Coverage for Over-The-Counter COVID-19 Diagnostic Tests

Summary of Material Modifications

This article is intended to notify you of changes to your benefits under the Professional Musicians, Local 47 & Employers’ Health & Welfare Fund (Plan) relating to coverage of COVID-19 diagnostic tests.

Beginning January 15, 2022, and in accordance with new federal guidance, the Plan will cover the cost of FDA-approved over-the-counter COVID-19 diagnostic tests, or “rapid antigen home tests,” purchased without a health care provider’s order or individualized clinical assessment. Further, this coverage is provided to you without any cost-sharing requirements, prior authorization, or other medical management requirements. Home tests purchased before January 15 are not eligible for reimbursement.

Under the federal guidance, plans must cover at least 8 rapid antigen home tests per 30-day period or calendar month, per participant or beneficiary in your household. If you purchase a home test from a pharmacy, store, or online retailer and you are charged for the test, you may submit a claim for reimbursement of the actual cost of the test. Some carriers, however, may have set up a network of preferred pharmacies and other retailers through which you may be able to ob- tain tests without an up-front payment. If this applies to you, reimbursements for tests purchased outside of the preferred network may be limited to the actual price of the test or $12.00 per test, whichever is lower.

Please contact your carrier for more information about this benefit, including how to claim reimbursement for your at-home COVID-19 tests.

For Blue Shield members, learn more about at-home testing and reimbursement or obtain a claim form.

For Kaiser members, learn more about at-home testing and reimbursement can be found here or sign on to the Kaiser site to submit a claim for reimbursement of your at-home tests.

Alternatively, every home in the U.S. is eligible to order four free at-home COVID-19 tests from the U.S. Postal Service. More information may be found at covidtests.gov. You can order your tests at special.usps.com/testkits. If you do not have internet access, call (800) 232-0233 (TTY 1-888-720-7489).

This notice is a Summary of Material Modifications to the Trust’s Summary Plan Description (SPD), and constitutes an addendum to the SPD. We are furnishing it to you in accordance with U.S. Department of Labor regulations §§2520.104b-3 and 2590.715-2715(b). If there is any inconsistency between this notice and the official Plan documents and contracts, the official Plan documents and contracts will control to the extent not amended by this notice. If you have any questions regarding this notice, please contact the Administrative Office during normal business hours at (818) 243-0222 or toll-free at (800) 753-0222, or email us with your questions.