Notification Regarding Over-the-Counter COVID-19 Test Coverage for South Dakota State Employee Benefits Program Members.

New federal regulations have mandated that employee’s covered by self-funded health plans like the South Dakota State Employee Benefits Program can now receive Over the Counter (OTC) COVID-19 Tests at no cost. These new regulations went into effect on Saturday, January 15.

Because OTC COVID-19 tests are typically not available for purchase through doctors' offices or other medical providers, pharmacies are the primary place where you can buy these tests. If you are covered under the health plan, you can now get tests at most pharmacies. You also have the option to order them online through in-network national retail pharmacy chains like CVS and Walgreens without an upfront payment.

You can find an in-network pharmacy here.

Covered OTC COVID-19 tests are limited to the tests for when specimens are self-collected and are read at home by the test-taker (not dropped off at or mailed to a laboratory for processing). There are currently 13 tests that qualify for this coverage. A resource to help you figure out whether a test qualifies as an OTC COVID-19 test will be available on Wellmark.com. The list is located under the “Your Questions Answered” menu halfway down the page.

Wellmark’s pharmacy benefit manager, CVS, is implementing a claims process to track OTC COVID-19 test claims. There is a limit of eight OTC COVID-19 tests per member per month. As an example, if you cover five members on the same health plan, your family is eligible to be reimbursed for up to 40 OTC COVID-19 tests each month. (Some test kits are sold with multiple tests in a single package. The limit number is based on individual tests.) OTC COVID-19 tests are for personal use and should only be used by you and your dependents on the same health plan that paid for those tests.

If you purchase an OTC COVID-19 test from an out-of-network pharmacy, you will still be eligible for reimbursement. This reimbursement may be limited to $12 per test (or $24 for a box of two).

Because this is a rapidly evolving situation, we will share new updates on the benefits website when we receive more information from Wellmark.

Processing Claims

CVS will process and pay claims for OTC COVID-19 tests that are purchased on or after January 15, 2022. Claims for OTC COVID-19 tests that are purchased before that date will not covered or reimbursed. OTC COVID-19 tests must be purchased from the pharmacy counter to be covered with no out-of-pocket costs. Members purchasing the test at a regular checkout will need to pay for that test at the retail price and submit a claim to CVS for reimbursement.

If you do pay out-of-pocket for OTC COVID-19 tests, you will need to submit a claim form to CVS. Visit CVS’s website for more information about CVS’s member-submitted claim process for OTC COVID-19 tests.

CVS has updated their website with banners directing members on where to submit a Covid home test reimbursement claim. The member will need to sign in to their account. The best way to do that is through myWellmark. Once you are signed into my Wellmark, click on find a pharmacy and this will take you to the CVS website. If it is your first time logging in, it will ask you to register. Subsequent visits will be single sign on via my Wellmark. Once on the CVS site, you should see a banner for the Covid test claim submission. You can also navigate to Plan and Benefits and click “Submit Prescription Claim”. Then Click “Submit at home COVID-19 test reimbursement claim.” The form will walk through the claim submission process step-by-step and ask you to upload a receipt.

For additional questions, please contact Wellmark Customer Support.