All but two members of the state's Public Employees' Benefit Program Board (PEBP) voted during a meeting to approve a surcharge of $55 a month on unvaccinated workers.
The approved proposal also stipulates a surcharge of $175 a month for workers' spouses, partners, and dependents 18 and older. That could be adjusted down the road.
The surcharges will go into effect on July 1, 2022.
They'll help offset the costs of COVID-19 testing, Laura Rich, executive officer of the board, said.
Testing costs through September were estimated at $3.3 million.
The board did not analyze the cost of COVID-19 hospitalizations for the proposal because that would have made the surcharge for spouses and dependents "significantly higher," Rich said. State rules bar making the surcharge on workers any higher.
Nevada's Department of Labor last month released guidance saying the surcharges were legal, and Rich compared them to surcharges on smokers imposed by plans in the past.
Exemptions are available for religious or medical reasons, as required by law.
Public commenters during the meeting, and those submitting written statements, spoke out against the proposal before the vote.
"I believe that the proposed surcharge is inappropriate and excessive," Ellen Crecelius, one member of the public, said in a statement. She noted that many people enjoy natural immunity, or the protection one gets after having recovered from COVID-19.