AT HOME OVER THE COUNTER COVID TEST REIMBURSEMENT INFO

How to get your At-Home Over-The-Counter COVID-19 Test

Starting January 15, per guidance from the “Agencies” (Department of Labor, Health and Human Services, and Treasury),
at-home over-the-counter (OTC) COVID-19 tests authorized by the U.S. Food and Drug Administration (FDA) can be
processed either free of charge through your MedOne prescription benefit or submitted for reimbursement. You will not
need a prescription or a note from your provider for coverage under this new guidance.

How do I get a free at-home over-the-counter (OTC) COVID-19 test?

We encourage you to firstly order your free at-home tests from directly via https://www.covidtests.gov/. These test kits
will not run through your MedOne prescription plan.

Effective for purchase dates on or after January 15, 2022, at-home over-the-counter COVID-19 tests authorized by the
U.S. Food and Drug Administration (FDA), can be processed either free of charge through your MedOne prescription
benefit or submitted for reimbursement. You will not need a prescription or a note from your provider for coverage
under this new guidance. The expiration of this guidance to cover at-home over-the-counter (OTC) COVID-19 tests under
the prescription benefit is unknown at this time.

Your prescription plan offers up to 8 free at-home over-the-counter COVID-19 tests authorized by the U.S. Food and
Drug Administration (FDA) per covered plan member per calendar month.

How much will I pay for a test kit processed at the pharmacy counter?

Please utilize a pharmacy in the MedOne network for processing of your test kit at point of sale (at the pharmacy
counter). The MedOne pharmacy network is the same network you utilize today for your prescription needs. If you have
the test kit ran through the MedOne pharmacy benefit at point of sale (at the pharmacy counter), your cost share will be
$0.

How much will I be reimbursed for an at-home COVID-19 test if I purchase the test upfront and then submit a claim
for reimbursement to MedOne (vs. it being ran through the MedOne pharmacy benefit at the pharmacy counter)?

Be sure to keep your receipt and product packaging if you need to submit a claim to MedOne for reimbursement.
MedOne will process your test kit claim at a rate of up to $12 per individual test (or the cost of the test, if less than
$12). Please see the attached OTC COVID-19 Test Claim form.

Where can I find a location that has at-home over-the-counter COVID-19 tests?

Plan members are encouraged to visit stores in-person or call to inquire about in-stock availability of test kits.

What if I buy more than one test at a time?

The plan is required to provide reimbursement for 8 tests per covered member per month, regardless of whether the tests are bought all at once or at separate times throughout the month. The tests may be packaged individually or with
multiple tests in one package (for example, two tests packaged in one box).

My employer requires that I test myself and send results as a condition of employment. Can I get these tests
reimbursed by the plan?

Under this guidance, plans are not required to provide coverage of testing (including an at-home over-the-counter
COVID-19 test) that is for employment purposes. Additionally, the guidance points out the tests must be for personal
use for a covered member under the prescription plan and has not been (or will not be) reimbursed by another source,
and is not for resale.

Who can I call if I have more questions?

If you have questions about processing of at-home over-the-counter COVID-19 tests through your MedOne prescription
benefit, please call MedOne at the phone number on your member ID card.

AT HOME OVER THE COUNTER COVID TEST REIMBURSEMENT FORM – CLICK HERE!