COVID-19 Test Reimbursement

On January 10, the Biden Administration finalized guidance for commercial insurance coverage of at-home diagnostic tests or over-the-counter (OTC) COVID-19 testing.

Effective January 15, 2022, private health insurers are required to cover up to eight at-home COVID-19 tests per 30 days (or per month) for plan members absent involvement of a health care provider and without cost sharing.

The new OTC coverage requirement:

  • Allows consumers with commercial health coverage to seek reimbursement from their commercial health plan for OTC tests they purchase online or in-person without the direct involvement of a health care provider.
  • Requires health plans to cover, without cost sharing, no less than 8 OTC tests per covered individual per 30 days (or per month) (i.e., if testing kits contain 2 tests per kit, then no less than 4 kits per month) in addition to all diagnostic tests ordered by a provider.
  • Allows heath plans to pay for OTC tests up front (via “direct coverage” or purchase) or reimburse individuals via the claims process.
  • Allows plans to limit reimbursement to the lesser of $12 per test or the actual price (whichever is lower), if a plan provides direct coverage of OTC tests.
  • Maintains the policy that plans are not obligated to cover routine screening for employment purposes and allows plans to require a patient attestation.

The guidance applies to group health plans and health insurance issuers offering group or individual health insurance coverage, including grandfathered health plans and Federal Employees Health Benefits plans (FEHB), and is effective January 15, 2022 through the public health emergency. The guidance does not apply to Medicare or Medicaid.

Plans are not required to provide direct coverage and may instead opt to require a plan member to submit a claim for plan reimbursement if they purchase an OTC COVID-19 test.

Plans

The Employee Assistance Resources Program is a confidential advisory and referral program available to you and your family members without charge. It is designed to assist employees who are experiencing personal, family, or work-related problems. Call 1-800-300-0628 

Covered employees and their eligible dependents are entitled to a wide range of medical and prescription services at the Partnership Health Center. All available services at the Health Center are provided with no co-pay or co-insurance.

Coverage is provided through Aetna with Integrity Health. There are (3) two medical plan options (PPO-A, PPO-B and TRS EHP). Quest Diagnostics is the primary in-network laboratory facility.

Contact Information

1. Call Aetna Member Services at 1-855-736-9533.

2. If you have called the Member Services number and are not satisfied, call or email Michelle Grossguth at 732-226-0096, michelle@integrityhealth.com or fax her at 732-832-2889 with the following information:

  • Your name and phone number
  • Date of service Name of the provider
  • Your issue, concern, or question
  • Claim and check number if appropriate. (If your question was about a check and you were told one has been issued, ask for the claim and check number.)

3. If you have a concern or question about a provider, email Michelle Grossguth at michelle@integrityhealth.com or fax her at 732-832-2889 with the provider’s information.

4. If you ever receive a collection notice, fax it immediately to Michelle Grossguth at 732-832-2889.

5. In order to protect member interests, Integrity Health employs the services of ELAP, an audit and review company to examine provider bills which may exceed acceptable standards. If you receive a letter from ELAP, call the number listed as requested.

Coverage is provided through BeneCard. Retail Generic co-pay is $3.00, Brand co-pay is $10.00 for a 30 day supply. Mail order Generic co-pay is $5.00, Brand co-pay is $15.00 for up to a 90 day supply.

Customer Service: 877-723-6005

Coverage is provided through Aetna Vision as of 7/1/19. Exam co-pay is $10.00. 

Customer Service: 877-973-3238

Coverage is provided through Delta Dental. There are (2) two dental plan options (Standard and HMO). The Standard plan allows you to use any provider as long as they accept Delta Dental. The HMO plan (Deltacare/Flagship) requires preselection of an in-network facility.

Customer Service:

Benefit Resource, Inc. administers the FSA plan. Employees can elect to set aside up to $2,750 for medical expenses and up to $5,000 (married, filing jointly) for dependent care expenses on a pre-tax basis. Note: If you wish to contribute toward a FSA, annual enrollment is required each year. The Enrollment Packet provides additional information. 

Contact Us

Lyn O'Neill, Benefits Coordinator

loneill@trschools.com

732-505-5500, Ext. 500112

Kathy Aimes, Benefits Coordinator

kaimes@trschools.com

732-505-5500, Ext. 500110