Page 19 - Work Force February 2022
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Empire Plan coverage for COVID-19 At-Home Tests
Public health experts, including the U.S. Centers for Disease Control and Prevention (CDC), recommend the use of at-home diagnostic tests as a tool to help mitigate the spread
of COVID-19.
The Biden-Harris administration has
taken steps to make at-home tests more accessible. Under direction from the
federal government, the Empire Plan will cover FDA-authorized at-home COVID-19 over-the-counter diagnostic tests.
All Empire Plan enrollees and dependents are eligible for this benefit. COVID-19 over-the-counter diagnostic tests are covered with no out-of-pocket cost at participating network pharmacies using your Empire Plan ID card (no doctor’s order or prescription is necessary). Empire Plan participants should go to the pharmacy counter with the COVID-19 test(s) so the pharmacy can process and bill your insurance directly.
Since this program was implemented as we were preparing to go to press, following are some Frequently Asked Questions the Empire Plan has assembled to assist participants:
Q1: Where can I get an over-the- counter (OTC) at-home COVID-19 test?
A1: COVID-19 at-home tests can be acquired at any pharmacy,
store or online retailer that sells FDA-authorized COVID tests. If you present your health insurance card at the pharmacy counter, you can get an OTC test through a participating
network pharmacy at no out- of-pocket cost.
Note: If you are charged for a test at a participating
network pharmacy, submit for reimbursement on Caremark’s website at If you need assistance, call
The Empire Plan at 1-877- 769-7447 and select option 4
for the Empire Plan Prescription Drug Program, 24 hours
a day, seven days a week.
Q2: How am I reimbursed for the COVID-19 at-home test?
A2: If you purchase an FDA- authorized at-home test at a non- participating network pharmacy (e.g., Amazon or other online retailer), keep your receipt and submit a claim to United Healthcare. The maximum reimbursement
per test is $12. United Healthcare, the Medical/Surgical Program administrator, will accept claim submissions.
Visit to access the reimbursement form, which can also be found at AtHomeTestForm.
Note: In the “Subscriber/ policyholder information” section of the form, Member ID is the 9-digit number starting with 890 or 891 and Plan/Group # is: 030500.
Q3: How many COVID-19 OTC at-home tests will be covered?
A3: There is a maximum of eight tests per plan member, per month. COVID-19 at-home tests have expiration dates indicated on the package. Using an expired test risks getting an inaccurate result.
Q4: Which tests are FDA- authorized?
A4: As of Jan. 18, 2022, the list of COVID-19 OTC FDA-authorized tests* are:
• BinaxNOW COVID-19 Antigen Self Test
• COVID-19 At-Home Test (SD Biosensor, Inc.)
• CLINITEST Rapid COVID-19 Antigen Self-Test
• iHealth COVID-19 Antigen Rapid Test
• CareStart COVID-19 Antigen Home Test
• BD Veritor At-Home COVID-19 Test
• SCoV-2 Ag Detect Rapid Self-Test • InteliSwab COVID-19 Rapid Test • Celltrion DiaTrust COVID-19 Ag
Home Test
• QuickVue At-Home OTC
COVID-19 Test
• Flowflex COVID-19 Antigen
Home Test
• Ellume COVID-19 Home Test
*The list of FDA-authorized tests is subject to change.
Q5: What if my test costs more than $12?
A5: Tests purchased at a participating network pharmacy will
be covered in full. For claims that are submitted via, the plan will reimburse up to $12 per test ($24 for a box that contains two tests) for a maximum of eight tests per plan member, per month.
Q6: My primary coverage is Medicare. Am I eligible for an OTC test?
A6: Yes, this plan benefit applies for plan members who have Medicare as their primary coverage, and Empire Plan as their secondary health plan coverage.
Q7: I already bought and paid for a COVID-19 OTC test. Can I submit
a claim for reimbursement for this test?
A7: Only tests purchased on or after Jan. 15, 2022, are eligible for reimbursement.
Q8: What other options do I have for ordering at-home tests?
A8: Beginning Jan.19, 2022, every home in the U.S. is eligible to order four free at-home COVID-19 tests via The tests are completely free. Orders will usually ship in 7-12 days.
Q9: I have additional questions. Who can assist me?
A9: Call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and select option 1 for the Empire Plan Medical Program, or option 4 for the Empire Plan Prescription Drug Program.
  Empire Plan vaccine coverage at network pharmacy
Select preventive vaccines are covered without co-payment when administered at a pharmacy that participates in the CVS Caremark national vaccine network. Vaccines available at a pharmacy are: • COVID-19
• Influenza (flu)
• Pneumococcal (pneumonia • Meningococcal (meningitis) • Herpes zoster (shingles) (no
cost to those 50 years and older)
The Empire Plan has
recently expanded coverage
for non-seasonal vaccines recommended by the Advisory Committee on Immunization Practices (ACIP). Added vaccines now covered through pharmacy include:
Effective Dec. 10, 2021:
• Tetanus, Diptheria, Pertussis
and DTap
Effective Jan 30, 2022:
• Hepatitis A and Hepatitis B
• Measles, Mumps, Rubella
• Varicella
• Human Papillomavirus (HPV)
To find out if a pharmacy participates in the CVS Caremark national vaccine network, visit and select CVS Caremark, then select
‘Find a Local Pharmacy.’ Be sure
to select ‘Vaccine network’ under Advanced Search. Call the pharmacy in advance to verify availability of the vaccine.
If you have questions about this expanded coverage or need help locating a pharmacy, call the Empire Plan at 1-877-769-7447 and press or say 4 to reach the Prescription Drug Program.
 February 2022
The Work Force 19

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