Coverage for COVID-19 tests and vaccines

All UC PPO plans cover COVID-19 PCR testing if ordered by a physician at the applicable laboratory plan benefits. 

In-network — At-home COVID-19 antigen tests are covered at no cost, but members may need to pay upfront and file a claim for reimbursement. PCR COVID-19 tests continue to be covered at $0 cost-share.

Out-of-network — Members need to pay upfront for at-home COVID-19 antigen tests and file a claim for reimbursement for up to half of the cost or a maximum of $12 per test, whichever is less. PCR COVID-19 tests are subject to applicable cost sharing unless delivered as part of covered urgent or emergency care.

Visit kp.org/covid for more information.  

In-network: COVID-19 tests (at-home over-the-counter (OTC) and diagnostic/antibody PCR tests), vaccines and therapeutics are covered at no cost, with no prior approval required.  

COVID-19 at-home OTC antigen tests are available at no cost if the tests are purchased at an in-network pharmacy counter.  Purchases made elsewhere (including the regular checkout line of your local retail pharmacy) must be paid for out-of-pocket and submitted for reimbursement up to the capped amount.

Out-of-network: Effective January 1, 2025, out-of-network COVID-19 tests, vaccines, and therapeutics are covered at 50% coinsurance. 

Members need to pay out-of-pocket for over-the-counter (OTC) antigen COVID-19 tests and submit a medical claim form for reimbursement. 

Note: Reimbursement for OTC antigen tests purchased in and/or out-of-network is capped at $12 per test, including tax and shipping costs, with a limit of eight tests per member in a 30-day period.