U.S. health insurance debt is on the rise as COVID cases surge once again, with more hospitalizations in December. As a result, some employers are considering whether to impose company health coverage surcharges on unvaccinated employees.

Average cost for employee health insurance overall jumped 6.3% in 2021, as most individuals were not required to pay costs in 2020. Small businesses who provide health insurance saw the fastest cost growth this year.

Federal healthcare reported Wednesday a booming $4.1 trillion spent last year on COVID tests, vaccines, and treatments for patients. Other health insurers have decided to lift pandemic full-coverage relief due to heavy costs.

As the Omicron variant has caused the virus to spread quickly again, some employers have taken initiative to revise their company health policies to further motivate staff vaccination.

That was the case with supermarket chain Kroger, who first issued a $50 surcharge Tuesday on employees who refuse the COVID vaccine. The additional charge will not apply to staff with medical and religious exceptions.

They are not the only employer to take this step, however, as Delta Air Lines placed a $200 charge requirement back in August.

NPR reported employers use “wellness programs” to encourage employee vaccinations for a safer work environment, and how these policies permit them to place penalties or rewards.

Businesses throughout the country are juggling with employees who won’t budge on their decision to not get vaccinated, and lawsuits of borderline enforcement.

An employer, according to federal law, has the option to alter their health insurance policies regarding COVID vaccinations, as long as they clearly define an option to waiver.