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COVID Test Kit Reimbursement

PCR COVID TESTING

If you go to a doctor’s office or wait in line at a public testing site, you will receive a polymerase chain reaction test (PCR). This is the most accurate test available for COVID, but you may have to wait anywhere from 24 hours to several days to get the results. There is no cost to Participants for PCR testing, but while it is the most accurate test, it may not always be warranted. The antigen test described below may be more appropriate for situations in need of faster response.

ANTIGEN COVID TESTING

When you go to a drug store, market, or wherever you shop for testing kits, you will get an antigen test that is capable of giving you results in 15 minutes. The Plan has negotiated with ESI so that all you have to do is present your insurance card to get the test(s). However, if there is a problem (this is a new program and they are still ironing out the wrinkles), or it is not a store where you normally shop, the Health Plan will reimburse up to $12 per test.

If you want, you can also order the tests from ESI by logging on to their website: https://www.express-scripts.com/covid-19/resource-center and they will mail you the tests.

There are few things to keep in mind about antigen testing:

  • While the results are available within 15 minutes, the antigen tests are not as accurate as the PCR test. If you have a positive result, you are most likely infected, but you may want to do tests over several days if you suspect you are infected with COVID in order to make sure the negative tests are correct.
  • Because the antigen tests are less sensitive to the Omicron COVID variant, you may get a false negative if you are infected with this strain.

If you are experiencing symptoms that you think may be due to COVID, or if you are going to be gathering with friends or family and want to be extra careful that no one is inadvertently exposed to COVID, an antigen test is a reasonable way to go.

If you get a positive result with an antigen test, you may want to contact your medical provider and arrange for a PCR test to make sure, but in the meantime, you can begin to monitor your symptoms in case you need additional medical care.

MAKING SENSE OF IT ALL

There are now many resources available to you at little or no cost, from vaccinations to treatments (including the new Pfizer pill, Paxlovid, and Merck’s Molnupiravir). The programs are federally sponsored, and will continue until the pandemic ends or the government comes up with new solutions. In the meantime, we urge everyone to take care, get tested, and stay safe. Together, we’ll get through this pandemic, and in the meantime, please use all the resources available.