Coverage for COVID-19 tests

CORE, UC Care, and UC Health Savings Plan will cover at-home over-the-counter antigen tests through Dec. 31, 2024. Effective Jan. 1, 2025, these plans will no longer cover them. All UC PPO plans will continue to cover COVID-19 PCR testing if ordered by a physician at the applicable laboratory plan benefits. 

To receive reimbursement for over-the-counter COVID-19 antigen tests purchased through 2024, members must upload a claim form and receipts through Accolade’s secure messaging system:

• Log in to your Accolade account via the Accolade app or member portal.
• Select “Messages” to begin your secure mobile submission.
• Select “Bill & Claims” to start a new conversation and submit your OTC COVID claim.
• A new message will appear to begin your message. Please submit the requested demographic and claim information, and clearly state this is a claim for OTC COVID from 2024. 
• Click on the paperclip to upload your claim image and hit send.  

Claims for OTC COVID tests must be received by Accolade within one year of the purchase date. For example, if you purchase an OTC COVID test on Dec. 1, 2024, Accolade must receive your claim documentation by Nov. 30, 2025.

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 at-home over-the-counter antigen tests are available at no cost at in-network retail pharmacies. Purchases made at non-pharmacy locations would require out-of-pocket payment and be subject to the reimbursement cap.

COVID-19 diagnostic/antibody PCR tests, vaccines and therapeutics are covered at no cost, with no prior approval required.  

Out-of-network: Effective January 1, 2025, UC Blue and Gold HMO will change its coverage for out-of-network COVID-19 tests, vaccines, and therapeutics to 50% coinsurance, from no cost in 2024.

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

At-home OTC antigen tests purchased in and/or out-of-network are limited to eight tests per member in a 30-day period, and the reimbursement is capped at $12 per test, including tax and shipping costs. 

Visit Health Net on COVID-19 tests for more information.