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COVID-19 Health Resources
COVID-19 Testing Coverage

Lifetime Benefit Solutions provides coverage in full for diagnostic/viral testing as well as antibody testing that is determined to be medically appropriate for the diagnosis and treatment of an individual by an attending provider as evidenced by an order from the attending provider.

  • The tests must be FDA approved or the subject of an emergency use order request and the lab performing the testing must be appropriately certified.
  • Testing that is ordered or performed solely for purposes of pandemic control or re-opening the economy, and not based on a determination by an attending provider that the test is medically appropriate for the diagnosis and treatment of an individual member, is not covered. This includes tests performed on an asymptomatic individual solely to assess health status as required by parties such as a government/public health agency, employer, school, or camp.
COVID-19 Testing Coverage FAQ for Lifetime Benefits Solutions Members

What are the different COVID-19 tests?

There are two primary types of tests associated with COVID-19. The diagnostic/viral test is for the purpose of diagnosing and treating an active COVID-19 infection. It is recommended for use in individuals with COVID-19 symptoms or a known or suspected exposure to COVID-19. The antibody test is for the purpose of determining whether there was a past COVID-19 infection.

What are the standards that apply to these tests for them to be considered for coverage?

We provide coverage in full for diagnostic/viral testing as well as antibody testing that an attending provider determines is medically appropriate for an individual as evidenced by an order from the attending provider. These tests must be FDA approved or the subject of an emergency use order request and the lab performing the testing must be appropriately certified (under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) and applicable New York state law and regulation) to be considered for coverage.

If my employer or school requires me to have a COVID-19 test, will my insurance cover the cost?

No. Testing that is ordered or performed solely for purposes of pandemic control or re-opening the economy, and not based on a determination by an attending provider that the test is medically appropriate for the diagnosis and treatment of an individual is not covered under the member’s health benefit. This includes tests performed on someone with no symptoms to assess health status as required by parties such as a government/public health agency, employer, school, or camp.

Please note that free COVID-19 testing is available at locations across the state operated by the New York State Department of Health. Individuals do not need to be symptomatic or essential workers to obtain a test from these state sites. For more information, call the health department’s 24-hour hotline at (888) 364-3065.

I am curious about my own immunity to COVID-19. If I ask my doctor to order the antibody test for me, will it be covered by my health insurance [health benefits plan]?

The NYS Department of Health has issued recommendations to health care providers for determining when a test is medically appropriate. Testing when ordered upon the request of a member solely to facilitate the member’s desire to self-assess COVID-19 immune status is not a recommended basis for testing and is not covered.

If I order a home testing kit on my own, will you reimburse me for that?

No. No testing is covered without an attending provider’s determination that the test is medically appropriate for an individual, as evidenced by an order.

Can I get my test done at my local pharmacy and have my insurance pay for it?

If an attending provider, including a pharmacist, determines that the test is medically appropriate for you and orders the test, the test can be performed at your local pharmacy if the pharmacy has received approval to conduct such testing under the waiver authority of CLIA and is approved by New York State as a limited service laboratory.

If I go to an urgent care center, can I get my test done there and have it covered?

For a test to be covered through your insurance, it must be prescribed by an attending provider who has determined through an individual assessment that a test is medically appropriate for you. The NYS Department of Health has issued guidance to health care providers for determining when a test is medically appropriate. Testing when ordered upon the request of a member solely to facilitate the member’s desire to self-assess COVID-19 immune status is not a recommended basis for testing and is not covered.

 

COVID-19 Vaccine Information

We will provide coverage for COVID-19 vaccines in accordance with applicable state and federal guidance. Because no FDA-approved vaccine is available, much is still unknown and we continue to monitor the situation as it develops.

 

COVID-19 Health Information

Given that the COVID-19 situation is rapidly evolving, the best resources for up-to-date health information are:

If you believe you may have symptoms of COVID-19, visit the Centers of Disease Control and Prevention's website for an updated list of symptoms and other resources.
If You Suspect You May Need Testing:

If you are showing symptoms of coronavirus COVID-19, please call your primary care doctor before going to any doctor’s office, emergency room or urgent care center. They will need to follow special protocols to meet you upon your arrival.

A telehealth visit with your doctor is also an option to do initial screenings, and telehealth services are covered for most members. Due to high call volumes, wait times may be longer than usual.

Recommended Precautions from the CDC

The U.S. Centers for Disease Control and Prevention recommends taking everyday preventive precautions to help prevent exposure to this virus and others like it by:

  • Avoiding close contact with people who are sick.
  • Not touching your eyes, nose or mouth.
  • Staying home when you are sick.
  • Covering your cough or sneeze with a tissue and throwing the tissue in the trash.
  • Cleaning and disinfecting frequently touched objects and surfaces using a regular household cleaning spray or wipe.
  • Following the CDC’s recommendations for using a facemask.
  • Washing your hands often with soap and water for at least 20 seconds if hands are visibly dirty and especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol.

Practicing good health habits every day helps to keep our community healthy.

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