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COVID-19 Coverage

This page can be used to help answer questions
that you may have related to COVID-19 and
resources available to you.

COVERAGE DETAILS

Testing
Covered at 100% when medically necessary, including the related office, urgent care,
emergency room and telehealth visit which
resulted in a COVID-19 testing.

Over the Counter COVID Tests
Eight (8) covered per member, per month when billed through the pharmacy or submitted for manual reimbursement using the OTC Covid-19

Order COVID Tests
Click here to order four (4) free tests per residential household - https://special.usps.com/testkits.

Direct -to-Consumer Options
Test kits can be ordered through the following mail order pharmacies. You may be responsible for any additional shipping costs, if applicable.
Serve You RX – Call 800.759.3203
Costco Pharmacy – Visit www.costco.com/home-delivery

  • Select Mail Order
  • Register for a new account
    • o You do not need to be a Costco member to use their mail order service
  • Select: Fill New Prescription
  • Select: My Doctor will Call or Fax. I do not have a written prescription”
  • In the Physicians Info Fields:
    • Enter Physician Name: Costco Test
    • Enter Physician Phone: (800) 111-1111
    • Enter Physician City: Seattle
    • Enter Physician State: WA
    • Enter Drug Information: COVID Tests

COVID Vaccines
Covered at 100%.

Inpatient Treatment for COVID-19
Subject to cost sharing following your plan design.

Out-of-Network Coverage
Subject to the in-network cost sharing structure for treatment of COVID-19.

CLAIMS FORM
INSTRUCTIONS

Complete form and Mail, Fax of Email this form along with receipts to:
Navitus Health Solutions
P.O. Box 999
Appleton, WI 54912-0999 OR

Fax:(920)735-5315 / Toll Free (855)668-8550
OR
Email: ManualClaims@Navitus.com

COVID Test Claim Form