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K-State Research and Extension
123 Umberger Hall
Manhattan, KS 66506-3401
785-532-5820
extadmin@ksu.edu

February 1, 2022

SEHP Coverage Update - At-Home COVID Tests

Submitted by Mary N Gatza

The below information is being provided to help you better understand the new coverage of at-home COVID-19 tests, how to obtain them, how to get reimbursed for them and what exactly is covered.

Listed below are some important items and reminders should you wish to use this benefit:

  • You do NOT need a prescription to purchase and receive benefits for at-home COVID-19 tests through the SEHP prescription plan with CVS Caremark.
  • For members of the SEHP, at-home COVID-19 tests are covered only through the CVS Caremark Prescription benefit. They are NOT covered under the medical plan (BCBSKS or Aetna).
  • This update applies to all members of the SEHP under the Caremark Prescription benefit.
  • These are NOT the same as the 4 free tests per household being offered through the Federal Government.
  • Your SEHP coverage includes up to 8 tests per covered individual per 30-day period.
    • If you purchase a multi-pack of tests, each test in the package counts as a single test.

Direct Network Pharmacy Purchase

  • Some pharmacies will be able to file and process claims directly. You will need to inquire at the Pharmacy counter (not the retail counter at the front of the store) to know if the pharmacy is able to file directly with CVS Caremark. If a pharmacy is able to file directly on your behalf, your cost share will be $0.
  • To locate a Network pharmacy, visit the locator tool through the CVS Caremark member portal.
  • Only select tests are covered through direct pharmacy purchase, including
    • ACON FLOWFLEX COVID-19 AG HOME TEST
    • ACCESS BIO ON/GO COVID-19 ANTIGEN SELF-TEST
    • ABBOTT DIAGNOSTICS SCARBO BINAXNOW COVID-19 AG CARD HOME TEST
    • ORASURE TECHNOLOGIES INTELISWAB COVID-19 RAPID TEST
    • QUIDEL QUICKVUE AT-HOME COVID-19 TEST (2-pack)
    • QUIDEL QUICKVUE AT-HOME COVID-19 TEST (5-pack)

Non-Network Pharmacy, Retail Location, or Online Retailer Purchase

  • If you purchase test kits at the “front of the store” (retail counter), through a Non-Network pharmacy, or through an online retailer, you will need to pay for the tests out of pocket and file a claim for reimbursement.
  • The claim can be filed through the online CVS Caremark member portal or through a paper claim form linked here.
  • If filing a claim for reimbursement, the maximum reimbursement amount allowed is $12 per test. A copy of the purchase receipt must be included with the claim submission.
  • Typically, a claim form will take 30 days to be processed and you will be reimbursed by check.
  • All manufacturers/brands are eligible for reimbursement under this benefit.
  • Home collection PCR tests are not covered at this time.

Additional Resources

  • CVS Caremark has provided a very helpful FAQ webpage for members regarding at-home COVID-19 tests. You may access that FAQ here.
  • Additional information regarding at-home COVID-19 tests is available through the CDC.
  • Due to the recent increase in COVID-19 cases, home test kits may be hard to find. To locate a KDHE testing location near you, visit KnowBeforeYouGoKS.com.
  • COVID-19 testing is also available free of charge to SEHP members and state employees through the HealthQuest Health Center in Topeka, KS. Appointments may be scheduled by calling 785-783-4080.
  • Should you have any questions, you may call CVS Caremark at 800-294-6324 or email the SEHP at SEHPBenefits@ks.gov.