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Vaccine Premium Differentials Are Permissible Under Wellness Plans and No Cost Shares Allowed for Authorized Vaccines and Boosters

October 7, 2021

A recently published FAQ prepared by the Departments of Labor, Health and Human Services and Treasury answers frequently asked questions regarding vaccine premium differentials and HIPAA nondiscrimination rules, as well as the cost shares for vaccine boosters.

Vaccine Premium Differentials

ERISA and other regulations prohibit plans “from discriminating against participants, beneficiaries, and enrollees in eligibility, premiums, or contributions based on a health factor.”  Health plans are allowed an exception to this prohibition and may provide discounts, subject to limitations, to participants who adhere to the requirements of wellness programs.  The maximum reward (or penalty) under a wellness program that is part of a group health plan is 30 percent of the cost of coverage (or 50 percent for wellness programs designed to prevent or reduce tobacco use).

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