United States Office of Personnel Management

The Federal Government’s Human Resources Agency

Tribal Benefits Administration Letter

Number: 22-601 Date: January 26, 2022 

Subject: FEHB Coverage of COVID-19 Over-theCounter Tests, Vaccines, and Therapeutics

On January 10, 2022, the Office of Personnel Management (OPM) issued 

FEHB Carrier Letter 2022-01 providing updated guidance on coverage for 

countermeasures against Coronavirus disease 2019 (COVID-19), including 

over-the-counter tests, vaccines, and therapeutics. This TBAL highlights that 

in Carrier Letter 2022-01, OPM has directed Federal Employees Health 

Benefits (FEHB) Carriers to follow Frequently Asked Questions (FAQs) Part 

51 issued by the Departments of Labor, Health and Human Services, and 

Treasury in providing coverage of over-the-counter (OTC) COVID-19 tests 

through FEHB plans for individualized diagnosis or treatment, including tests 

that have been authorized, cleared, or approved for use without the 

involvement of a health care provider. This coverage must be provided 

without imposing any cost-sharing requirements, prior authorization, or 

other medical management requirements. 

FEHB plans may place a limit of eight OTC COVID-19 tests per covered 

individual per month at no charge. That means a family of four, all on the 

same plan, would be able to get up to 32 of these tests covered by their 

FEHB plan per month at no charge. Generally, there is no limit on the 

number of tests, including at-home tests, that are covered if ordered or 

administered by a health care provider following an individualized clinical 

assessment, including for those who may need them due to underlying 

medical conditions. Plans may, but are not required to, provide such 
(Tribal) Benefits Administration Letter 22-601

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coverage for at-home OTC COVID-19 tests purchased before January 15. In 

addition, FEHB plans are not required to provide coverage of testing 

(including an OTC COVID-19 test) that is for employment purposes. 

FEHB plans may, but are not required to, set up programs that allow covered 

individuals to get OTC COVID-19 tests directly through preferred 

pharmacies, retailers or other entities with no out-of-pocket costs, 

eliminating the need for enrollees to submit a claim for reimbursement. 

When FEHB plans make tests available for upfront coverage through 

preferred pharmacies or retailers, they are still required to reimburse tests 

purchased by enrollees outside of that network, at a rate of up to $12 per 

individual test (or the cost of the test, if less than $12). For example, if an 

FEHB plan offers direct coverage through a preferred pharmacy but an 

enrollee instead purchases tests through an online retailer, the FEHB plan is 

still required to reimburse the enrollee up to $12 per individual test. 

OPM is directing FEHB Carriers to provide plain language education and 

information resources to support FEHB enrollees seeking OTC COVID-19 

testing, including how to obtain OTC COVID-19 tests directly from their FEHB 

plan or through designated sellers, and how to submit a claim for 

reimbursement. This may include Carriers prominently posting pertinent 

information to their websites, or direct communication by email or other 

means generally used by the Carriers to reach covered individuals. 

Please see these FAQs providing consumer information on coverage of OTC 

COVID-19 tests that you may share with employees. If employees have 

questions on specific FEHB plans’ coverage and reimbursement, including 

reimbursement for tests purchased before January 15, 2022, please direct 

them to contact their FEHB plan for more information. 
(Tribal) Benefits Administration Letter 22-601

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For questions concerning this Tribal Benefits Administration Letter, please 

contact your Tribal Benefits Officer. If you are a Tribal Benefits Officer and 

have questions, please contact the Tribal Desk at tribalprograms@opm.gov 

or 202-606-2530.

Sincerely,

Laurie Bodenheimer

Associate Director 

Healthcare and Insurance