Effective January 1, 2021, and for so long as the COVID-19 Public Health Emergency remains in effect, the Plan-wi1l cover immunization that is intended to prevent or mitigate coronavirus disease (COVID-19) and that is, with respect to the individual involved:
Practices of the Centers for Disease Control and Prevention (CDC), which has been adopted by the Director of the CDC, (a "Qualifying Coronavirus Preventive Service") on an in-network and out-of-network basis, without participant cost sharing (such as a copayment, coinsurance, or a deductible), prior authorization, or other medical management requirements.
As of January 15, 2022, in accordance with the latest federal mandate, the Trustees of Teamsters Local 641 Welfare Fund will cover at-home, self-administered COVID-19 test kits for our Plan members without a prescription. The most convenient way to obtain these kits, at no cost to you, is to use your Express Scripts Pharmacy card at any participating pharmacy. You may also be reimbursed for purchased kits by forwarding a reimbursement claim form to Express Scripts. Claims and instructions may be obtained at https://express-scripts.com/covid-19/resource-center
Coverage is limited to eight at home over the counter self-administered COVID-19 tests per covered individual in a household per 30-days without a healthcare provider order or clinical assessment. If multiple tests are sold in one package, (one package includes two tests), it counts as two tests toward the quantity limit.
To be eligible for reimbursement, of purchased COVID-19 tests:
- Must be purchased on or after January 15, 2022 -Must be for personal
- Must be used to identify the potential COVID-19 infection
- May not used for employment purposes
- May not used for surveillance testing
- Must be self-administered with results that can be self-read
- Must not be resold, given, or supplied to persons other than family
members covered under the same policy
- Will not be reimbursed by any other source but through Express Scripts
- Reimbursement amount for each individual test is $12.00, regardless o
PLEASE NOTE: that residential households may also order four free tests through USPS at the following website: https://special.usps.com/testkits .For additional details on the requirements, please visit https://www.cms.gov/files/document/faqs-part-51.pdf
If you are covered under Medicare Part B
- Medicare Part B will cover a COVID-19 test received at a hospital, laboratory, pharmacy,
or doctor's office if it is ordered by a doctor or another authorized health care
- Medicare Part B does not pay for over-the-counter COVID-19 tests at this time.
- Free Home Tests can be obtained at the above USPS site and some community Centers
We will let you know if Medicare changes the above coverages.
If you have any questions on the above enhancements to our Plan, please do not hesitate to contact us at the Welfare Fund Office at (908) 687-4488.
NANCY FRADELLA - CLAIMS ANALYST
ALICE RYAN - CLAIMS ANALYST