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COVID-19 coverage for members

Select your coverage type to view the enhanced health insurance benefits that are available to you. These benefits will stay in effect through the dates indicated on this page, so long as permitted under current state and federal emergency declarations.

$0 copay for the COVID-19 vaccine

No matter where in the country you get the COVID-19 vaccine, including the booster, it will be covered as a preventive service at no cost to you as a member.

No-cost COVID-19 diagnostic testing

Now through Oct. 13, 2022, we are waiving deductibles, copayments, and other cost-sharing for COVID-19 diagnostic testing when ordered by your medical provider.

Learn how to get tested

Early Prescription Refills

Early refill limits are waived on prescriptions filled at retail and specialty pharmacies until the end of the Public Health Emergency. Regular copays and other standard coverage requirements may apply.

UPMC MyHealth 24/7 Nurse Line

Our nurses offer support and advice on a wide range of health issues, including coronavirus. The MyHealth 24/7 Nurse Line is available at 1-866-918-1591 (TTY: 711).

$0 copay for virtual visits for the diagnosis of suspected COVID-19, including UPMC AnywhereCare

We are waiving all member cost sharing, including deductibles or copayments, for virtual health care visits for the diagnosis of suspected COVID-19. Preventive services that can be provided by telehealth will continue to be covered without member cost sharing.

If you are under the weather, you can reach a health care professional 24/7 without leaving your home through UPMC AnywhereCare*. Your smartphone, computer, or tablet is all you need!

Learn how to download the app, enroll, and use UPMC AnywhereCare
Visit UPMC AnywhereCare

In-network, inpatient COVID-19 treatment

Your plan includes coverage for necessary, comprehensive inpatient treatment of COVID-19. Standard provider network and authorization rules apply to non-emergency COVID-19 treatment. Effective January 21, 2022, these services will be covered subject to standard cost sharing under your plan.

Monoclonal antibody treatment

Coverage for necessary monoclonal antibody treatment is available when administered in accordance with FDA guidelines. Standard provider network rules apply to this treatment. Effective January 21, 2022, standard cost sharing under your plan will also apply to these services.

*UPMC Health Plan members located in Pennsylvania at the time of virtual visit may select a UPMC-employed provider or a provider from Online Care Network II, P.C. (OCN), subject to availability and discretion of the provider. Members located outside of Pennsylvania will receive service from OCN. OCN is not an affiliate of UPMC.

Your wait time for UPMC AnywhereCare may be longer than usual due to increased call volume. If there is a wait, you can stay in the virtual waiting room or choose "text me when the provider is available."

If you have questions about your coverage, see your plan documents or contact Member Services at 1-877-539-3080 (TTY: 711) seven days a week from 8 a.m. to 8 p.m. for the most up-to-date information regarding your benefits.

During the current public health emergency, members can receive no-cost diagnostic testing for COVID-19 when it is ordered by a licensed attending provider for purposes of individualized diagnosis and treatment.

$0 for the COVID-19 vaccine

All Pennsylvanians ages 6 months and older can get a COVID-19 vaccine.

The CDC’s guidelines for children receiving booster shots are:

First Boosters

  • Children ages 5+ can receive a Pfizer-BioNTech booster if they:

Second Boosters

  • Children ages 5-11 are not recommended to get second boosters at this time. Children ages 12+ can receive a second Pfizer-BioNTech booster if they:

Keep in mind that these guidelines can change over time as we learn more about COVID-19 vaccines and boosters, For the most current information, check the CDC website.

COVID-19 vaccine and booster shots are covered no matter which one your child gets or where your child gets it in the United States.

Purchase or Reimbursement for COVID-19 self-tests

UPMC for Kids (CHIP) members can purchase FDA approved COVID-19 self-tests, through an in-network pharmacy for $0 or request reimbursement for COVID-19 self-tests they have paid for out-of-pocket at retail. COVID-19 self-tests are home tests that can be purchased over-the-counter (OTC), are self-administered, and self-read. They are also called OTC, rapid, or rapid antigen tests.

Purchasing COVID-19 Self-Tests at the Pharmacy

UPMC for Kids (CHIP) members can purchase FDA approved COVID-19 self-tests at an in-network pharmacy for $0. If a COVID-19 self-test is purchased at an out-of-network pharmacy, you will have to pay out-of-pocket and request reimbursement using the COVID-19 Over-the-Counter (OTC) Testing Reimbursement form.

UPMC for Kids (CHIP) members can only get 2 COVID-19 self-tests per week when purchasing at a pharmacy.

No prescription is needed for purchasing COVID-19 self-tests at an in-network or out-of-network pharmacy. Tests that are mailed or dropped off at a lab or office, even if purchased OTC, are not eligible for $0 purchase or reimbursement. These lab-read tests are eligible for coverage only when obtained with a prescription.

Requesting Reimbursement

You can request reimbursement by submitting your COVID-19 Over-the-Counter (OTC) Testing Reimbursement form online or by calling a Health Care Concierge.

To submit online, view the COVID-19 Over-the-Counter (OTC) Testing Reimbursement form and instructions.

To speak with a Health Care Concierge call 1-833-280-8510 (TTY: 711) Monday through Friday from 7 a.m. to 7 p.m. and Saturday and Sunday from 8 a.m. to 5 p.m.

In addition to filling the form out, you will need to submit a picture or copy of your receipt (showing description and costs) and a picture of the test kit (showing the UPC/NDC code). Be sure to save a copy of your receipt for your own records. If the reimbursement request is missing any information or required documentation, claims may be denied. When possible, we will attempt to outreach to you to collect missing information. During periods of high volume, this outreach may be suspended in order to ensure that we can continue processing reimbursements as quickly as possible for all members. If your claim is denied, you can submit it again to correct any problems or supply missing information. You can submit for reimbursement up to 365 days from the date of purchase.

UPMC for Kids (CHIP) will only accept requests for reimbursement of COVID-19 self-test purchased on or after 08/30/2021.

UPMC for Kids (CHIP) members can request reimbursement for up to 8 COVID-19 self-tests per 28 days, per member. Please note, each individual COVID-19 self-test counts towards the total of 8 per 28 days, not each box, package, or set of testing kits. For example, if the item you purchased has two COVID-19 self-tests in the box, this will count as 2 COVID-19 self-tests with 6 eligible COVID-19 self-tests remaining for the 28 days.

Any FDA approved COVID-19 self-tests purchased from a U.S. retail or pharmacy location, including a U.S. retailer website (e.g., Amazon), is eligible for reimbursement. Only COVID-19 self-tests purchased from legally established retailers, whether online or in person, are eligible for coverage. COVID-19 self-tests purchased via eBay, Facebook Marketplace, or other person-to-person transactions are not eligible for reimbursement.

Members should exercise caution buying from websites that are unfamiliar to them, especially those that only sell COVID-19 self-tests, require members to enter insurance information, or that claim to handle submission of reimbursement requests on behalf of the member. While not all such sites are fraudulent, the high demand for COVID-19 self-tests has increased the risk of fraud.

Only COVID-19 self-tests that are purchased for individual diagnostic use are eligible for reimbursement. This includes testing following a known or suspected exposure or when experiencing symptoms of illness.

Our reimbursement process is normally completed within 60 days but due to the unique nature of this new coverage requirement, processing may be delayed during periods of high volume. We are issuing reimbursement checks as quickly as possible and appreciate your patience as we work to ensure that all UPMC for Kids (CHIP) members are able to receive reimbursement for their purchases.

No out-of-pocket costs for members for in-network COVID-19 treatment

No out-of-pocket costs for members for monoclonal antibody treatment

Monoclonal antibody treatment for COVID-19 is covered at no cost through Oct. 13, 2022. a,b

No-cost COVID-19 diagnostic testing

Now through Oct. 13, 2022, we are waiving copayments for COVID-19 diagnostic testing when ordered by your child’s medical provider.

Learn how to get tested

Early Prescription Refills

Early refill limits are waived on prescriptions filled at retail and specialty pharmacies until the end of the Public Health Emergency. Regular copays and other standard coverage requirements may apply.

UPMC MyHealth 24/7 Nurse Line

Our nurses offer support and advice on a wide range of health issues, including coronavirus. The MyHealth 24/7 Nurse Line is available at 1-866-918-1591 (TTY: 711).

$0 copay for virtual visits for the diagnosis of suspected COVID-19, including UPMC AnywhereCare

We are waiving all member copayments for virtual health care visits for the diagnosis of suspected COVID-19. Preventive services that can be provided by telehealth will continue to be covered without member cost sharing.

UPMC Health Plan's telemedicine service, UPMC AnywhereCare, has expanded to offer care to children of all ages. With UPMC Children's AnywhereCare*, children ages 0-17 can have virtual visits 24/7 with UPMC Children's Hospital of Pittsburgh providers over live video. Anytime, day or night. Members who are 18 years old and older will continue to use UPMC AnywhereCare.

Learn how to download the app, enroll, and use UPMC AnywhereCare
Visit UPMC AnywhereCare

Resources for UPMC for Kids Members

If you have experienced a financial hardship and are unable to pay your premiums because of a decrease or loss of income, please fill out our CHIP documentation form with “Income change/Reassessment” as your reason for contacting us. If you would like to speak to a representative, call us at 1-800-978-8762 (TTY: 711) Monday through Friday from 8 a.m. to 7 p.m.

UPMC for Kids

Visit UPMC for Kids to learn more about member benefits. For those currently enrolled in Pennsylvania Children’s Health Insurance Program (CHIP), CHIP has made temporary changes designed to ease access to CHIP and to keep families enrolled for the duration of the public health emergency. Read the COVID-19 CHIP Notice from the Pennsylvania Department of Human Services.

UPMC for Kids Members Health Care Concierge Services

If you have questions, our UPMC for Kids Health Care Concierge team will help you and your child every step of the way. Call 1-800-650-8762 (TTY: 711) Monday through Friday from 7 a.m. to 7 p.m. and Saturday from 8 a.m. to 3 p.m.

Health Management Programs

If your child needs day-to-day help with a health condition, UPMC for Kids is here for you, thanks to our care management programs. A nurse can help you and your child to better understand your child’s condition. Call 1-866-778-6073 (TTY: 711) Monday through Friday from 7 a.m. to 8 p.m. and Saturday from 8 a.m. to 3 p.m.

Additional Resources

The United Way of Pennsylvania

The United Way of Pennsylvania helps you connect with resources in your community, such as food/meals, housing, clothing, community services, financial assistance, and more. Visit pa211.org, dial 211, or text your ZIP code to 898-211.

Pennsylvania Statewide Support and Referral Helpline for COVID-19

The Department of Human Services has partnered with the Center for Community Resources (CCR) to create and staff the Pennsylvania Statewide Support and Referral Helpline for COVID-19. The Support and Referral Helpline is a 24-7 listening and referral service provided to all of Pennsylvania during the COVID-19 crisis. Call 1-855-284-2494 (TTY: 724-631-5600) to speak with a caseworker who’s there to counsel Pennsylvanians struggling with anxiety and other challenging emotions due to the COVID-19 emergency. You can also visit the Center for Community Resources.

Pennsylvania Department of Human Services

For emergency cash and food assistance visit COMPASS.

Food Assistance Resources

For the Food Bank’s Doorstep Delivery program, call 412-460-3663 ext. 655 Monday through Friday from 8 a.m. to 4:30 p.m. or visit Greater Pittsburgh Community Food Bank.

Behavioral Health Resources

It’s normal if you or your child(ren) are experiencing feelings of anxiety or depression right now. Resources are available to support you and your family’s mental well-being. Visit the websites or call the numbers below for more information.

If you have questions about your coverage, see your plan documents or contact Member Services for the most up-to-date information regarding your benefits.

*UPMC Children’s AnywhereCare is available only to patients who are in Pennsylvania. In order for a child to have a UPMC Children’s AnywhereCare visit, the child’s parent or legal guardian must be with the child during the video portion of the visit, and the child and parent or legal guardian must be in Pennsylvania during the visit. If you are located outside of Pennsylvania at the time of service, you may select the standard UPMC AnywhereCare module and you will receive care from a provider employed or contracted by Online Care Network II PC (OCN) at the discretion of the provider. OCN is not an affiliate of UPMC.

During the current public health emergency, members can receive no-cost diagnostic testing for COVID-19 when it is ordered by a licensed attending provider for purposes of individualized diagnosis and treatment.

aUPMC Health Plan will cover these services from in-network providers with no member cost share until Oct. 13, 2022, subject to permissibility under the current federal and/or state emergency declarations and associated guidance.

bFor more information on monoclonal antibody treatments, visit UPMC.com/AntibodyTreatment or call 866-804-5251 from 7 a.m. to 8 p.m., seven days a week.

$0 for the COVID-19 vaccine

All Pennsylvanians ages 6 months and older can get a COVID-19 vaccine.

CDC's Guidelines for Boosters

First Boosters

  • People ages 5+ can receive a Pfizer-BioNTech booster if they:
  • People ages 18+ can receive a Pfizer-BioNTech or Moderna booster if they:
    • Received a second Pfizer-BioNTech or Moderna shot at least 5 months ago.
    • Are moderately or severely immunocompromised and received a second Pfizer-BioNTech or Moderna shot at least 3 months ago.
    • Received a Johnson & Johnson/Janssen shot (only 1 shot needed) at least 2 months ago.

Second Boosters

  • You can receive a second Pfizer-BioNTech or Moderna booster if you are 50 years of age and older and received your first Pfizer-BioNTech, Moderna, or Johnson & Johnson/Janssen booster at least 4 months ago.
  • You can receive a second Pfizer-BioNTech or Moderna booster if you are moderately to severely immunocompromised and received your first Pfizer-BioNTech, Moderna, or Johnson & Johnson/Janssen booster at least 4 months ago.
    • People ages 12-17 will receive the Pfizer-BioNTech booster.
    • People ages 18+ will receive either the Pfizer-BioNTech or Moderna booster.

Keep in mind that these guidelines can change over time as we learn more about COVID-19 vaccines and boosters, For the most current information, check the CDC website.

COVID-19 vaccine and booster shots are covered no matter which one you or your child gets or where you or your child gets it in the United States.

Purchase or Reimbursement for COVID-19 self-tests

UPMC for You (Medicaid) members can purchase FDA approved COVID-19 self-tests, through an in-network pharmacy for $0 or request reimbursement for COVID-19 self-tests they have paid for out-of-pocket at retail. COVID-19 self-tests are home tests that can be purchased over-the-counter (OTC), are self-administered, and self-read. They are also called OTC, rapid, or rapid antigen tests.

Purchasing COVID-19 Self-Tests at the Pharmacy

UPMC for You (Medicaid) members can purchase FDA approved COVID-19 self-tests at an in-network pharmacy for $0. If a COVID-19 self-test is purchased at an out-of-network pharmacy, you will have to pay out-of-pocket and request reimbursement using the COVID-19 Over-the-Counter (OTC) Testing Reimbursement form.

No prescription is needed for purchasing COVID-19 self-tests at an in-network or out-of-network pharmacy. Tests that are mailed or dropped off at a lab or office, even if purchased OTC, are not eligible for $0 purchase or reimbursement. These lab-read tests are eligible for coverage only when obtained with a prescription.

Requesting Reimbursement

You can request reimbursement by submitting your COVID-19 Over-the-Counter (OTC) Testing Reimbursement form online or by calling a Health Care Concierge.

To submit online, view the COVID-19 Over-the-Counter (OTC) Testing Reimbursement form and instructions.

To speak with a Health Care Concierge call 1-833-280-8510 (TTY: 711) Monday through Friday from 7 a.m. to 7 p.m. and Saturday and Sunday from 8 a.m. to 5 p.m.

In addition to filling the form out, you will need to submit a picture or copy of your receipt (showing description and costs) and a picture of the test kit (showing the UPC/NDC code). Be sure to save a copy of your receipt for your own records. If the reimbursement request is missing any information or required documentation, claims may be denied. When possible, we will attempt to outreach to you to collect missing information. During periods of high volume, this outreach may be suspended in order to ensure that we can continue processing reimbursements as quickly as possible for all members. If your claim is denied, you can submit it again to correct any problems or supply missing information. You can submit for reimbursement up to 365 days from the date of purchase.

UPMC for You (Medicaid) will only accept requests for reimbursement of COVID-19 self-test purchased on or after 08/30/2021.

UPMC for You (Medicaid) members can purchase at the pharmacy or request reimbursement for up to 8 COVID-19 self-tests per 28 days, per member. Please note, each individual COVID-19 self-test counts towards the total of 8 per 28 days, not each box, package, or set of testing kits. For example, if the item you purchased has two COVID-19 self-tests in the box, this will count as 2 COVID-19 self-tests with 6 eligible COVID-19 self-tests remaining for the 28 days.

Any FDA approved COVID-19 self-tests purchased from a U.S. retail or pharmacy location, including a U.S. retailer website (e.g., Amazon), is eligible for reimbursement. Only COVID-19 self-tests purchased from legally established retailers, whether online or in person, are eligible for coverage. COVID-19 self-tests purchased via eBay, Facebook Marketplace, or other person-to-person transactions are not eligible for reimbursement.

Members should exercise caution buying from websites that are unfamiliar to them, especially those that only sell COVID-19 self-tests, require members to enter insurance information, or that claim to handle submission of reimbursement requests on behalf of the member. While not all such sites are fraudulent, the high demand for COVID-19 self-tests has increased the risk of fraud.

Only COVID-19 self-tests that are purchased for individual diagnostic use are eligible for reimbursement. This includes testing following a known or suspected exposure or when experiencing symptoms of illness.

Our reimbursement process is normally completed within 60 days but due to the unique nature of this new coverage requirement, processing may be delayed during periods of high volume. We are issuing reimbursement checks as quickly as possible and appreciate your patience as we work to ensure that all UPMC for You (Medicaid) members are able to receive reimbursement for their purchases.

No out-of-pocket costs for members for in-network COVID-19 treatment

Now through Oct. 13, 2022, we are waiving all deductibles, coinsurance, and copays for in-network, inpatient COVID-19 treatment for members.

No out-of-pocket costs for members for monoclonal antibody treatment

Monoclonal antibody treatment for COVID-19 is covered at no cost through Oct. 13, 2022. a,b

No-cost COVID-19 diagnostic testing

Now through Oct. 13, 2022, we are waiving deductibles, copayments, and other cost-sharing for COVID-19 diagnostic testing when ordered by your medical provider.

Learn how to get tested

Early Prescription Refills

Early refill limits are waived on prescriptions filled at retail and specialty pharmacies until the end of the Public Health Emergency. Regular copays and other standard coverage requirements may apply.

UPMC MyHealth 24/7 Nurse Line

Our nurses offer support and advice on a wide range of health issues, including coronavirus. The MyHealth 24/7 Nurse Line is available at 1-866-918-1591 (TTY: 711).

$0 copay for virtual visits for the diagnosis of suspected COVID-19, including UPMC AnywhereCare

We are waiving all member copayments for virtual health care visits for the diagnosis of suspected COVID-19. Preventive services that can be provided by telehealth will continue to be covered without member cost sharing.

If you or your child is under the weather, you can reach a health care professional 24/7 without leaving your home through UPMC AnywhereCare* and Children’s AnywhereCare. Your smartphone, computer, or tablet is all you need!

With Children’s AnywhereCare, your child (ages 0-17) can now have a video visit with a provider from UPMC Children’s Hospital of Pittsburgh.**

Learn how to download the app, enroll, and use UPMC AnywhereCare
Visit UPMC AnywhereCare

*UPMC Health Plan members located in Pennsylvania at the time of a virtual visit may select a UPMC-employed provider or a provider from Online Care Network II, P.C. (OCN), subject to availability and discretion of the provider. During the COVID emergency, members located outside of Pennsylvania will receive service from OCN. OCN is not an affiliate of UPMC. After the COVID emergency ends, UPMC AnywhereCare virtual visits are not covered services when UPMC for You and UPMC Community HealthChoices members are traveling outside of Pennsylvania.

Your wait time for UPMC AnywhereCare may be longer than usual due to increased call volume. If there is a wait, you can stay in the virtual waiting room or choose "text me when the provider is available."

If you have questions about your coverage, see your plan documents or contact Member Services for the most up-to-date information regarding your benefits.

**UPMC Children’s AnywhereCare is available only to patients who are in Pennsylvania. In order for a child to have a UPMC Children’s AnywhereCare visit, the child’s parent or legal guardian must be with the child during the video portion of the visit, and the child and parent or legal guardian must be in Pennsylvania during the visit. During the COVID emergency, members located outside of Pennsylvania will receive service from Online Care Network II PC (OCN). OCN is not an affiliate of UPMC. After the COVID emergency ends, UPMC AnywhereCare virtual visits are not covered services when UPMC for You members are traveling outside of Pennsylvania.

During the current public health emergency, members can receive no-cost diagnostic testing for COVID-19 when it is ordered by a licensed attending provider for purposes of individualized diagnosis and treatment.

aUPMC Health Plan will cover these services from in-network providers with no member cost share until Oct. 13, 2022, subject to permissibility under the current federal and/or state emergency declarations and associated guidance.

bFor more information on monoclonal antibody treatments, visit UPMC.com/AntibodyTreatment or call 866-804-5251 from 7 a.m. to 8 p.m., seven days a week.

$0 for the COVID-19 vaccine

All Pennsylvanians ages 6 months and older can get a COVID-19 vaccine.

CDC's Guidelines for Boosters

First Boosters

  • People ages 5+ can receive a Pfizer-BioNTech booster if they:
  • People ages 18+ can receive a Pfizer-BioNTech or Moderna booster if they:
    • Received a second Pfizer-BioNTech or Moderna shot at least 5 months ago.
    • Are moderately or severely immunocompromised and received a second Pfizer-BioNTech or Moderna shot at least 3 months ago.
    • Received a Johnson & Johnson/Janssen shot (only 1 shot needed) at least 2 months ago.

Second Boosters

  • You can receive a second Pfizer-BioNTech or Moderna booster if you are 50 years of age and older and received your first Pfizer-BioNTech, Moderna, or Johnson & Johnson/Janssen booster at least 4 months ago.
  • You can receive a second Pfizer-BioNTech or Moderna booster if you are moderately to severely immunocompromised and received your first Pfizer-BioNTech, Moderna, or Johnson & Johnson/Janssen booster at least 4 months ago.
    • People ages 12-17 will receive the Pfizer-BioNTech booster.
    • People ages 18+ will receive either the Pfizer-BioNTech or Moderna booster.

Keep in mind that these guidelines can change over time as we learn more about COVID-19 vaccines and boosters, For the most current information, check the CDC website.

COVID-19 vaccine and booster shots are covered no matter which one you get or where you get it in the United States.

CARES Act and enhanced benefits for members

The Coronavirus Aid, Relief, and Economic Stimulus (CARES) Act helps to protect Americans from the impacts of COVID-19. Benefits include:

  • Diagnostic testing for COVID-19 ordered or administered by a provider. All tests are subject to current standards of medical practice, including but not limited to CDC guidance on the appropriate use of testing.
  • Visits. Emergency department, doctor’s office, telemedicine, and urgent care visits that involve a diagnostic assessment of the need for COVID-19 testing and/or that result in necessary COVID-19 diagnostic testing. This includes related diagnostic services provided during the visit (e.g., other labs or chest imaging) as part of the COVID-19 assessment.
    • Vaccinations for COVID-19 (including boosters).*
    • Over-the-Counter (OTC) COVID-19 tests (full cost of up to 8 per member per month).
      • See additional information below under “Reimbursement for COVID-19 self-tests”

Learn how to get tested

Reimbursement for COVID-19 self-tests

Commercial members can request reimbursement for COVID-19 self-tests they have paid for out-of-pocket at retail. Self-tests are home tests that can be purchased over-the-counter (OTC), are self-administered, and self-read. They are also called OTC, rapid, or rapid antigen tests.

Sign in using your UPMC Health Plan login to complete the COVID-19 Over-the-Counter (OTC) Testing Reimbursement form online

View COVID-19 Over-the-Counter (OTC) Testing Reimbursement form and instructions (PDF)

Call a Health Care Concierge at 1-833-280-8510 (TTY: 711) Monday through Friday from 7 a.m. to 7 p.m. and Saturday and Sunday from 8 a.m. to 5 p.m.

In addition to filling the form out, you will need to submit a picture or copy of your receipt (showing description and costs) and a picture of the test kit (showing the UPC/NDC code). Be sure to save a copy of your receipt for your own records. If the reimbursement request is missing any information or required documentation, claims may be denied. When possible, we will attempt to outreach to you to collect missing information. During periods of high volume, this outreach may be suspended in order to ensure that we can continue processing reimbursements as quickly as possible for all members. If your claim is denied, you can submit it again to correct any problems or supply missing information. You can submit for reimbursement up to 365 days from the date of purchase.

Each member must fill out their own, separate, individual form. For example, if you bought a COVID-19 self-test for yourself and your two children, you would need to submit three separate reimbursement forms; One for yourself and one for each of your children. If you have a dependent who does not live at home, they can submit their own request for reimbursement up to the quantity of 8 eligible COVID-19 self-tests per month. Reimbursement checks are only issued to the name/address of the primary subscriber on the policy. A dependent who submits their own form will still receive a check issued to the subscriber on the account.

UPMC Health Plan will only accept requests for reimbursement of COVID-19 self-test purchased on or after 1/15/2022.

Any FDA authorized test purchased from a U.S. retail or pharmacy location, including a U.S. retailer website (e.g., Amazon), is eligible for reimbursement. Only COVID-19 self-tests purchased from legally established retailers, whether online or in person, are eligible for coverage. COVID-19 self-tests purchased via eBay, Facebook Marketplace, or other person-to-person transactions are not eligible for reimbursement.

Members should exercise caution buying from websites that are unfamiliar to them, especially those that only sell COVID-19 self-tests, require members to enter insurance information, or that claim to handle submission of reimbursement requests on behalf of the member. While not all such sites are fraudulent, the high demand for COVID-19 self-tests has increased the risk of fraud.

Only COVID-19 self-tests that are purchased for individual diagnostic use are eligible for reimbursement. This includes testing following a known or suspected exposure or when experiencing symptoms of illness. Reimbursement for provider ordered tests must be completed using the out-of-network claim form.

Each commercial member can request reimbursement for up to 8 COVID-19 self-tests per calendar month, per member. Please note, each individual COVID-19 self-test counts towards the total of 8 per calendar month, not each box, package, or set of testing kits. For example, if the item you purchased has two COVID-19 self-tests in the box, this will count as 2 COVID-19 self-tests with 6 eligible COVID-19 self-tests remaining for the calendar month.

Our reimbursement process is normally completed within 60 days but due to the unique nature of this new coverage requirement, processing may be delayed during periods of high volume. We are issuing reimbursement checks as quickly as possible and appreciate your patience as we work to ensure that all commercial members are able to receive reimbursement for their purchases.

UPMC Health Plan enhanced benefits

COVID-19 member cost-sharing waivers (such as deductibles, copays, and coinsurance) for the following services are not mandated by the CARES Act or other guidance. As indicated in previous documentation of our COVID-19 benefit extensions, these enhancements will end and applicable cost-sharing will be reinstated effective January 21, 2022. This includes the following services:

  • In-network inpatient treatment of COVID-19.
  • In-network monoclonal antibody treatment for COVID-19.
  • Necessary emergency and inpatient treatment for members who experience a severe adverse reaction requiring emergency medical care immediately following vaccine administration.
  • Follow-up mammograms or ultrasounds due to abnormal screening results shortly after receipt of COVID-19 vaccine due to swollen lymph nodes.

Beginning January 21, 2022, these services will be covered subject to standard cost sharing under your plan.

UPMC MyHealth 24/7 Nurse Line

Our nurses offer support and advice on a wide range of health issues, including coronavirus. The MyHealth 24/7 Nurse Line is available at 1-866-918-1591 (TTY: 711).

*Coverage applies to FDA-authorized vaccines administered in the United States.

Purchase or Reimbursement for COVID-19 self-tests

UPMC Community HealthChoices (CHC) members can purchase FDA approved COVID-19 self-tests, through an in-network pharmacy for $0 or request reimbursement for COVID-19 self-tests they have paid for out-of-pocket at retail. COVID-19 self-tests are home tests that can be purchased over-the-counter (OTC), are self-administered, and self-read. They are also called OTC, rapid, or rapid antigen tests.

Purchasing COVID-19 Self-Tests at the Pharmacy

UPMC Community HealthChoices (CHC) members can purchase FDA approved COVID-19 self-tests at an in-network pharmacy for $0. If a COVID-19 self-test is purchased at an out-of-network pharmacy, you will have to pay out-of-pocket and request reimbursement using the reimbursement form COVID-19 Over-the-Counter (OTC) Testing Reimbursement form.

No prescription is needed for purchasing COVID-19 self-tests at an in-network or out-of-network pharmacy. Tests that are mailed or dropped off at a lab or office, even if purchased OTC, are not eligible for $0 purchase or reimbursement. These lab-read tests are eligible for coverage only when obtained with a prescription.

Requesting Reimbursement

You can request reimbursement by submitting your COVID-19 Over-the-Counter (OTC) Testing Reimbursement form online or by calling a Health Care Concierge

To submit online, view the reimbursement form and instructions.

To speak with a Health Care Concierge call 1-833-280-8510 (TTY: 711) Monday through Friday from 7 a.m. to 7 p.m. and Saturday and Sunday from 8 a.m. to 5 p.m.

In addition to filling the form out, you will need to submit a picture or copy of your receipt (showing description and costs) and a picture of the test kit (showing the UPC/NDC code). Be sure to save a copy of your receipt for your own records. If the reimbursement request is missing any information or required documentation, claims may be denied. When possible, we will attempt to outreach to you to collect missing information. During periods of high volume, this outreach may be suspended in order to ensure that we can continue processing reimbursements as quickly as possible for all members. If your claim is denied, you can submit it again to correct any problems or supply missing information. You can submit for reimbursement up to 365 days from the date of purchase.

UPMC Community HealthChoices (CHC) only accept requests for reimbursement of COVID-19 self-test purchased on or after 08/30/2021.

UPMC Community HealthChoices (CHC) members can purchase at the pharmacy or request reimbursement for up to 8 COVID-19 self-tests per 28 days, per member. Please note, each individual COVID-19 self-test counts towards the total of 8 per 28 days, not each box, package, or set of testing kits. For example, if the item you purchased has two COVID-19 self-tests in the box, this will count as 2 COVID-19 self-tests with 6 eligible COVID-19 self-tests remaining for the 28 days.

Any FDA authorized COVID-19 self-test purchased from a U.S. retail or pharmacy location, including a U.S. retailer website (e.g., Amazon), is eligible for reimbursement. Only COVID-19 self-tests purchased from legally established retailers, whether online or in person, are eligible for coverage. COVID-1 self-tests purchased via eBay, Facebook Marketplace, or other person-to-person transactions are not eligible for reimbursement.

Members should exercise caution buying from websites that are unfamiliar to them, especially those that only sell COVID-19 self-tests, require members to enter insurance information, or that claim to handle submission of reimbursement requests on behalf of the member. While not all such sites are fraudulent, the high demand for COVID-19 self-tests has increased the risk of fraud.

Only COVID-19 self-tests that are purchased for individual diagnostic use are eligible for reimbursement. This includes testing following a known or suspected exposure or when experiencing symptoms of illness.

Our reimbursement process is normally completed within 60 days but due to the unique nature of this new coverage requirement, processing may be delayed during periods of high volume. We are issuing reimbursement checks as quickly as possible and appreciate your patience as we work to ensure that all UPMC Community HealthChoices (CHC) members are able to receive reimbursement for their purchases.