Can We Charge Higher Health Insurance Premiums for Unvaccinated Employees?

Last week, a client asked a timely and interesting question. The employer asked whether it can begin charging higher group health insurance premiums to employees who have declined the COVID-19 vaccination. The premium difference would be an approach similar to that already imposed by many plans for employees who use tobacco products. Presumably, it potentially would be justified by the additional costs of hospitalization and related expenses associated with treatment of unvaccinated plan participants for COVID-19 related illness.


After giving the question some thought, our response to the client was that there is currently no clear legal roadmap for charging the higher premiums. First, HIPAA non-discrimination and wellness plan rules, along with EEOC wellness plan regulations are somewhat in a state of flux, and higher premium charges potentially could be a prohibited penalty against non-vaccinated participants. Additional state law restrictions against group medical plan premiums may also limit employers’ ability to charge unvaccinated participants more.  [MORE]

Healthy Mind Healthy Body

This past year presented so many different challenges and obstacles that tested our strength and resiliency. The global pandemic forced us to cope with situations we never even imagined, and a lot of us struggled with our mental health as a result. Throughout the pandemic, many people who had never experienced mental health challenges found themselves struggling for the first time. The month of May is Mental Health Awareness Month, and we are focusing on different topics that can help process the events of the past year and the feelings that surround them, while also building up skills and supports that extend beyond COVID-19.  

The past year forced many to accept tough situations that they had little to no control over. If you  found that it impacted your mental health, you aren’t alone. In fact, of the almost half a million individuals that took the anxiety screening at, 79% showed symptoms of moderate to severe anxiety. It is important to be aware of and take steps to improve your mental health, such as focusing on managing anger and frustration, recognizing when trauma may be affecting your mental health, challenging negative thinking patterns, and making time to take care of yourself. It’s important to remember that working on your mental health and finding tools that help you thrive takes time. Change won’t happen overnight. Instead, by focusing on small changes, you can move through the stressors of the past year and develop long-term strategies to support yourself on an ongoing basis.  
Mental illnesses are real, and recovery is possible. By developing your own tools to thrive, it is possible to find balance between life’s ups and downs and continue to cope with the challenges brought on by the pandemic. 

What is mental illness? 

A mental illness is a condition that affects a person's thinking, feeling, behavior or mood. These conditions deeply impact day-to-day living and may also affect the ability to relate to others. If you have — or think you might have — a mental illness, the first thing you must know is that you are not alone. Mental health conditions are far more common than you think, mainly because people don’t like to, or are scared to, talk about them. However: 
  • 1 in 5 U.S. adults experience mental illness each year 
  • 1 in 20 U.S. adults experience serious mental illness each year 
  • 1 in 6 U.S. youth aged 6-17 experience a mental health disorder each year 
  • 50% of all lifetime mental illness begins by age 14, and 75% by age 24 
A mental health condition isn’t the result of one event. Research suggests multiple, linking causes. Genetics, environment and lifestyle influence whether someone develops a mental health condition. A stressful job or home life makes some people more susceptible, as do traumatic life events. Biochemical processes and circuits and basic brain structure may play a role, too. None of this means that you’re broken or that you, or your family, did something “wrong.” Mental illness is no one’s fault. And for many people, recovery — including meaningful roles in social life, school and work — is possible, especially when you start treatment early and play a strong role in your own recovery process. 
Mental Health & Youth 
It is normal for children and youth to experience various types of emotional distress as they develop and mature. For example, it is common for children to experience anxiety about school, or youth to experience short periods of depression that are transient in nature. When symptoms persist, it may be time to seek professional assistance. While most youth are healthy, physically and emotionally, one in every four to five youth in the general population meet criteria for a lifetime mental disorder and as a result may face discrimination and negative attitudes. As with physical health, mental health is not merely the absence of disease or a mental health disorder. It includes emotional well-being, psychological well-being, social well-being and involves being able to 
  • navigate successfully the complexities of life, 
  • develop fulfilling relationships, 
  • adapt to change, 
  • utilize appropriate coping mechanisms to achieve well-being without discrimination. 
  • realize their potential, 
  • have their needs met, and 
  • develop skills that help them navigate the different environments they inhabit. 
The presence or absence of various combinations of protective and risk factors contribute to the mental health of youth and efforts can be undertaken to promote positive mental health and prevent or minimize mental health problems. Youth with mental health disorders may face challenges in their homes, school, community, and interpersonal relationships. Despite these challenges, for most youth, mental health distress is episodic, not permanent, and most can successfully navigate the challenges that come from experiencing a mental health disorder with treatment, peer and professional support and services, and a strong family and social support network. 
Warning Signs and Symptoms 
Certain thoughts, behaviors, symptoms and conditions are directly related to mental illness. We often don’t examine how we might excessively use alcohol, for example, to calm our anxious minds after a long day. Or how a loved one’s refusal to enter therapy might not just be personal preference. Trying to tell the difference between what expected behaviors are and what might be the signs of a mental illness isn't always easy. There's no easy test that can let someone know if there is mental illness or if actions and thoughts might be typical behaviors of a person or the result of a physical illness. 
Each illness has its own symptoms, but common signs of mental illness in adults and adolescents can include the following: 
  • Excessive worrying or fear 
  • Feeling excessively sad or low 
  • Confused thinking or problems concentrating and learning 
  • Extreme mood changes, including uncontrollable “highs” or feelings of euphoria 
  • Prolonged or strong feelings of irritability or anger 
  • Avoiding friends and social activities 
  • Difficulties understanding or relating to other people 
  • Changes in sleeping habits or feeling tired and low energy 
  • Changes in eating habits such as increased hunger or lack of appetite 
  • Changes in sex drive 
  • Difficulty perceiving reality (delusions or hallucinations, in which a person experiences and senses things that don't exist in objective reality) 
  • Inability to perceive changes in one’s own feelings, behavior or personality (”lack of insight” or anosognosia) 
  • Overuse of substances like alcohol or drugs 
  • Multiple physical ailments without obvious causes (such as headaches, stomach aches, vague and ongoing “aches and pains”) 
  • Thinking about suicide 
  • Inability to carry out daily activities or handle daily problems and stress 
  • An intense fear of weight gain or concern with appearance 
Mental health conditions can also begin to develop in young children. Because they’re still learning how to identify and talk about thoughts and emotions, their most obvious symptoms are behavioral. Symptoms in children may include the following: 
  • Changes in school performance 
  • Excessive worry or anxiety, for instance fighting to avoid bed or school 
  • Hyperactive behavior 
  • Frequent nightmares 
  • Frequent disobedience or aggression 
  • Frequent temper tantrums 
Self Care Tips 
Taking good care of yourself is an important part of staying well so that you can be there for the ones you love. It’s like the advice we’re given on airplanes – to put on your oxygen mask first before trying to help someone else. Simply put, in order to care for those you love you must first care for yourself.  
It’s natural to feel stress, anxiety, grief, and worry during difficult times. Whether you’re among the 1 in 5 Americans that experiences a mental illness in a given year, or could simply benefit from boosting your wellbeing amid the stress and disruption of the COVID-19 public health crisis, practicing self-care is an important part of staying well so you can be there to support the ones you love. Consider the following tips from the Centers for Disease Control and Prevention and Mental Health America to help take care of your emotional health during this stressful and anxious time: 
  1. Take care of your body - Try to eat healthy well-balanced meals, exercise regularly, and get plenty of sleep. Avoid alcohol, tobacco, and other drugs. Learn more about wellness strategies for mental health. 
  2. Take breaks - Make time to unwind and remind yourself that strong feelings will fade. Try taking in deep breaths. Try to do activities you usually enjoy. 
  3. Stay informed - When you feel that you are missing information, you may become more stressed or nervous. Watch, listen to, or read the news for updates from officials. Be aware that there may be rumors during a crisis, especially on social media. Always check your sources and turn to reliable sources of information like your local government authorities. 
  4. Avoid too much exposure to news - Take breaks from watching, reading, or listening to news stories. It can be upsetting to hear about the crisis and see images repeatedly. Try to do enjoyable activities and return to normal life as much as possible and check for updates between breaks. 
  5. Seek help when needed - If distress impacts activities of your daily life for several days or weeks, talk to a clergy member, counselor, or doctor. If you need someone to reach out to for mental health support, contact the SAMHSA helpline at 1-800-985-5990 or one of these free hotlines for help. 
  6. Stay connected - At a time when social interactions have dramatically shifted due to COVID-19 and stay-at-home orders, the power of connection can play a big role in maintaining wellbeing. 
  7. Connect with yourself - Learning about your mental health may help you understand your hard times are not your fault. Try journaling about your experiences or making a list of your accomplishments to turn back to when you are feeling low. 
  8. Connect with others - During the time of COVID-19 and social distancing, connecting virtually with positive, loving people you care about and trust may ease stress and help your mood. Share your concerns and how you are feeling with a friend or family member. Maintain healthy relationships and build a strong support system. 
  9. Connect to your community - One way to help feel emotionally strong and resilient in times of stress is to connect to a broad community. Consider virtually volunteering with a community organization that helps fill a need. Giving to others may help build strong community bonds, while boosting the connections that can be important for strong mental health. 
Where to Get Help 
Don’t be afraid to reach out if you or someone you know needs help. Learning all you can about mental health is an important first step. Reach out to your health insurance, primary care doctor or state/county mental health authority for more resources. Contact the National Alliance on Mental Illness (NAMI) NAMI HelpLine to find out what services and supports are available in your community.  
If you or someone you know needs helps now you should immediately call the National Suicide Prevention Lifeline at 1-800-273-8255 or call 911. 
Need Immediate Help In A Crisis? 
National Suicide Prevention Lifeline – Call 800-273-TALK (8255) 
If you or someone you know is in crisis—whether they are considering suicide or not—please call the toll-free Lifeline at 800-273-TALK (8255) to speak with a trained crisis counselor 24/7 in the Lifeline network closest to your location. Your call will be answered by a trained crisis worker who will listen empathetically and without judgment. The crisis worker will work to ensure that you feel safe and help identify options and information about mental health services in your area. Your call is confidential and free. 
Crisis Text Line – Text NAMI to 741-741   
Connect with a trained crisis counselor to receive free, 24/7 crisis support via text message. 
National Domestic Violence Hotline – Call 800-799-SAFE (7233) 
Trained expert advocates are available 24/7 to provide confidential support to anyone experiencing domestic violence or seeking resources and information. Help is available in Spanish and other languages. 
National Sexual Assault Hotline – Call 800-656-HOPE (4673) 
Connect with a trained staff member from a sexual assault service provider in your area that offers 
  • Video - 10 Common Signs of a Mental Health Condition in Teens and Adults  (1:49 min) 
  • Online Screenings - Take a Mental Health Test 
  • Work Health Survey - Survey meant to help identify strategies to help companies do better 
  • Infographic - You are Not Alone (Mental Illness in America) 
  • Infographic - The Ripple Effect of Mental Illness (Person, Family, Community, World) 
  • Infographic - Common Warning Signs of Mental Illness 
  • YOGA POSE - YogaPose is the largest free digital library of yoga poses searchable by symptom. As a form of holistic healing, it utilizes yoga as a form of alternative medicine to help or ease the symptoms of both mental and physical illnesses. Users are able to search the Yoga Pose database of comprehensive yoga poses based on the ailment they are experiencing. Each yoga pose profile features an easy-to- follow Yoga Pose video, medical information, and related flows. 
  • PsychHub - PsychHub is the world’s largest online platform for mental health education with revolutionary Learning Hubs to take you from knowledge learned to behavior changed. 

Employee well-being and performance

There’s a lot of talk about employee well-being right now. Throughout the course of the pandemic, the consequences of a lack of well-being have been laid bare over the last year. But employee well-being isn’t a new phenomenon. It’s been lurking in the shadows, affecting work performance for as long as the notion of “work” has existed. I caution you against dismissing the emphasis on employee well-being as only being related to the pandemic. Instead, we must recognize it as an opportunity to re-tool management to improve both productivity and engagement moving forward. 

Well-being at its most fundamental level is literal. It’s about “being well.” The work of well-being is taking intentional steps to feel better (or less unwell) in all areas of our lives.  When we are physically diminished for any reason, our work suffers. Hungover, tired, hungry, or any number of other issues can cause us not to be at our best. A lack of physical well-being is probably the easiest to see and notice, which I think is why most wellness programs have focused there in the past. But, being unwell can have many causes. 

Well-being isn’t just about avoiding pain or suffering. It’s about recognizing that we all have core human needs as human beings that need to be met for us to be happy, content, and able to be the best version of ourselves. Being “well” means your core needs are met in a way that allows you to make choices about how to invest your time, energy, and talent.
Being “well” means you’re operating as a whole person with your full potential at your disposal. “Well” is an aspiration. And, it’s one that I believe all humans share. When our well-being is in a good place, it feels great. Well-being has come to the forefront now because the past year has introduced multiple threats to our well-being that almost felt like a coordinated attack. 

Illness led the news, but our safety and financial security also came under attack simultaneously. Relationships were strained, and unhealthy habits revealed themselves as a temporary solution to our anxiety. Life piled on the well-being challenges one after the other as if it were a contest to see how much we could handle before we break. Some of us broke. Many are on the verge of breaking. This is where far too many people find themselves today.  

As a manager or leader, this should be alarming to you. Because as we know from our own experiences when we aren’t well, we can’t do our best work. While this has always been true, the consequences of not supporting our employees’ well-being are starker and more catastrophic than ever before. If you want a high-performing team who will stay with you through good and bad times, supporting well-being needs to move to the top of your priority list and stay there. 


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