COVID-19 Vaccine FAQs

In a remarkable achievement of medical science, the COVID-19 vaccines have been the fastest developed in history. While this is great news, employers have been struggling to keep up with new laws and policies surrounding the vaccine. This article features COVID-19 FAQs from our compliance partner, Guardian HR, and the American Assn. of Health Plans (AHIP). 

Can an employer mandate that employees be vaccinated?

Guardian HR: Yes, the EEOC even directly addressed this in guidance released in December 2020. However, employers who wish to mandate vaccinations must address how to handle employees who don’t want to be vaccinated due to ADA protected disability/health related reasons, and legitimate religious objections protected under Title VII. Employers will need to carefully weigh the health and safety risk posed by unvaccinated workers with the legal and employee relations issues inherent in a mandate. There is no easy answer here and employers should seek the counsel of qualified employment law advisors if they are considering a mandate.

Could an employer only mandate vaccinations for a portion of their employees?

Guardian HR: Again, the answer is yes (maybe), and this may be the best approach for some employers. Employers are required to provide a safe workplace and need to address COVID related safety and health risks. But those risks, and the effectiveness of using a vaccine mandate to address them, will vary within an organization based on the types of jobs and other workplace variables. Safety and health risks may be addressed using other tactics such as working remotely or implementing appropriate worksite procedures for some jobs. Anytime employers implement policies for only some of their employees and not others, there is a risk of accusations of discrimination. Any employer considering this kind of approach should only do so with careful planning and good advice from employment law advisors.

My employees are essential – can’t they get the vaccine earlier?

Guardian HR: The Federal Government has issued guidelines for the distribution of available vaccines, and essential workers are higher in the list of priorities than is the general population. However, states are taking different approaches as to which workers are considered essential, and where those workers fall in the distribution plan for that state. This may change as the Biden administration implements new distribution policies over the next weeks and months.
What about employee incentives to get vaccinated?
Guardian HR: This one is easier. We think many employers will consider some kind of incentive for employees. Here are a few thoughts:
If the incentive is something like a gift card or bonus, it must be treated as taxable income to the employee
The employer could provide an incentive through their wellness plan – something like $XX.XX off your health insurance contribution if you get vaccinated. This would be considered a participatory incentive so you would not need to follow the HIPAA reasonable alternative rules for someone who does not want to get the incentive. We are not sure how many employers will want to amend existing wellness initiatives for this purpose; this one will be interesting to watch.
Another good idea we have heard is for employers to provide paid time off for employees to get vaccinated.

How is the COVID-19 vaccine covered by health insurance providers?

AHIP:

• Health insurance plans that are compliant with the ACA must cover vaccines without cost sharing for in-network and out-of-network
• Health insurance providers must cover related items and services if the primary purpose of the visit is the COVID-19 vaccine
• Health insurance providers have 15 business days from the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practice (ACIP) recommendation to cover a vaccine and are encouraged to cover as soon as possible
• Grandfathered plans and other “underinsured” plans – that is, those that are not required to be ACA-compliant – are not required to cover vaccines without cost sharing.
• People on grandfathered plans and other “underinsured” will qualify as uninsured or underinsured, with administration fees paid by HRSA

How is vaccination data shared with health insurance providers?

AHIP:

• Vaccination information will be transmitted to health insurance providers through claims for administration charges
• Providers (and sites) will input patient information into the CDC’s Immunization Information Systems or federal systems, which will then be ready for analysis
• Some health plans have access to the CDC’s Immunization Information Systems

How are COVID-19 vaccines being coded and billed?

AHIP:

• CMS has indicated no preference for billing COVID-19 vaccines as a medical or pharmacy benefit
• The AMA has released coding conventions for COVID-19 vaccines that include specific vaccine and dose information.
• The National Council for Prescription Drug Programs has created a coding convention that differentiates between doses of a vaccine
• Medicare will pay $28.39 for administration of a single-dose COVID-19 vaccine, or $16.94 for the first dose and $28.39 for a final dose of a multi-dose vaccine

What’s the timing and availability for COVID-19 vaccines?

AHIP:

• Vaccines must be approved by the FDA under an Emergency Use Authorization (EUA) or Biologics License Application, then recommended by ACIP
• Vaccines do not need to be recommended as “routine” by ACIP
• Plans are required to cover vaccines within 15 business days of ACIP recommendation
• ACIP will make allocation recommendations; states and jurisdictions will decide who receives vaccines when
• CVS and Walgreens will establish clinics in long-term care facilities

How are Americans getting educated about the COVID-19 vaccine and when to get their second dose?

AHIP:

• Health insurance providers intend to educate their members about the safety and efficacy of COVID-19 vaccines. To improve health equity, health insurance providers will target disadvantaged, underserved communities
• Operation Warp Speed will use V-Safe, a text messaging program, as well as calls, physical cards, and other communications to remind people when to get their second dose of the COVID-19 vaccine

How is the COVID-19 vaccine being administered in Long-Term Care Facilities?

AHIP:

• CVS, Walgreens, and Managed Health Care Associates will set up clinics in long-term care facilities skilled nursing facilities, and other non-independent living homes for the administration of COVID-19 vaccines
• They will conduct 3 clinics at each site – first dose, second dose, and one for missed second doses.
• States/jurisdictions will decide program enrollment and prioritization – each selects a single vaccine for administration in all LTC facilities
• Insurance plans will receive claims for administration of vaccines under these programs