Blue Cross Blue Shield of Vermont to Cover Certain Take Home Rapid COVID Tests

UPDATED: January 14, 2022

New Regulations for Plan Coverage of At-Home COVID Testing

Following federal regulations regarding the coverage of over the counter (OTC) COVID-19 tests, beginning January 15, 2022, members can receive reimbursement for the costs of at home COVID-19 tests. This applies to all members except those on retiree health care plans. Please note we are still working through all of the details and will continue to update this page in the following days and weeks.

Note: If you receive coverage through your employer and do not have Vermont Blue Rx pharmacy coverage (see below), your employer may have a preferred pharmacy established for you to receive this benefit. We encourage you to check with your employer to verify your COVID-19 rapid test coverage options.

If you are looking for at home tests, free tests may be available through government services. Visit COVIDtests.gov for more information. The Vermont Department of Health website also lists additional information about where to possibly find tests and when to use a test. 

Vermont Blue Rx Pharmacy Coverage

Back of Member ID Card
  • Members who have pharmacy benefits through Vermont Blue Rx can go to their local, in-network pharmacy, present their member ID Card, and request a take home rapid COVID-19 test covered under the pharmacy benefit. We encourage you to go through the pharmacy when possible as it is no cost to you and doesn’t require seeking reimbursement.

    Not sure if you have Vermont Blue Rx pharmacy coverage? Your ID card can help! If you have this coverage, your member ID card will have the Vermont Blue Rx logo on the back.
  • There is a limit of 8 tests per member, per month.

Reimbursement (beginning 01/15/2022)

If you purchased a COVID-19 test on/after January 15, 2022, and are seeking reimbursement, you must complete the below steps. There is a limit of 8 tests per member, per month.

  1. Complete the Member Medical Claim Form using the following information:
    • Provider Information: Include the name and address of the shop, vendor, or practice that sold you the test. 
    • Description of Service: COVID-19 Rapid At-Home Test
    • Procedure Code: 87426
    • Modifier: -CG
    • Diagnosis code: Z20.822
    • Charge: List the amount paid excluding any additional charges such as tax, postage, or shipping and handling.
    • Units: While we’re covering up to 8 tests per member, per month, our system allows only 3 kits to be billed on a single date. If you’ve purchased more than 3 kits on a single day, please split the purchase into 3 lines with the first line listing the date of purchase and the next line(s) listing subsequent day(s). Example: A member purchases 4 test kits on January 15. The claim should be entered as:
      • Line 1: 01/15/22 – 3 units
      • Line 2: 01/16/22 – 1 unit
    • POS: 12
  2. While members can submit a claim using fax or mail, the quickest and easiest method is to submit through the Member Resource Center, following the instructions on top of the claim form.
  3. Finally, don’t forget to include a copy of your receipt with the claim form.

Covered Tests

All over the counter rapid tests that have Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA) are covered under the federal regulation (antigen and LAMP tests). We will reimburse members for rapid COVID-19 tests listed on the FDA’s OTC approved list which are taken and read for results at home. Tests that are taken at home but sent to the lab for processing are not eligible for reimbursement at this time.

Tests that are purchased for return-to-work will not be covered per the federal regulations.

Additional Information

  • For more information about the coverage of at-home rapid COVID tests, contact our Customer Service team at (800) 247-2583.
  • We will also keep information updated on our COVID-19 Updates page.
  • The Vermont Department of Health is asking community members to confidentially report results for more accurate representation of active COVID-19 cases in the community.

Original News Release: December 8, 2021

Berlin, Vermont — Vermonters who receive their pharmacy benefit through Blue Cross and Blue Shield of Vermont (Blue Cross) will have coverage for certain FDA-authorized take home rapid COVID-19 tests beginning in December. As cases rise to alarming levels in our state, we need to use every tool at our disposal to stem the spread of COVID-19 in our communities. At-home testing is just one component and must be part of a suite of health precautions to keep our families and community safe this winter. 

Take-home rapid COVID-19 tests will be covered with a prescription from a provider or pharmacist. There is a limit on the number tests per person per month. Because of a shortage of tests nationally and difficulties for pharmacies in procuring the appropriate tests, we strongly encourage Vermonters to avoid stockpiling. All FDA-Approved test kits in the Medispan database will be covered through our member’s pharmacy benefit without any individual cost-share.

We join our Vermont health care partners in encouraging our neighbors to redouble their COVID precautions. Our hospitals are nearing capacity and ICUs are struggling to meet the demand of patients with high acuity while at the same time treating the high number of critical COVID cases. We must remain vigilant, despite our exhaustion with the pandemic. Please:

  • Wear a mask when indoors in public places, and outdoors when you are unable to social distance, and wash hands often.
  • Get vaccinated if you are not already and boosted as soon as you are able. Encourage your friends and loved ones to join you.
  • Stay home when you or your children are experiencing symptoms, and while awaiting test results. If your children are involved in a childcare or after-school program, remind them of your expectation around COVID precautions.

These safeguards will not only stem the spread of COVID, it will also keep your family, your parents, your friends, and your community safe as we fight this terrible disease together. 

How to get a free take home rapid COVID-19 test
Members who have pharmacy benefits through Vermont Blue Rx can go to their local, in-network pharmacy, present their member ID Card, and request a take home rapid COVID-19 test covered under the pharmacy benefit. When purchasing tests, you’ll want to show the member ID card for each family member you’re purchasing a test for.

For take home rapid COVID-19 tests purchased before January 15, 2022, there is a limit of 16 tests per month, per member. As many testing kits include 2 tests per package, this is generally 8 testing kits. Due to limited supply, some pharmacies may not have covered tests in stock. In this case, you will be asked to pay out of pocket and submit a reimbursement claim. 

Members who purchased a test kit prior to January 15, 2022, those out of the state of Vermont, or don’t have pharmacy coverage through Vermont Blue Rx, may also submit a claim for reimbursement. Coverage can vary for members covered through their employer. We encourage you to check with your employer to verify if your plan will cover the rapid at home tests.

Tips for seeking reimbursement for a take home rapid COVID-19 test purchased before 01/15/2022

  1. Before submitting a reimbursement form, see if your test qualifies. Blue Cross is covering over the counter rapid tests that have Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA). Test kits that do not have EUA or are taken at home but sent to the lab for processing are not eligible for reimbursement at this time. 
  2. Complete the Member Medical Claim Form using the following information:
    • Provider Information: Include the name and address of the shop, vendor, or practice that sold you the test. 
    • Description of Service: COVID-19 Rapid At-Home Test
    • Procedure Code: 87426
    • Modifier: -CG
    • Diagnosis code: Z20.822
    • Charge: List the amount paid excluding any additional charges such as tax, postage, or shipping and handling.
    • Units: Our system allows only 3 kits to be billed on a single date, so if you’ve purchased more than 3 kits on a single day, please split the purchase into 3 lines with the first line listing the date of purchase and the next two lines listing subsequent days. Example: A member purchases 4 test kits on January 5. The claim should be entered as:
      • Line 1: 01/05/22 – 3 units
      • Line 2: 01/06/22 – 1 unit
    • POS: 12
  3. While members can submit a claim using fax or mail, the quickest and easiest method is to submit through the Member Resource Center, following the instructions on top of the claim form.
  4. Finally, don’t forget to include a copy of your receipt with the claim form.