Articles of Interest

SHEET METAL #10 BENEFIT FUND

Coverage of Over-The-Counter (OTC) Covid-19 Tests
Effective January 15, 2022

Please note that there are free at-home Covid-19 Tests available from the Federal Government: Every home in the U.S. is eligible to order 4 free at-home Covid-19 tests. Click the link below to order your free at-home tests.

www.COVIDtests.gov

Message to all Active and Pre-Medicare Retirees
​
The U.S. Department of Labor has issued guidance that health plans are required to cover the cost of at-home OTC Covid-19 tests at 100% beginning January 15, 2022, and through the duration of the declared public health emergency related to Covid-19.

Sheet Metal #10 Benefit Fund Plan Coverage of At-Home Covid-19 Test Kits is subject to the following provisions:

• ​​When was coverage of at-home Covid-19 tests effective? Covid-19 tests are covered if purchased on and after January 15, 2022, and through the end of the declared public health emergency related to Covid-19.  

• What is the best way to purchase the tests? The best way for you to purchase a test is at your regular in-network Prime Therapeutics pharmacy.  Be sure to purchase the tests at the pharmacy counter (rather than the main checkout) so that the claims can be properly processed by Prime Therapeutics. 

• How many tests are covered? Coverage is provided for up to eight (8) tests per covered individual in a 30-day period. Coverage is provided through the Plan’s prescription drug benefit program administered by Prime Therapeutics.

For example, a family of four covered under the Plan, may receive at no cost up to 32 tests (8 per covered person) in a 30-day period if purchased at an in-network provider. 

• What kind of tests are covered? Only FDA-approved tests will be covered under this program. Be sure to check the packaging on the test to see that it is an FDA-approved test before purchasing.

 

• Do I have to pay anything for the tests if I buy them in-network? No. The Plan will cover the cost of at-home Covid-19 tests without cost-sharing (no deductible or coinsurance) for tests purchased directly or online at a Prime Therapeutics in-network pharmacy. ​

Important note: For At-Home Covid-19 test purchases only, CVS will be considered in-network.  For all other pharmacy benefits, CVS will remain out-of-network with no coverage or reimbursement.

• What if I purchased the tests out-of-network? If you purchase tests from an out-of-network pharmacy, a non-pharmacy retailer, or the front counter of a participating pharmacy, your reimbursement will be the actual amount you paid per test or $12 per test, whichever is less.  You must then submit for reimbursement of your expenses through Prime Therapeutics in the method listed below under “What if I already bought and paid for tests on or after January 15, 2022, but before receiving this notice or if I purchased tests from a non-network provider or a non-pharmacy retailer?”  

 

• What if I already bought and paid for tests on or after January 15, 2022, but before receiving this notice or if I purchased tests from a non-network provider or a non-pharmacy retailer? If you purchased tests previously or purchased them from a non-network provider, a non-pharmacy retailer, or at the front counter of a participating pharmacy and have your receipts for the purchase, you can submit for reimbursement through the Plan’s Administrator, Wilson-McShane Corporation. See the link below to a claim form. Once completed, you can file it by mailing it to:

Wilson-McShane Corporation
3001 Metro Drive, Suite 500
Bloomington, MN 55425
Or by Fax: 952-851-3521
 
​Submitted forms must be completed in its entirety and will be processed for reimbursement in approximately 45 days.

• Important note: Covered at-home Covid-19 tests include only those for at-home medical use by you or your covered household family members. Tests for employment purposes, resale, or travel requirements will not be covered or reimbursed under this program.

COVID-19 OTC Reimbursement Claim Form

Remember, the Sheet Metal #10 Benefit Fund is a self-funded Plan in which the cost of all claims, including the costs of OTC COVID-19 tests, are paid directly out of the Fund.  This is your Health Plan, we encourage you to be good stewards of the Plan. 

If you have any questions, please contact the Plan Administrator, Wilson-McShane Corporation, at (952) 854-0795 or the Fund Office at (651) 770-0991.