Over-the-Counter At-Home COVID-19 Tests

OTC COVID-19 tests are covered only for members of Baylor Scott & White Health Plan and its subsidiaries under the pharmacy benefit in the following lines of business:

• Individual/Marketplace health plans
• Commercial group health plans (Self-Funded and Fully Insured)*

Important notes:
* This benefit does not apply to members whose pharmacy benefits are carved out (i.e. pharmacy plans that are not offered through Baylor Scott & White Health Plan). Members with carved-out pharmacy benefits should talk to their employer about OTC COVID-19 testing coverage.

OTC COVID-19 tests are not covered for employment purposes. For example, tests are not covered if your employer requires that you test yourself multiple times per week as a condition of employment or for pre-employment screening.

Covered tests include at-home COVID-19 test kits authorized by the FDA and do not require an order from a medical provider. The most common are BinaxNOW^™, CLINITEST^®, Flowflex^™, i-Health^®, InteliSwab^™, Ellume^™, On/Go^™, QuickVue^® and At-home test kits (Roche). Look for an FDA Emergency Use Authorization label on the package.

Yes. Members can get up to eight (8) tests per month for no additional out-of-pocket cost under your pharmacy benefit. (e.g., a family of 4 would be eligible for 32 tests a month).

Important note:
Coverage is per test. A box/kit containing two (2) tests counts as two (2) tests.

Members with Pharmacy Benefits Administered by Cigna

Members with pharmacy benefits administered by Cigna may visit any provider or retailer (including mail order) to purchase their OTC at-home COVID-19 test kit. You will be reimbursed at the price you paid for the test kit(s). Keep your receipt(s) and the name(s) of your at-home test kit(s) and submit to Baylor Scott & White Health Plan for reimbursement.

All Other Individual/Marketplace and Group Members

1. Pay $0 at a preferred network pharmacy
Visit the pharmacy counter at a preferred network pharmacy: Baylor Scott & White Pharmacies, Walmart, Sam's Club, Walgreens, Kinney Drugs or Rite-Aid (includes Bartell Drugs). Present your member ID card and ask to have your OTC at-home COVID-19 test kit(s) submitted to OptumRx, the administrator of your pharmacy benefit. You can get up to eight (8) tests per month for no additional out-of-pocket cost under your pharmacy benefit.

2. Purchase a test kit and be reimbursed up to $12
Purchase an FDA-authorized OTC COVID-19 test kit at other stores or online retailers not listed above. You will be reimbursed up to $12 per test for up to eight (8) tests per covered member per month without a prescription. Keep your receipt(s) and the name of your at-home test kit(s). You'll need that information to submit a claim for reimbursement.

3. Order a test kit to be mailed to your home.
Log into the MyBSWHealth member portal, scroll to the section that reads “Please click here to view your Pharmacy Claims” and click the "View" button. This brings you to the OptumRx site where you will scroll down and select “Get at-home COVID-19 tests with $0 copay.” Follow the directions as prompted to receive test kits in the mail.

Important note:
Members are limited to eight (8) tests (4 kits) per household per calendar month for mailed test kits.

Members with Pharmacy Benefits Administered by Cigna

Members with pharmacy benefits administered by Cigna will be reimbursed at the price paid for the test kit(s). Keep your receipt(s) and the name(s) of your at-home test kit(s) and submit to Baylor Scott & White Health Plan for reimbursement.

All Other Individual/Marketplace and Group Members

If you paid out-of-pocket for an FDA-authorized OTC COVID-19 test kit on or after Jan. 15, you can submit your claim within one year of your purchase date. Reimbursement of up to $12 per test will be available through the end of the federal emergency health period. A separate claim must be submitted for each member.

To receive the quickest possible reimbursement, submit a claim online.