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> The flip side of that is that they aren't contributing much to insurance premiums.

Can we be certain of that? That is, even if the vaccination costs $30 to $40, will the insurance be billed for that amount, or do they get billed something like $300 instead?

I haven't tried to pay for a influenza vaccination out of pocket recently, so I don't know what most places would charge.

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The price the insurance company pays is almost never going to be higher than what you would pay if you're uninsured. You're confusing your co-pay with the uninsured cost of a flu shot. If Sam's Club and Costco can offer flu shots for $15 [0], it's a safe bet that the cost to an insurance company is less than that.

[0] https://www.bradsdeals.com/blog/where-to-get-a-cheap-flu-sho...

I actually have a high-deductible health plan which will pay 100% of the cost for preventative care (like influenza vaccinations).

Even so, that's more money that the insurance company is paying out that could just as well be paid for directly everyone who gets the vaccine. If routine care was affordable without having to involve insurance, then insurance premiums wouldn't be as high and the out-of-pocket costs for medical care wouldn't be as high either.

Insurance will usually pay less than the cash price. They have a better idea of the cost than individuals and more leverage.

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