Spurred by rising Covid cases and the Delta variant’s spread, a wave of major employers announced the same rule for unvaccinated workers this week: They will need to submit to regular surveillance testing. The new requirement raises a thorny question: Who pays for those coronavirus tests?

Doctors typically charge about $50 to $100 for the tests, so the costs of weekly testing could add up quickly. Federal law requires insurers to fully cover the tests when ordered by a health care provider, but routine workplace tests are exempt from that provision.

“It’s really up to the employer,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. “They can require employees to pick up the tab.”

Employers have so far taken a range of approaches, from fully covering the costs to having unvaccinated workers pay full freight.

The U.S. government will pay for its unvaccinated workers’ coronavirus testing, Karine Jean-Pierre, the deputy White House press secretary, said at a news briefing Friday.

President Biden announced rules on Thursday that amount to a two-tier system for the country’s four million federal employees. Those who do not get vaccinated will have to social-distance, wear face coverings and comply with limits on official travel. Those who do get vaccinated will have no such requirements.

The unvaccinated will also have to submit to regular coronavirus testing. Each federal agency will come up with a plan for testing its unvaccinated work force. The costs and procedures of each agency’s testing protocols will depend on the number of unvaccinated people they need to monitor.

“The agencies are going to be implementing this program themselves, so they’ll be in charge of how that moves forward,” Ms. Jean-Pierre said.

Among the employers taking a different approach is Rhodes College in Tennessee: It will have unvaccinated students, faculty and staff pay a $1,500 fee per semester to cover the costs associated with a weekly coronavirus testing program.

Rhodes, a small liberal arts college, estimates that three-quarters of its employees are vaccinated. It is still collecting information about the vaccination rate among its 2,000 students, and it strongly encourages vaccination. But it is waiting until full Food and Drug Administration approval of the vaccines before mandating them.


July 30, 2021, 7:36 p.m. ET

“This is not a punishment,” said Meghan Harte Weyant, the college’s vice president for student life. “For students who choose to return to campus unvaccinated, they will have to cover their costs. This is intended to ensure that students who are vaccinated do not have to bear that cost.”

Other employers are having workers chip in for the costs of coronavirus testing. MGM Resorts, which owns many hotels and casinos in Las Vegas, will charge a $15 co-pay for the testing at an on-site clinic for unvaccinated workers, multiple news outlets reported last week. Workers will also have the option to be tested at an outside provider.

MGM Resorts did not respond to a New York Times request for comment on the new policy.

These disparate approaches could provide a menu of options for workplaces still deciding who will pay for unvaccinated workers’ coronavirus tests, and how much.

New York and California started testing requirements for unvaccinated state workers this week, but neither has specified who will pay for the service. Neither governor’s press office responded to a Times request for comment.

Many states and cities still have free coronavirus testing sites that they started earlier in the pandemic. Long Beach, Calif., announced this week that it would require testing for unvaccinated city workers. In a statement to The Times on the new rule, the city said that workers “will have the option to do their mandated testing for free at the Long Beach Health Department” when the requirement takes effect in mid-August.

But many Americans also get tests at doctor’s offices and pharmacies, which will typically bill patients and their insurance for the service.

Understand the State of Vaccine Mandates in the U.S.

Federal law requires insurers to fully cover coronavirus tests ordered by health care providers, meaning the doctor cannot apply a deductible or co-payment to the service. Rules written by the Trump administration, and continued into the Biden administration, excluded routine workplace testing from that requirement.

In practice, insurers do often end up covering employer-mandated tests — it’s hard to tell from a doctor’s bill whether a workplace ordered the care — but they could start reviewing cases of patients who suddenly have claims every week for the same service.

“If they are starting to see a significant number of people who have these tests submitted every week, or twice a week, under federal law they would be within their authority to say this looks like routine workplace testing and not cover it,” said Professor Corlette of Georgetown.

This means unvaccinated workers who have to obtain their own coronavirus testing could have to pay their own fees. Some patients have faced surprise medical bills for coronavirus tests, which can range from a few dollars to over $1,000.

Some of those bills were the result of an employer-mandated test. In the last year, The Times has asked readers to send in their medical bills for coronavirus testing and treatment, and reviewed multiple cases of surprise charges for a workplace-required test.

That includes Marta Bartan, who needed a coronavirus test to return to a job last summer working as a hair colorist in Brooklyn. As The Times reported, she received a $1,394 bill from a hospital running a drive-through site.

“I was so confused,” she said at the time. “You go in to get a Covid test expecting it to be free. What could they have possibly charged me $1,400 for?”