Before the U.S. Equal Employment Opportunity Commission (EEOC) gave employers the go-ahead to incentivize workers to get COVID-19 vaccines, few businesses were offering cash or other rewards to vaccinated employees.
Using financial incentives to promote coronavirus shots may now increase following the EEOC's May 28 release of updated and expanded technical assistance on how the Americans with Disabilities Act (ADA) and the Genetic Information Nondiscrimination Act (GINA) apply when an employer offers incentives to employees to get a COVID-19 vaccine.
The guidance clarified that under the ADA, an employer may offer an incentive to employees for voluntarily getting a vaccine administered by the employer or its agent if the incentive is not so substantial as to be coercive.
Even this modest and vaguely defined restriction, however, does not apply when employers offer incentives to employees who voluntarily provide documentation that they received a COVID-19 vaccination on their own from a third-party provider that is not their employer or an agent of their employer, such as a pharmacy, public health department or other health care provider in the community.
Under GINA, the EEOC said, as long as an employer does not acquire genetic information while administering the vaccines, the employer may offer employees incentives for getting vaccinated.
Incentive Concerns
A survey conducted from April 15 to May 16 by HR consultancy Mercer found that among 431 employer respondents, few provided financial incentives for getting vaccinated:
- Just 7 percent provided cash or gift cards.
- 1 percent provided contributions to health spending accounts (e.g., health savings accounts or flexible spending accounts).
David Zieg, clinical services leader at Mercer, said he hasn't seen data on average incentive payments but, he continued, "based on my anecdotal experience, it likely sits somewhere around $200 to $300."
The EEOC's guidance states no specific limit on incentives for vaccinations that are not administered by employers or their agents, which "should provide a reasonable level of comfort for employers who were somewhat reluctant to offer cash or gift card incentives because of the legal uncertainty," said Wade Symons, Mercer's regulatory resources group leader. "We would expect more employers to offer incentives in an effort to boost vaccination rates, and our recent conversations with employers reflect this."
Expect more employers to offer incentives in an effort to boost vaccination rates.
Offering PTO
While employers have been skittish about financial incentives, many are providing extra paid time off (PTO) so employees don't have to use existing vacation or sick days to get vaccinated, Mercer found:
- 53 percent are offering PTO to get vaccinated.
- 34 percent are offering PTO to recover from side effects.
Zieg noted that "given the prevalence of side effects, especially after the second dose of the [two-dose Pfizer and Moderna] vaccines, providing a little additional PTO to recover is a prudent gesture to support employee vaccination."
Providing Vaccination Access
Aside from incentives and PTO, employers are making it easier for employees to get vaccinated by providing onsite or near-site vaccinations, the survey found:
- 6 percent are already doing this.
- 11 percent plan to begin soon.
- 20 percent are considering it.
According to Zieg, "some pharmacy chains and local providers are now offering onsite vaccination clinics to employers," including small businesses with fewer than 100 planned vaccinations for employees and dependents. "Availability is variable but appears to be increasing around the U.S.," he noted.
But given the new EEOC guidance, Symons said, "there are a couple of areas of risk for employers to consider if the employer is providing the vaccine onsite or contracts with a third party to provide the vaccine to employees." An employer would be subject to the vaguely defined "coercive" standard when offering incentives to employees get vaccinated, "unless the incentive is so small that it could not be considered coercive—think a T-shirt or water bottle," he pointed out.
The lack of a standard for what would be considered coercive, Symons said, "may be a deterrent for employers that have arranged for onsite vaccination to provide an incentive, given that whether an incentive feels coercive to an employee is certainly going to vary individual by individual."
Another potential risk is in making sure vaccination information is kept confidential, he noted. "If an employer is collecting proof of vaccination, that is medical information, and the ADA requires that the information be stored separately from regular personnel files," Symons said. "Employers should have protocols in place to keep vaccine-status information private."
Getting Vaccinated—and Back to Work
"Employers understand that by taking an active part in supporting the vaccination of employees, they can play a crucial role in ending the pandemic," said Jeff Levin-Scherz, population health leader at consultancy Willis Towers Watson. "A common strategy for employers is to make vaccines an easy choice for employees by first helping convince them to get the vaccine and then making it easy for them to do so."
In the consultancy's 2021 Emerging Trends in Health Care Survey, conducted Feb. 23 through March 12 with responses from 446 large U.S. employers:
- 84 percent of respondents said immunization would reactivate the nation's economy.
- 80 percent said it will allow more employees to return to the workplace.
Relatively few employers (10 percent), however, believed vaccines should be mandatory.
Do Vaccination Incentives Work? While financial incentives have been shown to encourage participation in some health improvement programs—such as for losing weight or quitting smoking—they may be less effective with the COVID-19 vaccine, according to David Asch, executive director of the Penn Medicine Center for Health Care Innovation and a professor of management at The Wharton School of the University of Pennsylvania. "Someone who has a lot of distrust of the vaccine might think, 'They'd never offer money if this was a good thing,' " he said in an interview with the Association of American Medical Colleges. "A better approach is to try to reduce obstacles that people face in getting vaccines," Asch advised. "Think of all those logistical, scheduling and access challenges that are limiting the use of vaccines." Another Kind of Incentive While financial incentives are being debated,
interest in getting vaccinated against COVID-19 increased after May 13 when Rochelle Walensky, director of the U.S. Centers for Disease Control and Prevention, announced that vaccinated people could take off their masks. "This shows incentives matter," Jonathan Reiner, professor of medicine and surgery at George Washington University School of Medicine, told CNN. "People needed a carrot, and the carrot was the ability to drop the mask in most settings." |
[Related SHRM article:
How Employers Are Educating Employees About Getting Vaccinated]