FILE - In this Oct. 21, 2020, file photo, an Exam Corp Lab employee, right, wears a mask as she talks with a patient lined up for COVID-19 testing in Niles, Ill. Millions of U.S. workers now have a Jan. 4 deadline to get a COVID vaccine. The federal government on Thursday, Nov. 4, 2021 announced new vaccine requirements for workers at companies with more than 100 employees as well as workers at health care facilities that treat Medicare and Medicaid patients. (AP Photo/Nam Y. Huh, File)

People who refuse to comply with the federal COVID-19 vaccine mandate for large employers may eventually face a pointed question: If they must get tested weekly, who pays for it?

The answer might stick them in the wallet.

In a nutshell, a federal mandate stipulates that employers with 100 or more workers require employees to be vaccinated or tested weekly beginning Jan. 4. But it doesn’t require employers to pay for the tests. Nor does it require health insurers to pay. (The issue currently is in limbo. A federal court issued a stay on the mandate; the Biden administration is appealing.)

The rules are based on the rationale vaccinations are free, easy to get and the best way to prevent COVID-19 infections, the White House said in announcing the policy earlier this month.

PCR tests, the most trusted kind, cost between $50 and $100, a Pennsylvania Department of Health spokeswoman said. A self-test — often cheaper — won’t do. The Occupational Safety and Health Administration (OSHA) is requiring employers to either observe the testing and results or have a professional third-party do so. In others words, employees can’t test themselves and turn in the results.

Having to pay for a COVID-19 test may come as a shock, given the amount of information about free testing since early in the pandemic. True, in early 2020 the federal government said health insurers and government programs must pay for tests for people who have symptoms or when ordered by a doctor. But even then, the requirement didn’t apply to testing required to meet employer mandates or return to work.

In the end, much will come down to who you work for. The mandate applies to an estimated 84 million people and an untold number of businesses. About a dozen large Pennsylvania employers contacted by PennLive either said they hadn’t decided whether they will pay for testing or declined to discuss it. Penn State University said it will cover testing costs through the spring, 2022 semester and hasn’t decided what it will do after that.

About 30 states have laws requiring employers to pay for work-related medical tests. But Pennsylvania isn’t among them, according to Lauren Winans, the CEO of Next Level Benefits in Pittsburgh.

On one level, she expects many employers will wait to see how the mandate plays out in court before making final decisions.

But if the mandate holds, she expects many employers will pay for testing in order to prevent an exodus of employees.

“Industries like high-tech and finance will likely be quick to adopt an employer-paid testing strategy when/if unvaccinated employees are working at on-site company locations,” Winans said in an email. “Industries like hospitality, construction, retail, and food/restaurants are going to have a tough time deciding whether to take the costly employer-paid weekly testing route or pushing the cost onto employees.”

In some industries, Winans said, employers might initially put the cost on employees and perhaps change their approach after seeing the impact on turnover.

In union settings, unions will have a say, she noted.

In general, Winans expects employers “will come down hard on the side of requiring employees to be vaccinated,” because the vaccinations are free, while there is a cost to weekly testing and lost productivity.

Gene Barr, the president of the Pennsylvania Chamber of Business and Industry, said he has little sense of what the majority of Pennsylvania businesses will do in terms of paying for tests. He said employers’ main concern is that people will quit to work for smaller firms where the mandate doesn’t apply. Businesses also fear that, even if they pay for tests, they’ll lose workers who view required testing an as infringement, he said.

Given such concerns, Barr said the chamber has asked the state to make clear that if people quit a job because of a vaccination mandate they are ineligible for state unemployment benefits.

For its part, the chamber requires employees to be vaccinated or undergo regular testing and — as the federal mandate also will require — wear a face mask at work. The chamber pays for the tests, said Barr, who noted more than 90% of chamber employees are vaccinated.

About 25,000 Pennsylvania state employees working at facilities such as state-run health care facilities and state prisons are subject to a Wolf administration mandate to be vaccinated or be tested. The state provides testing at the facilities and covers the cost, a spokesman said. If an employee chooses to go elsewhere, the employee must pay.

Meanwhile, health insurers typically don’t pay for surveillance testing. For example, Capital Blue Cross and Highmark, major insurers serving the Harrisburg region, confirmed they don’t cover COVID-19 tests that aren’t ordered by a health care provider for someone who might have COVID-19. “Therefore, weekly tests required as a condition of employment are not a covered benefit and will not be paid for by health insurance,” Capital Blue Cross said in an email.

A health department spokeswoman said she knew of no source of free testing for people who have to get tested because of an employer mandate.

There are more uncertainties. The biggest is the future of the mandate itself, which is a key policy of the Biden administration. A federal court has stayed the mandate and the Biden administration appealed. Two dozen attorneys general and others around the country have filed suits against the mandate.

Beyond that, employees who defy the mandate face additional questions: Who pays for time away from work getting tested? Who pays for employees’ time while standing in line for workplace tests or waiting for results? This much is certain: The federal government doesn’t plan to require employers to pay for those things either.

However, Winans suspects employers will pay for time spent getting tested, and notes they might run afoul of other laws if they don’t.

“It would truly be a double whammy if an employer does not pay for the testing or the time an employee spends performing the job requirement, leaving the employee to experience a pay decrease in order to assist their employer to comply with a federal mandate,” she said.