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Due to the end of the federal COVID-19 public health emergency, over-the-counter (OTC) tests for COVID-19 will no longer be covered beginning May 12, 2023. Please do not submit claims for OTC COVID-19 tests that were purchased on or May 12, 2023 as we will not reimburse for them.

However, if you purchased OTC COVID-19 tests out-of-pocket before May 12, 2023, you can still submit a pharmacy claim form for reimbursement for up to 12 months after the date of purchase. To access pharmacy claim forms, click Prescriptions under Doctors & Care.

• If you see Go to Prime Therapeutics: Mail the Prescription Drug Claim Form, and the required information listed on the form, to the address on the form.
• If you do NOT see Go to Prime Therapeutics: Follow the instructions on screen to be redirected to the appropriate vendor’s website, where you can find information about submitting pharmacy claims.

Due to the end of the federal COVID-19 public health emergency, over-the-counter (OTC) COVID-19 testing will no longer be covered beginning May 12, 2023.

If you purchased OTC COVID-19 tests out-of-pocket before May 12, 2023, you can still submit a pharmacy claim form for reimbursement for up to 12 months after the date of purchase. To access pharmacy claim forms, click Prescriptions under Doctors & Care.

• If you see Go to Prime Therapeutics: Mail the Prescription Drug Claim Form, and the required information listed on the form, to the address on the form.
• If you do NOT see Go to Prime Therapeutics: Follow the instructions on screen to be redirected to the appropriate vendor’s website, where you can find information about submitting pharmacy claims.

There were changes to certain coverage and/or out-of-pocket costs when the federal COVID-19 public health emergency ended on May 11, 2023.

Here is what changed beginning May 12, 2023:

Vaccines

Just like other preventive health services, you will have no out-of-pocket costs for the COVID-19 vaccine and boosters when you use an in-network provider. The COVID-19 vaccine and boosters are still the best way to protect yourself from serious illness related to COVID-19.

COVID-19 Testing and Treatment

• “Diagnostic” Testing and Treatment through a Healthcare Provider: If you need to be tested because you have symptoms or were exposed to someone who has COVID-19, your testing is considered “diagnostic.” You will continue to have coverage for “diagnostic” lab tests and treatment when received in network. However, you may have to pay a copay, deductible and/or coinsurance based on your benefits. If you have out-of-network coverage and use an out-of-network provider, you will pay more out of pocket.
• “Surveillance” Testing through a Healthcare Provider: If you need to be tested to go to work or school, for travel or for some other reason not related to illness, then your testing is considered for “surveillance.” These claims are not covered by insurance, and you will have to pay the entire cost of the test.
• Over-the-Counter Testing: You will have to pay for over-the-counter, at home COVID-19 tests.

Telemedicine

COVID-19-related care will be treated like any other telemedicine service. For in-network care, you will pay your copay, coinsurance and/or deductible. This includes services received through Horizon CareOnline℠.

For information about your specific telemedicine coverage, click What’s Covered under Benefits & Coverage. Then, on the Medical tab choose Telemedicine from the Service you may need menu.