Coverage for over-the-counter home COVID tests under the HealthSelectSM Prescription Drug Program

PLEASE NOTE: The following information applies only to health plan participants who are not enrolled in Medicare. If you’re enrolled in Medicare and have prescription drug coverage through HealthSelect Medicare Rx, please contact UnitedHealthcare for information on coverage of COVID-19 tests. 

Effective January 15, 2022, the federal government is requiring most group health plans to cover the cost of a limited number of certain over-the-counter home COVID-19 antigen tests for participants. This includes the HealthSelect of Texas®, Consumer Directed HealthSelectSM and HealthSelectSM Out-of-State plans offered through the Employees Retirement System of Texas (ERS). 

The tests will be covered under your pharmacy benefit. To get these tests at no cost to you, you must use your prescription insurance card at an in-network pharmacy. You don’t need a prescription for these tests at the covered limit. Just present your prescription insurance card and the tests you want. 

Important information: 

  • Coverage allows for eight tests per plan participant every 30 days. 
    • For example, if your HealthSelect coverage includes yourself, your spouse and three children, every 30 days your household can get up to 40 tests—eight each for all five participants—at no cost to you. 
  • Under federal guidelines, the plan covers only specific tests. Please see the list of covered tests below. It will be updated as new FDA-approved tests become available.
  • Some packages of home tests have more than one test. Your covered 30-day limit is based on the number of tests, not the number of boxes. 
    • For example, if you have individual coverage and purchase boxes that have two tests in each box, your insurance will cover four boxes (with a total of eight tests) in a 30-day period.
  • If you buy your tests at an out-of-network pharmacy and/or without using your prescription card, you must pay the cost up front. You can submit the expense through direct management reimbursement (DMR). Learn more about DMR and get the reimbursement form.
    • If you use DMR, your coverage is still limited to the tests listed below, as well as eight tests per insured participant each 30 days. 
    • If you use DMR, your reimbursement is capped at $12 for each test (not each box).
  • Your medical benefits will continue to cover other (non-home) COVID-19 tests, such as PCR tests at doctors’ offices and other testing sites. 

Covered over-the-counter home COVID-19 tests:

  • Flowflex Kit Home Test
  • Quickvue Home Kit COVID-19
  • Ellume COVID-19 Kit Home Test
  • BinaxNow COVID-19 Kit Home Test
  • Inteliswab Kit COVID-19
  • On/Go COVID  Kit Antigen

You can find more information about coverage and reimbursement of at-home COVID tests on the OptumRx website.