WebIf you purchase the test through a retailer (e.g., at the front register), you will be charged the full cost of the test and will need to submit a claim form to be reimbursed. Reimbursement will be $12 per OTC test. Tests obtained at an out-of-network pharmacy or retailer are eligible for reimbursement at $12 per OTC test. Members will be ... WebJan 15, 2024 · COVID-19 Over-the-Counter Test Reimbursement Form Complete this form for each covered member You can submit up to 8 tests per covered member per month Tests must be FDA-authorized Tests must be purchased on or after January 15, 2024 Your commercial plan will reimburse you up to $12 per test.
COVID-19 Testing, Treatment, and Reimbursement
WebBeginning Jan. 15, 2024, UnitedHealthcare will cover the cost of FDA -authorized or approved over-the-counter (OTC) at -home COVID-19 diagnostic tests purchased on or after Jan. 15, 2024, through the end of the national public health emergency on May 11, 2024. WebJan 24, 2024 · You can submit a claim to United Healthcare online at myuhc.com or by downloading, printing and mailing a reimbursement form. If you complete the form offline, mail it to the address on... rod wave dark conversation
Forms - OptumRx
WebInstructions for submitting form 1. Covered member can submit a monthly claim form for up to (8) COVID 19 test kits or as defined by your State benefit. 2. Include the original receipt for each COVID-19 test kit 3. Read the Acknowledgement (section 4) on the front of this form carefully. Then sign and date. Print page 2 of this form on the back ... WebOver-the-counter, at-home COVID-19 Test Reimbursement Claim Form Important! • If you are submitting for over-the-counter, at-home COVID-19 test reimbursement, you need to complete and sign the claim form. Do not submit for at-home COVID-19 test reimbursement without signing the claim form or your submission will be rejected. WebSubscriber’s Statement of Claim. Send this claim to: Blue Shield of California, P.O. Box 272540, Chico, CA, 95927-2540. Please note that this form is to be used only when the … oura market cap