The Department of Employee Trust Funds is working with state health officials and health plans participating in the State of Wisconsin Group Health Insurance Program to ensure you receive the care you and/or your covered dependents need during the COVID-19 pandemic. For more information about group health insurance benefits and coverage related to the COVID-19 pandemic, visit Your Health Benefits and COVID-19.
Below you will find important information and resources about federally regulated COVID-19 at-home test kit coverage effective January 15, 2022.
- Non-Medicare Member Coverage
- Medicare Member Coverage
- Excluded COVID-19 Test Types
- Pre-Tax Saving Account Coverage
- COVID-19 Test Kit Coverage Resources
Every household is eligible to order four (4) free at-home COVID-19 tests. Orders will usually ship in 7-12 days.
If you are enrolled in the Group Health Insurance Program and not yet on Medicare, you have coverage for eight (8) individual at-home COVID-19 tests every 30 days. Tests can be purchased from pharmacies, retail locations, or online. Only tests approved by the Federal Food and Drug Administration, or FDA, will be covered. To verify if a test is approved by the FDA, see this list of approved at-home test kits and scroll down to view a searchable table of approved tests.
As of January 18, 2022: All test coverage for non-Medicare members will be processed through Navitus, the pharmacy benefit manager.
- Test limits: You are covered for eight (8) individual at-home COVID-19 tests every 30 days effective January 15, 2022.
- Tests are counted individually, not per box – i.e., four (4) boxes with two (2) tests each equals eight (8) tests.
- If you buy your test at a pharmacy:
- Purchase tests at the pharmacy counter to ensure the Navitus pharmacy benefit is applied correctly.
- Tests will be covered with no out-of-pocket costs at in-network pharmacy chains and groups.
- To see in-network pharmacies near you anywhere in the United States, including local Wisconsin pharmacies, go to www.etf.benefits.navitus.com, click on your plan type (blue boxes), and the Pharmacy Search option will appear in the right-hand menu.
- Tests purchased at a non-network pharmacy can be reimbursed up to $12 per test by submitting a reimbursement claim form and any required documentation to Navitus.
- If you want to purchase more than 8 individual tests in a 30-day period (i.e., 5 boxes with 2 tests each) you will be charged for the additional tests at $12 per test in-network and $48 per test out-of-network.
- If you buy your tests from a retail store, online, or at a provider’s office:
- Submit a reimbursement claim form and any required documentation to Navitus.
- The maximum reimbursement amount for tests purchased at a retail location is $12 per test.
Information about test coverage may also be available from your health plan. Your health plan may contact you directly via mail, email, or text message with additional details about at-home test kit coverage—which may include instructions to purchase tests through Navitus or to submit a Navitus reimbursement claim form.
Centers for Medicare & Medicaid Services (CMS) will not currently reimburse Medicare members for over-the-counter test kit purchases.
- Original Medicare cannot pay for at-home tests through this program at this time. Medicare programs offered by ETF—including the Medicare Advantage, Medicare Plus, and Medicare Coordinated plans—will not reimburse for over-the-counter tests.
Medicare members have several resources to receive free at-home tests, including:
- Collection kits provided by the State of Wisconsin and Vault Medical Services
- HHS-provided test kits available at community health centers and Medicare-certified clinics. Learn more about this program here.
Only at-home COVID-19 tests purchased for personal use on or after January 15, 2022, will be covered.
The following tests are excluded from coverage:
- Tests to meet employer requirements, such as testing in lieu of vaccination.
- Tests for public health surveillance (i.e., not to diagnose a specific condition).
- Tests that are not specifically for you or a covered dependent.
Laboratory diagnostic (sometimes called PCR tests) and antibody tests still require orders from a doctor to be covered.
At-home COVID-19 testing kits will continue to be an eligible expense for Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA).
- Your FSA/HSA funds can be used to purchase additional tests during each 30-day period covered by pharmacy and medical benefits.
- You can pay for COVID-19 tests using your FSA/HSA payment card, or pay for the test out of pocket and submit a claim for reimbursement through the Optum Financial member portal, mobile app, or claims form.
For more information about coverage for at-home COVID-19 test kits, visit: