OVER-THE-COUNTER (OTC) COVID-19 TESTING BENEFIT

OVER-THE-COUNTER (OTC) COVID-19 TESTING BENEFIT
Thursday, January 27, 2022

The Trustees of the National Automatic Sprinkler Industry (NASI) Welfare Fund are pleased to announce a new benefit for over-the-counter (OTC) COVID-19 tests for claims incurred on and after January 15, 2022 through the remainder of the COVID- 19 public health emergency.

What is Covered?

Under this benefit, the Fund will provide 100% coverage (subject to the out-of-network reimbursement and number of tests limits described below) for OTC COVID-19 tests that are approved by the federal government* and are not purchased with a prescription or order from your health care provider. Tests must be purchased for personal use and not for employment purposes or resale. Tests purchased before January 15, 2022, will not be covered.

How Many Tests are Covered Per Person Per 30-Day Period?

Participants and beneficiaries are limited to eight (8) OTC COVID-19 tests (that are not purchased with a physician’s order or prescription) per covered individual per 30-day period. In applying this limit, the Fund will count each test separately, even if multiple tests are sold in one package. For example, in the case of a married participant with one dependent child, the Fund will cover no more than twenty-four (24) tests per 30-day period, eight (8) for each covered family member.

Can I use my NASI ID Card at Retail Pharmacies in the Express Scripts Network for these Tests for FREE?

Yes. The Fund uses Express Scripts (ESI) as its Pharmacy Benefit Manager. ESI has developed a program whereby you should be able to use your NASI ID Card at any retail pharmacy in the ESI network to obtain covered OTC COVID-19 tests at no charge without any out-of-pocket payment. Be sure to obtain your test from the pharmacy counter, not the regular checkout lane.

Are Tests Available for FREE Through Express Scripts’ Mail Order Service?

Yes. We are pleased to report that free tests should be available through ESI’s mail order service effective January 28, 2022.

How Much Will I Be Reimbursed if I Pay Out-of-Pocket? ($12 Reimbursement Limit for Tests Purchased Out-of-Network)

Tests obtained directly from the mail order service or the pharmacy counter of any in-network retailer should be free, with no upfront payment. In addition, you may be reimbursed by the Fund Office for the full cost of any test purchased out-of-pocket from January 15 through January 27, 2022, even those purchased from non-preferred pharmacies or other out-of-network retailers. However, reimbursements for tests purchased on or after January 28, 2022 from non-preferred pharmacies or other out-of-network retailers will be limited to $12 per test ($24 per two-pack), or the actual price of each test (whichever is lower). For this reason, we encourage you to purchase tests offered at participating pharmacies in the ESI network. To find a pharmacy in the ESI network, visit express-scripts.com and click “Find a Pharmacy.” You may also use the ESI mobile app.

What Happens If I Can’t Find a Test for Free Using my NASI ID Card at an In-Network Retail Pharmacy or by Mail Order?

If you have trouble obtaining a test for free using your NASI ID Card at an in-network retail pharmacy or through ESI’s mail order service, and you provide upfront, out-of-pocket payment for a test (even when purchased from an out-of-network pharmacy or other retailer), you may submit your receipt to the Fund Office for reimbursement.

If you would like to submit a request for reimbursement to the Fund Office, you may email the following information to C19@nasifund.org: (1) your name, address, and your NASI ID Card number (i.e., the number that starts with “SFI”); (2) the name(s) of covered individual(s) that the test or tests were purchased for; (3) a copy of the itemized receipt for your test(s) that shows the price, date of purchase, and UPC (universal product code); and (4) a picture of your test(s) that includes the bar code. Remember, reimbursements for tests purchased out-of-network will be capped at $12 per test.

What About Tests Ordered by my Doctor?

COVID-19 tests (including federally-approved OTC COVID-19 tests) that are administered at the direction of your doctor will continue to be processed in accordance with current Plan rules at no cost to participants. There is no quantity limit on the number of tests per 30-day period that the Fund will cover when ordered by a health care provider.

Where Else Can I Get a Free OTC COVID-19 Test Kit?

The federal government is making available a half-billion tests to the American public beginning on January 19, 2022. These free tests will be available to all households. Tests can be ordered online at COVIDTests.gov and will initially be limited to four (4) tests per residential address.

Conclusion

The Trustees are committed to responding as necessary to the COVID-19 pandemic to support you and your family during this difficult period. As always, if you have any questions, please contact the Fund Office.

While this notice is intended to summarize a recent modification to the Plan’s rules, in the event there is any discrepancy between this summary and the official Plan document, the official Plan document shall apply. The Trustees reserve the right to amend the Plan at any time. If you have questions, please contact the Fund Office.