SmartHealth Coverage Relating to the Diagnosis and Treatment of COVID-19

You and your family can fight COVID-19 by getting vaccinated and following the advice of your doctor, providers and the CDC. SmartHealth covers the cost of the FDA-approved vaccine at no cost to members.

Upcoming changes to COVID-19 coverage

• Effective 1/1/2023, standard cost sharing will apply for COVID-19 inpatient treatment.

• Virtual urgent care visits provided by Ascension Online Care will continue to be covered with $0 cost to SmartHealth members.

• Mandated coverage will continue until the public health emergency is lifted. This includes:

  • Physician’s office, clinic or urgent care visits related to COVID-19 will be covered at 100%, without member cost-sharing (any tier level).

  • Emergency department visits that result in an order for or administration of a COVID-19 test will be covered with no member cost-sharing (any tier level). All other emergency department visits will be covered under the present schedule of benefits.

  • Laboratory charges directly related to COVID-19 testing will be covered with no member cost sharing, regardless of whether the testing occurs at a physician’s office, clinic, urgent care, emergency department or another laboratory. 

  • There are no prior authorization requirements for members to receive COVID-19 testing or for COVID-19 or suspected COVID-19 inpatient admissions.

SmartHealth will cover 100% of the cost for up to eight FDA approved test kits within 30 days, obtained through:

• Ascension Rx retail locations.
• Cigna retail pharmacy network locations (including Walgreens, Walmart, CVS, etc.).

Each test is counted separately, even if there are multiple tests in one package. Members do not need a prescription from a healthcare provider or any clinical assessment to purchase a COVID-19 test. Present your prescription ID card at the pharmacy counter to pay for the test. FDA approved tests obtained outside of Ascension Rx or the Cigna retail pharmacy network will be covered and reimbursed up to $12 per test.

Submitting a reimbursement
Make sure to keep your receipt of purchase, as you will need it to submit your claim to Cigna for reimbursement. The submission needs to include:

• The purchase receipt documenting the date of purchase and the price.

• UPC code for the OTC COVID-19 test.

• Signed, completed attestation stating the test: 

  • is not for employment purposes.

  • has not and will not be reimbursed by another source, and is not for resale. 

For questions about SmartHealth coverage, benefits and claims please contact Customer Service at (888) 492-6811. 

For providers:
Applicable diagnosis codes related to COVID-19 can be found here.