COVID-19 Testing and Treatment
Using SHP for COVID-19 Testing and Treatment
In accordance with NYS Insurance guidance SHP / SHP Plus is currently providing the following benefits for plan members who require testing and/or treatment for COVID-19.
Effective through June 13th, 2022:
- 100% coverage in-network laboratory tests to diagnose the novel coronavirus (COVID-19)
- 100% coverage for visits to diagnose the novel coronavirus (COVID-19) at the following locations, including through telehealth: an in-network provider’s office, an in-network urgent care center, any other in-network outpatient provider setting able to diagnose the novel coronavirus (COVID-19), or an emergency department of a hospital for COVID-19 diagnostic and antibody testing and the associated visit that accompanies that testing
- Copayments, coinsurance, or annual deductibles may be imposed in accordance with the applicable policy or contract for any follow-up care or treatment for the novel coronavirus (COVID-19), including an inpatient hospital admission, as otherwise permitted by law
More detail on coverage for testing:
COVID-19 testing will only be covered by SHP if a student meets clinical criteria for testing and the testing is recommended and ordered by a licensed provider. If a student is asymptomatic and is seeking testing for return to work, school, general health surveillance, self -surveillance, or self-diagnosis, SHP/SHP Plus will NOT cover those tests. Learn more about what will be covered here by SHP/SHP Plus. And see information from the CDC about antibody testing.
Will SHP cover the Cost of COVID-19 diagnostic testing under any circumstance?
Aetna will cover, without cost share, diagnostic (molecular PCR or antigen) tests to determine the need for member treatment.* This includes to direct-to-consumer/home-based diagnostic or antigen tests. Aetna’s health plans generally do not cover a test performed at the direction of a member’s employer in order to obtain or maintain employment or to perform the member’s normal work functions or for return to school or recreational activities, except as required by applicable law.
Aetna will cover, without cost share, serological (antibody) tests that are ordered by a physician or authorized health care professional and are medically necessary. Aetna’s health plans do not cover serological (antibody) tests that are for purposes of: return to work or school or for general health surveillance or self-surveillance or self-diagnosis, except as required by applicable law. Refer to the CDC website for the most recent guidance on antibody testing.
This policy for diagnostic and antibody testing applies to Commercial, Medicare and Medicaid plans.**
* Aetna will follow all federal and state mandates for insured plans, as required.
** Disclaimer: Regulations regarding testing for Aetna Medicaid members vary by state and, in some cases, may change in light of the current situation. Providers are encouraged to call their provider services representative for additional information.
See more detail on Aetna's website.
Home Test Kit Reimbursement
Home test kits may be eligible for reimbursement through OptumRx if the test was purchased after January 15, 2022. For more information on what tests are eligible for reimbursement, visit OptumRx's website.
You will need the following information to complete the form.
MemberID: (This is your W number which is the same as your Aetna W number)