Many behavioral economic "nudges" have impacts that are different than expected. For instance, behavioral economists were enthusiastic about well-designed lotteries to encourage vaccination. But these were ineffective at increasing vaccination rates; in fact, states with lotteries or financial incentives had a steeper drop-off in vaccination rates than states that did not have such programs in place. Design the evaluation program before the vaccination surcharge is put in place so that you can adjust the program based on its impact.

Add flexibility to any surcharge program so that previously unvaccinated employees can eliminate their surcharge when they are vaccinated.

Employers often deploy wellness plan incentives on a plan year basis, which would provide no incentive to get vaccinated until the following year's open enrollment. A well-designed vaccine surcharge program would allow employees to have surcharge removed throughout the year shortly after an employee is vaccinated.

Communicate the health insurance premium surcharge for unvaccinated employees early and often.

Incentives work only if employees understand them, and a vaccination mandate requiring multiple injections with the opportunity for exemptions is especially difficult to communicate. Premium surcharges are also combined with other payroll deductions, and they are not especially visible to most employees throughout the year. The most effective communications can focus on peers getting vaccinated and the potential to prevent financial and health loss. Resources for communications are available from the Health Action Alliance and the Centers for Disease Control and Prevention.

Be mindful of the potential impact of a health insurance surcharge on health equity.

Vaccine surcharge programs can exacerbate existing disparities. Lower-wage employees and those with lower educational levels are most likely to remain unvaccinated and are sometimes more poorly positioned to navigate reasonable alternative standards. Employers can be sure that educational materials are culturally appropriate and available in multiple languages, and they can recruit co-workers from diverse backgrounds to serve as influencers in this effort.

Keep up all other efforts to promote vaccination and keep employees safe.

Vaccination surcharges could nudge some employees to get vaccinated but are less likely to be effective if employers fail to provide scheduling flexibility and paid time off for vaccination. Vaccinations are just one part of the effort to protect the workplace from COVID; likewise, surcharges should be just one element of a comprehensive approach to increase vaccination rates and keep workers safe.

Instant Insights /

7 ways to improve the effectiveness of your vaccine surcharges

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