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COVID-19 Testing Coverage

Your health plan covers COVID-19 testing in full*, including antibody testing, if:

  • You show possible symptoms or have had known close contact with someone else who has tested positive for COVID-19 AND
  • It is ordered by your doctor and deemed medically appropriate

Please Note: COVID-19 testing for those who do not have symptoms, but who are required to have testing by their employer, school or a government or public health agency, is not covered.

Free COVID-19 testing is available at any of the 700+ testing sites throughout New York state operated by the New York State Department of Health (NYSDOH). Anyone can get tested and you do not need to show symptoms of COVID-19, although appointments may be required. To find a NYSDOH testing site, please call the health department’s 24-hour hotline at 1-888-364-3065 or refer to the New York Department of Health website.

*For self-insured group plan members, please consult with your employer’s human resources or health benefits representative for COVID-19 testing-related benefits.

 COVID-19 Viral and Antibody Testing Policy
COVID-19 Testing LocationsCOVID-19 Testing Coverage FAQNY Cluster Zone Lookup Tool
COVID-19 Testing Coverage FAQ for Commercial, Medicaid Managed Care and Medicare Advantage Plan Members

What are the different COVID-19 tests?

There are two primary types of tests associated with COVID-19. The diagnostic/viral test is for the purpose of diagnosing and treating an active COVID-19 infection. It is recommended for use in individuals with COVID-19 symptoms or a known or suspected exposure to COVID-19. The antibody test is for the purpose of determining whether there was a past COVID-19 infection.

What are the standards that apply to these tests for them to be considered for coverage?

We provide coverage in full for diagnostic/viral testing as well as antibody testing that an attending provider determines is medically appropriate for an individual as evidenced by an order from the attending provider. These tests must be FDA approved or the subject of an emergency use order request and the lab performing the testing must be appropriately certified (under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and applicable New York state law and regulation) to be considered for coverage.

If my employer or school requires me to have a COVID-19 test, will my insurance cover the cost?

No. Testing that is ordered or performed solely for purposes of pandemic control or re-opening the economy, and not based on a determination by an attending provider that the test is medically appropriate for the diagnosis and treatment of an individual is not covered under the member’s health benefit. This includes tests performed on someone with no symptoms to assess health status as required by parties such as a government/public health agency, employer, school, or camp.

Please note that free COVID-19 testing is available at locations across the state operated by the New York State Department of Health.  Individuals do not need to be symptomatic or essential workers to obtain a test from these state sites.  For more information, call the health department’s 24-hour hotline at 1-888-364-3065.

I am curious about my own immunity to COVID-19. If I ask my doctor to order the antibody test for me, will it be covered by my health insurance [health benefits plan]?

The NYS Department of Health has issued recommendations to health care providers for determining when a test is medically appropriate. Testing when ordered upon the request of a member solely to facilitate the member’s desire to self-assess COVID-19 immunity status is not a recommended basis for testing and is not covered.

If I order a home testing kit on my own, will you reimburse me for that?

No. No testing is covered without an attending provider’s determination that the test is medically appropriate for an individual, as evidenced by an order.

Can I get my test done at my local pharmacy and have my insurance pay for it?

If an attending provider, including a pharmacist, determines that the test is medically appropriate for you and orders the test, the test can be performed at your local pharmacy if the pharmacy has received approval to conduct such testing under the waiver authority of CLIA and is approved by the NYS Department of Health as a limited service laboratory.

If I go to an urgent care center, can I get my test done there and have it covered?

For a test to be covered through your insurance, it must be prescribed by an attending provider who has determined through an individual assessment that a test is medically appropriate for you. The NYS Department of Health has issued guidance to health care providers for determining when a test is medically appropriate. Testing when ordered upon the request of a member solely to facilitate the member’s desire to self-assess COVID-19 immune status is not a recommended basis for testing and is not covered.

Do these rules apply to members of Medicaid managed care or Child Health Plus?

Yes.

Do these rules apply to members of Medicare Advantage plans?

Yes.
If You Suspect You May Need Testing:
If you believe you may have symptoms of COVID-19, visit the Centers for Disease Control and Prevention's website for an updated list of symptoms and other resources.
  1. Do not go directly to any doctor’s office, emergency room or urgent care center – Call your primary care doctor first
  2. Practice social distancing
  3. A telehealth visit using your smartphone, tablet, or computer is also an option for initial screenings. Note: Due to high call volumes, wait times may be longer than usual.
  1. You can contact your local county health department for testing options if you don’t have a primary care doctor.
Learn about Telemedicine and Schedule Appointment
COVID-19 Health Information

Given that the COVID-19 situation is rapidly evolving, the best resources for up-to-date health information are:

Remember

Follow the 3 W's

WASH Your Hands
WEAR A Mask
WATCH Your Distance
Watch: How to Properly Wear a Mask

You may think you know how to wear a mask, but these quick tips will help you know you're fully protecting yourself.

Watch
Don't Forget About The Flu
Because of COVID-19, it’s even more important to do everything you can to keep yourself and your family healthy. This includes getting a flu shot. Everyone six months of age and older should get the flu vaccine annually – especially if you or someone in your home is at higher risk. To get your flu shot, visit your local pharmacy, your doctor, or see if your employer offers the flu vaccine.
Stay Informed
The best way to stay informed and have access to your coverage is online. Let’s get you set up online today. For help or questions with your insurance plan, call the number on your Member Card for personalized care, or contact us.
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