage of OTC COVID-19 Tests | JGS Insurance 

Agencies Issue Guidance on Coverage of OTC COVID-19 Tests

Compliance Update

On January 10, 2022, the Depts. of Labor, Health and Human Services (HHS), and the Treasury issued FAQ guidance regarding the requirements for group health plans and health insurance issuers to cover over-the-counter (OTC) COVID-19 diagnostic tests. Specifically, plans and issuers must cover the costs of up to eight free over-the-counter at-home tests per covered individual per month without imposing any cost-sharing requirements, prior authorization, or other medical management requirements.

Under guidance issued in June 2020, at-home COVID-19 tests had to be covered only if they were ordered by a health care provider who determined that the test was medically appropriate for the individual. At that time, the FDA had not yet authorized any at-home COVID-19 diagnostic tests. Since then, several types of OTC at-home tests have been approved. As of January 15, 2022, the cost of these tests must be covered, even if they are obtained without the involvement of a health care provider. However, the FAQs do not require tests to be covered if they are not for individualized diagnosis (such as tests for employment purposes).

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Link to FAQ

We will continue monitoring any developments and provide further information, as needed.