COVID-19 Update view more

Coronavirus (COVID-19) testing and treatment coverage

1/17/2022

Updated: January 17, 2022

Find Testing Near You

Health Centers: Federally qualified health centers are an important part of the national response to the COVID-19 pandemic. Find a health center near you for available COVID-19 screening and testing. Please call the health center for more information about availability of low or no-cost testing. Additional testing sites may be available in your area. Contact your health care provider or your state or local public health department for more information.

Pharmacy Testing Sites: The Department of Health and Human Services (HHS) has established more than 10,000 free community-based pharmacy testing sites around the country. To respond to the omicron variant surge, HHS and the Federal Emergency Management Agency (FEMA) are creating surge testing sites in states across the nation. Find a pharmacy testing site near you for available COVID-19 screening and testing.

Effective January 15, 2022, new Federal guidance requires private health insurers to cover up to eight at-home COVID-19 tests per month for commercial plan members without cost sharing. Note that provider ordered tests do not count toward the monthly limit. This coverage requirement will last until the end of the Federal Public Health Emergency.

Specifics about the finalized guidance:

  • Commercial plan members of CommunityCare (either through group or individual coverage) are able to be reimbursed by CommunityCare for OTC tests they purchase through mail, retail, or online.
  • Reimbursement for tests is limited to the lesser of the actual cost or $12 per test.
  • CommunityCare is working with our pharmacy network to provide access via retail and mail order through direct coverage rather than member reimbursement; however, this is not a requirement of the final guidance.
  • Members may obtain, without cost share, a maximum of 8 OTC tests per covered individual on a monthly basis. Note, the 8 test limit is measured per test, so if a testing kit has 2 tests per package, the limit would be 4 packages.
  • The guidance clearly identifies that it does not impact prior guidance indicating plans are not required to cover the cost of surveillance testing, tests for return to work screening or other employment related purposes.
  • The guidance also allows health plans to continue fraud, waste, and abuse mitigation programs and permits plans to require a patient attestation to purpose.

CommunityCare will be fully compliant with the new Federal guidance regarding at-home diagnostic tests or over the counter COVID-19 testing by January 15th, 2022.

COVID-19 treatment

Member cost share including copays, coinsurance and deductibles will be applied in accordance with your benefit plan for treatment related to COVID-19.

Telemedicine services

Effective January 1, 2022, CommunityCare will adopt standard Telemedicine benefits as required under the Oklahoma Telehealth Parity Law for all commercial plans excluding Grandfather and Transitional (aka Grandmother) plans.

For Services that can be performed via Telemedicine the cost-share will be the same as if the service was provided at non-Telemedicine location. (Example: A Primary Care office location visit and a Primary Care telehealth visit will have the same copay applied.)

Medicare Advantage plans will follow Centers for Medicare & Medicaid Services (CMS) guidelines and list of services eligible for Telemedicine.

If you have questions, please contact your provider relations representative or the Provider Connection Line at (918) 594-5207 or (877) 321-0018.

Prior authorization

Prior authorization will not be required for any COVID-19 testing or COVID-19 disease treatment, such as outpatient or inpatient therapeutics or COVID-19 related prescription medications. Prior authorization will be required for facility admissions.

Prescription refills

Early refills of maintenance medications from the pharmacy will also be covered, and longer fills up to 90 days for employer group members and many medications up to 100 days for our Medicare Advantage members are available.

Contact us

Members may contact CommunityCare customer service at (918) 594-5242 for questions about coverage or information on how to access telemedicine services and what will be required for reimbursement.

Helpful resources to keep you informed






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