Question: Can we require our employees to get flu shots?
Answer: While there is no law that prohibits employers from mandating flu shots — and in some states, the law requires all healthcare workers to get flu shots — you should carefully determine if the benefits to your business outweigh the risks. There has been a rise in litigation brought by employees who object to this requirement for medical, religious or personal reasons. The Equal Employment Opportunity Commission (EEOC) has filed or joined several lawsuits over claims that inflexible mandatory vaccination policies are discriminatory.
Employees may be entitled to exemptions from a flu shot policy for medical reasons under the Americans with Disabilities Act (ADA) or religious reasons under Title VII of the Civil Rights Act of 1964. Requests for exemptions must be evaluated individually yet treated consistently; a difficult task. You will need to engage in an interactive process with the employee, just as you would for any other request for accommodations, to determine if they can be granted without presenting undue hardship to your company.
The EEOC recommends against mandatory flu shot policies, instead suggesting employers encourage employees get vaccinated on their own. Offering no-cost flu shots on site can further improve workplace vaccination rates by making it more convenient for employees.
If you choose to enact a mandatory flu shot policy, write it carefully to protect your company from the risk of discrimination claims. Make sure the policy:
Is worded concisely.
Outlines the reasoning behind the policy.
Is applied consistently. (Managers who enforce it should be trained on the policy and how to handle requests for exemptions.)
Explains the process for requesting exemptions due to medical contraindications or sincerely held religious beliefs. Any medical information obtained as part of the request for an exemption should be kept confidential.
Get 6 tips for maintaining a healthy workforce during a seasonal flu outbreak. ThinkHR customers can learn more about the ADA and Title VII by logging into their accounts. If a pandemic flu or other disease outbreak happens, our white paper, How to Handle an Infectious Disease Outbreak, is a good resource. The CDC maintains a list of vaccination laws for various illnesses.
Flexible spending accounts (FSAs), also called Section 125 plans after the relevant section of the Internal Revenue Code, are commonplace benefits. But, perhaps because they are common, some employers and employees don’t understand some of the regulations that apply to these plans.
IRS Publication 969 titled “Health Savings Accounts and Other Tax-Favored Health Plans” is an excellent primer for FSAs and other tax-favored benefits. The most recent version used for preparing 2017 tax returns can be found here.
Among the recent questions received at Compliance Corner was this one: If an employer offers an HSA and a FSA, and an employee elects both is that permissible? Once again with compliance questions, there is no short answer!
The difficulty arises because, according to the IRS in Revenue Ruling 2004-45, an “eligible individual” for a HSA is an individual covered under a high deductible health plan (HDHP) who does not have “coverage for any benefit which is covered under the high deductible health plan.” The FSA, as it is traditionally designed, violates this rule.
But, there is a work around as the Revenue Ruling notes. The work around is a “limited purpose FSA.” A “limited purpose FSA” allows reimbursement of dental and vision expenses. A typical FSA covers medical expenses allowed by IRS Code Section 213(d) – which is much more expansive than dental and vision services.
Another example of a “limited purpose FSA” is known as a “post-deductible FSA.” The “post-deductible FSA” is aptly named as the plan doesn’t reimburse for any medical expenses incurred before the minimum HDHP deductible has been met.
Both the “limited purpose FSA” and the “post-deductible FSA” are covered on page 4 ofIRS Publication 969.
With skyrocketing healthcare costs, how can employers afford employee coverage and still offer dependent benefits? This is a very real challenge facing employers today.
Most companies follow a similar pattern when offering employee benefits. They start off with health insurance, paying 50% or more of the employee premium, and allow employees to add their dependents at their own cost. Some employers will also pay for dental coverage, life insurance, vision insurance, and disability coverage – usually in that order, though it can vary based on what benefits the employer thinks are important or believes the employees will appreciate.
Due largely to costs, most employers no longer pay for dependent coverage. The employees’ family members don’t work for the company, and providing benefits to the whole family would be really expensive, so they leave that up to their workers. Plus, we’re even seeing a new trend developing among larger companies to limit participation of spouses in the health plan when other employer options are available.
But, let’s remember most employees get up in the morning to provide for their families. Not including benefits for the ones they love most can leave hard-working employees feeling like an adult stuck at the kids’ table. If a company can figure out ways to extend a few of the benefits to family members, employees will appreciate those benefits even more, which means the company will see a higher return on its investment.
It’s probably not practical for most companies to pay 100% of the cost of health insurance for employees, their spouses, and their children. But then again, health insurance isn’t the only benefit out there. Here are a few ideas for companies that want to provide some cost-effective benefits for the whole family…
1. Contribute to a Health Savings Account
Employees can use their HSA funds on themselves, their spouses, and their tax-dependent children, even if they’re not on the health plan. This is a point that brokers and employers should emphasize during the annual enrollment meeting. With the employer HSA contribution, parents can take their kids to the doctor or the dentist, get them glasses, or pay for monthly prescriptions. They’ll appreciate the employer’s benefit plan every time they use their HSA card.
2. Pay for Ancillary Benefits
For some reason, employers get it in their minds that they have to be consistent in the way they pay for the various benefits they offer. However, the truth is that they can leave the dependent health insurance costs up to the employees and pay for lower-cost benefits like dental or life insurance. Dental insurance is about one-tenth of the cost of health insurance and people value it almost as much, so it’s a great benefit for a company to pay for (one with orthodontia benefits for the kids will be especially appreciated). And group life insurance is cheap, so employers can provide a base level of benefits for the employee, spouse, and children and then allow them to buy up if they want.
3. Allow employees to purchase voluntary benefits
Even with no employer contribution, there’s value in offering voluntary or worksite benefits like accident or critical illness insurance. Why? Because it’s a lot less expensive than health insurance and can help to offset high medical bills. This means that an employee who can’t afford to cover his family members on his health plan can still reduce their exposure with these relatively inexpensive products.
4. Educate employees about CHIP
The Children’s Health Insurance Program offers quality coverage to low-income families at a very affordable price. The cutoff level, costs, and benefits vary by state, but here’s a quick example of how it works. In Texas, families with incomes below 200% of the federal poverty level, or $50,058 per year, can qualify for CHIP. For those who qualify, they can cover all of their children for just $50 per year or less. Spending a couple of minutes explaining the Children’s Health Insurance Program during an enrollment meeting and handing out a free brochure is a great way to help employees at no cost and with almost no effort. Why wouldn’t an employer want to do that?
5. Offer telehealth!
While almost all employee benefits have an additional charge for family members, telehealth benefits are often good for the employee, spouse, and tax-dependent children (and/or tax-dependent parents). This is especially important for employees who can’t afford to cover family members on their health plan. While telemedicine is not insurance and not intended as a replacement for insurance, it does provide family members with access to health care.
For example, an uninsured spouse can pick up the phone and call a doctor (for herself or her child), get a prescription if necessary, and then save on the cost of that prescription at the pharmacy. She can also email a specialist to get her medical questions answered, consult with an advocate when searching for lower-cost providers, and get help reviewing, organizing and negotiating medical bills. That’s a lot of benefits!
Ultimately, employers offer benefits to attract and retain employees, and for this to work they need to provide benefits their employees truly appreciate. Any benefits that the employer can make available not only to the employees, but also to the employees’ family members, will be doubly appreciated.
Keep this in mind when you’re designing your organizational benefits package. If your goal is to get the most out of your benefits dollar while keeping your employees and their families happy and healthy, considering these options is a great strategy.