Great idea - how big is too big for a vaccine incentive?
To encourage employees to get the COVID-19 vaccine, employers may offer a financial incentive. When this involves a discount on health insurance, employers can’t forget about wellness program regulations.
Regulations relating to the Health Insurance Portability and Accountability Act (HIPAA) and Affordable Care Act (ACA) protect participants from discrimination based on a health factor, and limit the discount that can be offered in return for taking part in a wellness program.
On October 4, the Departments of Labor, Health and Human Services, and the Treasury released guidance to clarify how employers can offer vaccination incentives while remaining in compliance with the regulations. The questions and answers below summarize highlights of the guidance.
Q. May a group health plan offer plan participants a premium discount for receiving a COVID-19 vaccine?
A. Yes, but it must comply with wellness program regulations.
Q. How can the discount comply?
A. It must meet the five criteria for activity-only wellness programs:
- The opportunity to qualify for the reward at least once a year.
- The plan’s rewards cannot exceed 30 percent of the total cost of employee-only coverage.
- The program must be reasonably designed to promote health or prevent disease.
- The reward must be available to all individuals, and there must be a reasonable alternative standard or waiver available for an individual who cannot meet the standard because of a medical reason.
- The availability of the reasonable alternative standard or waiver must be disclosed in plan materials.
Q. If the discount complies with wellness program regulations, does it automatically comply with other federal laws that impact wellness program discounts, like the Americans with Disabilities Act (ADA) or Genetic Information Nondiscrimination Act (GINA)?
A. No. Employers should also consider guidance from the Equal Employment Opportunity Commission. The EEOC allows incentives, but cautions against offering very large incentives when a vaccination is offered by the employer.
However, this limitation does not apply if an employer offers an incentive to employees who receive a COVID-19 vaccine on their own, from a third-party provider, such as a pharmacy or public health provider.
Q. If incentives aren’t related to the group health plan, are they covered by the HIPAA/ACA wellness program regulations?
A. No, but they would still need to comply with the EEOC’s guidance (and not be very large if offered by the employer).
Is this program compliant?
A group health plan offers a 25 percent discount to plan participants who get the COVID-19 vaccine. The same discount is provided to participants who cannot get the vaccine due to a medical condition if the individual attests to complying with mask guidelines for unvaccinated individuals. Does this comply with the HIPAA/ACA guidance?
Yes, because:
- The reward does not exceed 30 percent of the total cost of employee-only coverage.
- The opportunity to qualify is offered annually.
- There is a reasonable alternative standard to qualify for the reward (the opportunity to comply with mask guidelines).
- The plan provides notice of the availability of the reasonable alternative standard.
- The program is reasonably designed to promote health and prevent disease.