CMS: Employer plans can't deny benefits to unvaccinated customers but can offer premium discounts

A healthcare worker administers a vaccine
The Centers for Medicare & Medicaid Services outlined new guidance to employer health plans that they cannot deny benefits to unvaccinated workers. (Kaiser Permanente)

Employer group health plans cannot deny benefits to customers who have not gotten the COVID-19 vaccine but can offer premium discounts to customers who decide to get the shot, new guidance from the Centers for Medicare & Medicaid Services (CMS) said.

But plans that increase premiums on the unvaccinated will have that increase count toward whether that coverage is affordable under the Affordable Care Act (ACA).

The updated FAQ document, released Monday, comes as some companies such as Delta Airlines have hiked up insurance premiums for unvaccinated workers.

CMS’ FAQ said COVID-19 vaccination can be considered a wellness program that enables a group health plan to offer premium discounts.

Any discount cannot exceed 30% of the total cost of employee-only coverage and “must give individuals eligible for the program the opportunity to qualify for the reward under the program at least once per year,” the FAQ said.

RELATED: How many employees have hospitals lost to vaccine mandates? Here are the numbers so far

But any group plan or insurer cannot discriminate against any participants based on a health factor.

“Plans and issuers may not discriminate in eligibility for benefits or coverage based on whether or not an individual obtains a COVID-19 vaccination,” the FAQ said.

Plans are required to meet certain affordability requirements under the ACA, meaning they can’t charge employees more than a certain percentage of their household income.

CMS said if a plan reduces a customer’s premium by 25% for getting vaccinated, that reduction doesn’t count toward the ACA’s affordability requirements. But, if there is a 25% increase for an unvaccinated customer, that “surcharge would not be disregarded in assessing affordability,” the FAQ said.

CMS’ notice comes as more and more companies could install insurance penalties for not getting vaccinated. Delta Airlines announced back in August that it will impose a $200 surcharge on any workers’ health plans that don’t get vaccinated.