Learn about at-home testing reimbursement

Oscar member

Where can I obtain at-home COVID-19 tests?

Oscar’s Direct Coverage program leverages a national network where pharmacies in the network may adjudicate a claim for OTC COVID tests, without a prescription, and with no up-front out-of-pocket costs to the member, under the plan’s pharmacy benefit. Additionally, many of the pharmacies in the national network offer delivery or shipping direct to members’ homes, offices, or other locations. If you go to the pharmacy counter, you may be able to present your member ID and ask them to bill your insurance just like you would a medication at no cost to you. (Note: If you’re a Cigna + Oscar or Cigna Administered by Oscar small group member, please scroll down to the "For Cigna + Oscar or Cigna Administered by Oscar small group members" section at the bottom of this page to learn more about how you can obtain COVID-19 tests through Cigna + Oscar's at Home Covid Test Reimbursement. You won’t be able to access a test through the pharmacy network shared at the link below.) Please note that many pharmacies are still working to set up this process and may require that you pay out of pocket for now. If that happens please see below for how to get reimbursed.Additionally, you are able to order free at-⁠home testing kits directly from the federal government via this site: https://www.covidtests.gov/ You can obtain a test through our network of pharmacies. Find one near you.

I paid for my at-home tests out of pocket. How do I get reimbursed?

Don’t sweat – if you purchased the tests on or after January 15, 2022, you’ll still be able to get reimbursed. Just use the OTC COVID Test Paper Claim form or follow the steps below:(Note: If you’re a Cigna + Oscar or Cigna Administered by Oscar small group member, please scroll down to the "For Cigna + Oscar or Cigna Administered by Oscar small group members" section at the bottom of this page to learn more about how you’ll be reimbursed. You won’t be reimbursed if you follow the process below.) 
  1. Please visit Caremark.com and sign in or register. Be sure to have your member ID available if you haven’t previously created an account with Caremark. (You can always access your member ID number through your online account here)
  2. Select “Plan & benefits”
  3. Select “Submit a prescription claim” and follow the prompts listed there

What are the requirements for reimbursement?

  • Your tests must be purchased on or after January 15, 2022. 
  • Your tests must be FDA authorized.
  • You must be an active member enrolled in individually purchased health care or on a small group plan. Reimbursement doesn’t apply to Medicare Advantage plans.
  • A maximum of eight (8) OTC tests will be covered per individual per 30 consecutive days (test kits that contain 2 tests per kit are counted as two tests towards the eight test limit). This quantity limit applies to OTC tests without a prescription only. 
  • Ideally, the receipt should only include the purchase of tests and no other items (i.e. a receipt that includes only the at-home COVID test(s) purchased and not other non-reimbursable purchases) is preferred as it will allow us to process your request more quickly. We recommend submitting using the online option noted above in the "I paid for my at-home tests out of pocket. How do I get reimbursed?" section above or using the OTC COVID Test Paper Claim form.

Reimbursement guidelines: 

FDA Authorized OTC COVID self-tests will be reimbursed and include the following.
  • Abbott BinaxNOW 
  • SD Biosensor COVID At Home Test
  • Siemens’s CLINITEST Self Test
  • iHealth COVID-19 Self Test
  • Access Bio’s CareStart Self Test
  • BD Veritor At-Home Test
  • InBios SCov-2 Detect Self Test
  • OraSure InteliSwab Rapid Test
  • Cellitrion DiaTrust Home Test
  • QuickVue At Home Test
  • ACON Flowflex Home Test
  • Ellume Home Test
  • Detect COVID-19 Test
  • Lucira Check-it COVID-19 Test
  • Cue Covid-19 at home test
Your tests must be for personal diagnostic use, have not been and will not be reimbursed by another source, and have not been and will not be for resale. COVID-19 tests for employment or back-to-school purposes are not reimbursable under the federal CARES Act.*  *In CA tests may be reimbursable subject to additional state law and guidance, as applicable. 

Circumstances in which costs could be incurred for OTC Covid-19 tests:

  • A maximum amount of $12 per test will be reimbursed to members who do not obtain the test through Direct Coverage. Members must follow the post-service reimbursement process to receive this reimbursement.
  • Members will only be reimbursed for up to eight tests per consecutive 30 days.  Should members reach that quantity limit based on the claims adjudicated at the pharmacy, any submitted receipts for tests purchased within that same rolling 30-day period will not be reimbursed.
  • For members who use the delivery/shipping service offered by pharmacies in the Direct Coverage network, members will be responsible for delivery or shipping costs, if the pharmacy requires a fee for that service.
  • For post-service reimbursement (paper claims), receipts must be submitted and must have a date of 1/15/2022 or onwards to receive reimbursement. Tests purchased prior to 1/15/2022 will not be reimbursed. You may also reference the instructions above in the "I paid for my at-home tests out of pocket. How do I get reimbursed?" section to submit using the online option.

For Cigna + Oscar or Cigna Administered by Oscar small group members

We’re grateful for your patience while we created an easy process for your COVID-19 over-the-counter (OTC) testing kits reimbursement.
  • Cigna + Oscar members can now complete a reimbursement form available here
  • Cigna Administered by Oscar members can now complete a reimbursement form available here.  
The completed form and purchase receipts should be sent via mail or fax:Mail Cigna PO Box 188061Chattanooga, TN 37422---FaxClaim forms may be faxed to: 859.410.2422.

Submission Instructions

When submitting your OTC test-kit claim, please include the required documentation with your form. Incomplete submissions may not be considered for reimbursement.
  • Use for COVID-19 over-the-counter (OTC) testing kits only.
  • Please include the purchase receipt clearly showing the date of purchase and testing kit charges.
  • Submit one form per customer. You’re eligible to be reimbursed for up to 8 tests per 30 days.
  • Please do not staple or paper clip the bills or receipts to the claim form.
  • You can be reimbursed for any take home tests that you’ve purchased after January 15th. 
Don’t forget: you’re eligible to order 2 sets of 4 free at-home COVID tests from the government. To learn more and order at-home test kits visit www.covidtests.gov.Things are changing quickly, and we promise to keep you up-to-date. Please check this page for the latest information about over-the-counter test kits. If you have additional questions about this process, reach out to your Care Guide by calling the toll-free number on your ID card.For all other states:Cigna + Oscar coverage is insured by Cigna Health and Life Insurance Company. CA: benefits administered by Oscar Health Administrators. Other states: benefits administered by Oscar Management Corporation. Pharmacy benefits are provided by Express Scripts, Inc.For AZ:Insured by Cigna Health and Life Insurance Company. Insurance benefits administered by Oscar Management, a third party administrator. Cigna insurance coverage contains exclusions and limitations. For complete details on product availability coverage, please refer to your plan documents or member ID card.

What are the requirements for reimbursement?

  • Your tests must be purchased on or after January 15, 2022. 
  • Your tests must be FDA authorized.
  • You must be an active member enrolled in individually purchased health care or on a small group plan. Reimbursement doesn’t apply to Medicare Advantage plans.
  • A maximum of eight (8) OTC tests will be covered per individual per 30 consecutive days (test kits that contain 2 tests per kit are counted as two tests towards the eight test limit). This quantity limit applies to OTC tests without a prescription only. 

Reimbursement guidelines: 

FDA Authorized OTC COVID self-tests will be reimbursed and include the following.
  • Abbott BinaxNOW 
  • SD Biosensor COVID At Home Test
  • Siemens’s CLINITEST Self Test
  • iHealth COVID-19 Self Test
  • Access Bio’s CareStart Self Test
  • BD Veritor At-Home Test
  • InBios SCov-2 Detect Self Test
  • OraSure InteliSwab Rapid Test
  • Cellitrion DiaTrust Home Test
  • QuickVue At Home Test
  • ACON Flowflex Home Test
  • Ellume Home Test
  • Detect COVID-19 Test
  • Lucira Check-it COVID-19 Test
  • Cue Covid-19 at home test