--- title: Group Insurers Required to Cover Over-the-Counter COVID-19 Tests Beginning January 15, 2022 description: Group Insurers Required to Cover Over-the-Counter COVID-19 Tests Beginning January 15, 2022 - Koppinger & Associates image: https://koppingerins.com/hubfs/Free%20Shutterstock%20Images/Pretty%20blonde%20customer%20looking%20at%20medicine%20in%20the%20pharmacy.jpeg --- [![Koppinger & Associates logo](https://koppingerins.com/hs-fs/hubfs/01609-KA-Logo-CC-1.png?width=1800&height=384&name=01609-KA-Logo-CC-1.png "Koppinger & Associates logo")](https://koppingerins.com) [![Koppinger & Associates logo](https://koppingerins.com/hs-fs/hubfs/01609-KA-Logo-CC-1.png?width=1800&height=384&name=01609-KA-Logo-CC-1.png "Koppinger & Associates logo")](https://koppingerins.com) - [Home](https://koppingerins.com) - Solutions - [Business insurance & P&C](https://koppingerins.com/business-insurance-pc-solutions) - [Employee benefits & HR](https://koppingerins.com/employee-benefits-and-hr-solutions) - [Knowledge Center](https://koppingerins.com/blog) - [About](https://koppingerins.com/about) - [Contact](https://koppingerins.com/contact) - [HR Library](https://auth.zywave.com) # Group Insurers Required to Cover OTC COVID Tests 1-15-22 January 13 2022 Categories: [HR Solutions](https://koppingerins.com/blog/tag/hr-solutions) ![Group Insurers Required to Cover OTC COVID Tests 1-15-22](https://koppingerins.com/hubfs/Free%20Shutterstock%20Images/Pretty%20blonde%20customer%20looking%20at%20medicine%20in%20the%20pharmacy.jpeg) Guidance has been issued regarding the requirements for group health plans and health insurance carriers to cover over-the-counter (OTC) COVID-19 diagnostic tests beginning **January 15, 2022.** **Legal Requirements** - Plans and issuers must cover the costs of COVID-19 tests during the COVID-19 public health emergency 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.** - Insurance companies and health plans are required to cover 8 OTC at-home tests per covered individual per 30-day period.  - There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an **individualized clinical assessment**, including for those who may need them due to underlying medical conditions. - Plans are not required to provide coverage of testing (including an at-home OTC COVID-19 test) that is **required by an employer for employment purposes**. See links below for full list of FAQs: [Department of Labor FAQs](https://koppingerins.com/hubfs/aca-part-51.pdf) [CMS FAQs](https://koppingerins.com/hubfs/1.10.22%20Internal%20QAs%20OTC%20Testing%20Guidance.pdf) **Plan Options** Plans and insurance carriers may place some limits on coverage, such as: - Requiring individuals to purchase a test and submit a claim for reimbursement rather than providing direct coverage to sellers. - Providing direct coverage through pharmacy networks or direct-to-consumer shipping programs and limiting reimbursements to other sources (the actual cost of the test, or $12, whichever is lower). - Setting limits on the number or frequency of OTC COVID-19 tests that are covered.  - Taking steps to prevent, detect and address fraud and abuse. **Count on #TeamKoppinger for the latest updates that affect you.** - - - - [mailto:?subject=Group%20Insurers%20Required%20to%20Cover%20Over-the-Counter%20COVID-19%20Tests%20Beginning%20January%2015,%202022&body=Group%20Insurers%20Required%20to%20Cover%20Over-the-Counter%20COVID-19%20Tests%20Beginning%20January%2015,%202022%20https://koppingerins.com/blog/group-insurers-required-to-cover-over-the-counter-covid-19-tests-beginning-january-15-2022](mailto:?subject=Group%20Insurers%20Required%20to%20Cover%20Over-the-Counter%20COVID-19%20Tests%20Beginning%20January%2015,%202022&body=Group%20Insurers%20Required%20to%20Cover%20Over-the-Counter%20COVID-19%20Tests%20Beginning%20January%2015,%202022%20https://koppingerins.com/blog/group-insurers-required-to-cover-over-the-counter-covid-19-tests-beginning-january-15-2022) [Previous post](https://koppingerins.com/blog/the-great-resignation-why-is-it-happening) [All posts](https://koppingerins.com/blog) [Next post](https://koppingerins.com/blog/its-time-to-turnover-a-new-employee-retention-strategy-koppinger-associates) ## Related Articles #### [Liability Education Part 1: Coverage Forms - Koppinger & Associates](https://koppingerins.com/blog/liability-education-part-1-coverage-forms) #### [Manufacturing Industry COVID-19 Preparedness Response Plan. - Koppinger & Associates](https://koppingerins.com/blog/manufacturing-industry-covid-19-preparedness-response-plan) #### [Manufacturing Industry COVID-19 Preparedness Response Plan. - Koppinger & Associates](https://koppingerins.com/blog/covid-19-preparedness-response-plan) [![01609-KA-Logo-WH](https://koppingerins.com/hs-fs/hubfs/01609-KA-Logo-WH.png?width=300&height=64&name=01609-KA-Logo-WH.png "01609-KA-Logo-WH")](https://20500700.hs-sites.com/) 3060 Commerce Dr. Suite 4 Fort Gratiot, MI 48059 At Koppinger & Associates, we are a team of dedicated insurance advisors who put the needs of our clients first. 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