The Trustees of the IUOE Local 4 Health & Welfare Fund are pleased to announce a new benefit for over-the-counter (OTC) COVID-19 tests for claims incurred on and after January 15, 2022 through the remainder of the COVID-19 public health emergency.
What is Covered?
Under this benefit, the Fund will provide 100% coverage for OTC COVID-19 tests that are approved by the federal government* and are not purchased with a prescription or order from your health care provider. Tests must be purchased for personal use and not for employment purposes or resale. Tests purchased before January 15, 2022 will not be covered.
How Many Tests are Covered Per Person Per 30-Day Period?
Participants are limited to eight (8) OTC COVID-19 tests (that are not purchased with a physician’s order or prescription) per individual per 30-day period. In applying this limit, the Fund will count each test separately, even if multiple tests are sold in one package. For example, in the case of a married participant with one dependent child, the Fund will cover no more than twenty-four (24) tests per 30-day period, eight (8) for each covered family member.
Can I use my ID Card at Retail Pharmacies in the CVS Network to Obtain Tests for FREE?
Yes. The Fund uses CVS Caremark (CVS) as its Pharmacy Benefit Manager (PBM). CVS is developing a program whereby you may use your ID card at many participating retail pharmacies in the CVS network to obtain covered OTC COVID-19 tests at no charge without making any out-of-pocket payment. However, at least initially, until this program is operational, it may be necessary for you to pay for an OTC COVID-19 test upfront and then seek reimbursement from CVS, as described below.
What Happens If I Can’t Find a Test for Free Using my ID Card at an In-Network Retail Pharmacy?
If you cannot find a test for free using your ID card at an in-network retail pharmacy, and you provide upfront, out-of-pocket payment for a test (even when purchased from an out-of-network pharmacy or other retailer), you may request direct reimbursement from CVS. To request reimbursement, you may submit your receipt via www.caremark.com, you may submit your receipt through the CVS mobile app, or you may submit a paper claim with your receipt to CVS directly.
Are Tests Available Through a Mail Order Service Sponsored by CVS?
No. At this time, tests will not be available through a CVS-sponsored mail order service. If this changes, you will be notified. However, you may be able to purchase tests from another retailer online with shipping and then seek reimbursement directly from CVS. Please note that shipping costs will not be reimbursed.
What Changes if CVS Offers OTC COVID-19 Tests via its Retail Pharmacy Network & a Mail Order Service? *IMPORTANT*
If CVS offers OTC COVID-19 tests through its retail pharmacy network and a home delivery service in accordance with federal guidelines, the Fund may limit reimbursement for OTC COVID-19 tests purchased from non-preferred pharmacies or other retailers (i.e., sellers outside of the CVS pharmacy network) to $12 per test, or the actual price of each test (whichever is lower). However, participants who purchase OTC COVID-19 tests from preferred pharmacies will continue to be reimbursed for the full cost of each test. For this reason, we encourage participants to purchase tests offered at participating pharmacies.
What About Tests Ordered by my Doctor?
COVID-19 tests (including federally-approved OTC COVID-19 tests) that are administered at the direction of your doctor will continue to be processed in accordance with current Plan rules at no cost to participants. There is no quantity limit on the number of tests per 30-day period that the Fund will cover when ordered by a health care provider.
Where Else Can I Get a Free OTC COVID-19 Test Kit?
The federal government is making a half-billion tests available through online ordering beginning on January 19, 2022. These free tests will be available to all households, including Medicare-eligible individuals. Tests can be ordered online at COVIDTests.gov and will initially be limited to four (4) tests per residential address.
Can I Have a SUMMARY of the Most Important Points?
Under this new program:
- You may seek reimbursement for up to eight (8) at-home OTC COVID-19 tests per 30-day period for you and each eligible dependent.
- You should be able to obtain tests directly from many CVS preferred pharmacies without any upfront, out-of-pocket cost by showing your ID card at the pharmacy counter.
- CVS is also currently developing procedures to allow you to obtain at-home OTC COVID-19 tests directly through the mail for free.
- Until CVS implements direct mail ordering procedures, the Fund must reimburse participants for the full cost of at home OTC COVID-19 tests purchased from “CVS preferred” and “non-preferred” pharmacies upon submission of claims for reimbursement and proof of purchase (receipts). If you experience any difficulties using your ID card at an in-network pharmacy, you should apply for reimbursement directly from CVS. SAVE YOUR RECEIPTS.
- Once CVS implements direct mail ordering procedures, there may be a $12 per test limit on reimbursement for at-home OTC COVID-19 tests obtained from “non-preferred” or “out-of-network” pharmacies.
- The Fund must cover only federally-approved at-home tests purchased on and after January 15, 2022. Tests purchased before January 15, 2022 will not be covered.
- If you have any question about whether or not a specific brand of test is covered, you should contact CVS at the number on your ID card.
- Tests must be purchased for personal use or use by a covered dependent, not for employment purposes, and not for resale.
- COVID-19 testing when ordered by a health care provider will continue to be covered at 100%. Tests ordered by a provider, including federally-approved OTC COVID-19 tests, do not count towards the eight (8) per covered person per 30-day limit.
- You may also receive tests at no cost to you or the Fund by ordering tests from the federal government at COVIDTests.gov.
The Trustees of the Fund are committed to responding as necessary to the COVID-19 pandemic to support you and your family during this difficult period. As always, if you have any questions, please contact the Fund Office at (508) 533-1400 or 1-888-486-3524.
While this notice is intended to summarize a recent modification to the Plan’s rules, in the event there is any discrepancy between this summary and the official Plan document, the official Plan document shall apply. The Trustees reserve the right to amend the Plan at any time. If you have questions, please contact the Fund Office.* Information on federally-approved tests may be found at https://www.fda.gov/medical-devices/coronavirus-disease-2019-covid-19-emergency-use-authorizations-medical-devices/in-vitro-diagnostics-euas.