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Insurers ordered to pay for home COVID tests

MONTPELIER — The Vermont Department of Financial Regulation this week issued an emergency regulation requiring health insurers to cover the costs of COVID-19 antigen at-home tests (commonly referred to as “rapid” tests).

The emergency rule covers approximately 140,000 Vermonters who purchase commercial insurance in Vermont’s individual, small and large group markets as well as the Vermont Education Health Initiative. The emergency rule requires health insurers to cover the retail purchase of most FDA-authorized COVID-19 antigen tests without cost-sharing for home use.

“Vermont has led the nation in testing, but we must continue to adapt and improve our strategies as we move forward,” Gov. Phil Scott said in a Tuesday press release. “At-home tests will increasingly be an effective and widely used tool for managing the virus, and expanding access is a priority for my team.”

Vermont was one of the first states to require commercial insurers to cover the costs of COVID-19 PCR testing and continues to be one of the only states to eliminate out-of-pocket insurance costs for those requiring treatment for COVID-19.

Once fully implemented, those covered by the rule will be able to obtain an at-home test through a pharmacy without upfront costs. Instead, at-home tests will be processed under an individual’s pharmacy benefit and the pharmacy will then seek reimbursement. Those purchasing at-home tests outside a pharmacy setting, however, will be required to submit a claim to their insurer for reimbursement. All covered individuals will need to file a claim through their insurance until the pharmacy benefit is fully implemented, which is likely to take several weeks.

“Eliminating financial barriers to COVID-19 testing and treatment has been in important component of Vermont’s pandemic response,” said Department of Financial Regulation Commissioner Michael Pieciak. “Making COVID-19 testing free and accessible helps limit the spread of the virus by identifying positive cases quickly, which is particularly important as we continue through the holiday season.”

Although Vermont lacks authority to extend the emergency rule to self-insured plans, the state is encouraging those plans to voluntarily follow the rule in anticipation of new federal regulations recently announced by the Biden Administration. The University of Vermont Health Network, Vermont’s largest self-insured plan, has indicated it intends to follow the emergency rule and the state of Vermont encourages other employers who self-insure to do the same.

It is important to inform your primary care provider if you test positive using an at-home COVID-19 test. Doing so will enable your primary care provider to discuss possible treatment options with you and allows them to report the positive case to the Vermont Department of Health to ensure the most robust surveillance data.

To help maintain an adequate supply of at-home test kits for all Vermonters, coverage is limited to eight test kits per person per month. Health insurers must process and reimburse appropriate claims for tests described in this emergency rule retroactively for tests purchased on or after Dec. 1.

For more information on the coronavirus, please visit the Vermont Department of Health online at healthvermont.gov/covid-19.

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