Individual + family plan COVID-19 FAQs

We’ll waive your copays, coinsurance and deductibles for medically necessary in-network COVID-19 diagnostic testing. This applies to testing that meets guidelines from Centers for Disease Control (CDC) and the Food and Drug Administration (FDA), and is ordered by an in-network medical professional. Testing isn’t covered as part of a return-to-work requirement, public surveillance program, or travel requirement.
 
These changes are retroactive to March 1, 2020, and will extend through April 30, 2023.

Effective Jan. 15, 2022, and for the duration of the national public health emergency, Medica members enrolled in individual plans and commercial fully and self-funded plans, and who have their pharmacy benefits through their Medica plan, have coverage for over-the-counter (OTC) FDA-authorized COVID-19 antigen tests without a prescription from a qualified health professional.

• Coverage includes up to eight FDA-approved OTC COVID-19 antigen home tests for each member per month covered under a subscriber's plan.
• Tests can be obtained through a network pharmacy or mail order at no cost using your Medica ID card.* Tests should be brought to the pharmacy counter to be submitted through the claims process.
• If 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 required to submit a claim form to process reimbursement.
• OTC tests purchased prior to Jan. 15, 2022 are not eligible for reimbursement.
• Tests purchased to fulfill employer-directed testing requirements are not eligible for reimbursement.
  *If you paid out-of-pocket for your OTC antigen tests, you can complete and submit a Pharmacy Claim Submission form (Note: you don’t need to enter the NCPD/NPI or have the form signed by the pharmacy).
  Completed forms and receipt(s) can be submitted at Medica.com/SignIn, or mailed to the following address for reimbursement:

Express Scripts
ATTN: Commercial Claims
P.O. Box. 14711
Lexington, KY 40512-4711

Or you can fax your claim form and receipt(s) to 1-608-741-5475.

A listing of FDA-approved Emergency Use Authorization (EUA) COVID-19 antigen tests can be found on the FDA's website.

Yes. We’ll waive your copays, coinsurance, and deductibles for Food and Drug Administration (FDA)-approved antibody tests after a suspected (not confirmed) COVID-19 diagnosis. An in-network provider must order the tests, and they must be medically needed. Testing isn’t covered as part of a return-to-work requirement, public surveillance program, or travel requirement.

Coverage for the antibody test applies both in-network and out-of-network. It includes office visits and other charges related to the antibody test when performed at in-network locations.

This coverage will extend through April 30, 2023.

Call your primary care provider if you have a cough, fever, or shortness of breath to find out if you meet testing criteria.

We'll waive your copays, coinsurance, and deductibles for COVID-19 inpatient hospital care. Effective March 1, 2020, through September 30, 2021.

Yes. Prior authorization isn’t required for admissions to long-term care facilities, acute inpatient rehabilitation, and skilled nursing and home health care facilities. This change is in effect through April 30, 2023.

It depends on the state where you purchased your policy.

Iowa, Kansas, Missouri and Nebraska Policies:
You must see a network provider for coverage of COVID-19-related costs.

Oklahoma Policies:
You must see a network provider for coverage of COVID-19-related costs. If you visit an out-of-network provider, services will apply to out-of-network benefits.

Minnesota, North Dakota and Wisconsin Policies
You can see any provider for coverage of COVID-19-related costs.

Maybe. If you have prescription benefits with us, and your medication needs to be filled early, submit your refill request to your pharmacy. They will determine if your prescription can be filled early.