Some businesses have increased the percentage employees contribute to plans in order to continue to provide health benefits, said Helen Darling, president and CEO of the National Business Group on Health in Washington, D.C. The standard cost division is for employers to pay about 80 percent and employees about 20 percent, she said. In today's health insurance environment, many companies are asking employees to pay up to 25 percent of those costs, she said.

Many people may not know the total cost of their health care benefits, said Michael Smeltzer, executive director of the Manufacturers' Association of South Central Pennsylvania. The group functions as an insurance broker for its members.

An association survey found the average annual cost per employee in 2010 was $11,413, including both employer and employee contributions, he said. The survey had 260 respondents, he said.

In other industries, the cost can be even higher, according to a study by Virginia-based Society for Human Resource Management. Its 2011 Health Care Benchmarking Survey reports the highest total annual health care benefits cost per covered employee is in the utility industry, at $20,567. Insurance, real estate, government and manufacturing rounded out the top five, according to the survey.

Members of the manufacturing association saw health care benefit cost increases between 5 percent and 125 percent, Smeltzer said.

"Passing cost on to an employee is a difficult thing," Smeltzer said. "But as the employer, I can't sit here and say I'll just absorb a 29 percent rate increase."

Most companies are trying to cover as much of health benefit cost increases as they can to minimize the direct impact to their employees, said Matt Pfeiffenberger, vice president of benefits and communications services for Murray Insurance Associates Inc., which does business as Murray Risk Management and Insurance.

The Lancaster-based business has seen a trend to higher-deductible insurance plans that feature lower premiums, he said.

High-deductible plans are paired with either a health reimbursement account or a health savings account, he said. Only the employer can deposit money into a reimbursement account for an employee to use toward their deductible. In general, money in a reimbursement account does not roll from year to year, he said. Employers and employees can contribute to a health savings account, and because of its savings nature, money can carry over to the next year, he said. Health savings account balances are not taxed if used for medical expenses.

High-deductible plans come with a responsibility for employees to become better health care consumers, Pfeiffenberger said. Asking for a second medical opinion, checking bills and invoices and discussing prescription medications with physicians are possible ways to keep costs down, he said.

Lancaster General Health offered a high-deductible benefit plan to its employees for the first time for 2012, said Mary Miskey, vice president of human resources operations. About four percent of the health system's 5,600 employees took advantage of it.

About half of the 1,600 benefit-eligible employees at Hershey Entertainment & Resorts Co. participate in its high-deductible health benefit plan, director of human resources Kim Mann said.

The Derry Township company rearranged some of its health benefit options in 2012 for cost reasons, she said. Some plans incurred higher premiums and others had deductible increases, she said.

The health benefits are paired with a wellness program to help employees change their behaviors, which controls their health care costs, she said.

"Managing health care costs is a shared responsibility," Mann said.

Many companies are shopping around more after receiving health benefit rate increases, said D. Edward Young, president and CEO of Teachers Protective Mutual Life Insurance Co. in Lancaster.

"Loyalty is a fairly rare thing to find these days in the health insurance business," he said.

There's been a slightly more competitive environment between health insurance carriers, said Marc Backon, senior vice president of commercial markets at Capital BlueCross in Dauphin County.

Companies of all sizes in every industry now make decisions about health benefits solely because of cost, he said.

The health insurer in Susquehanna Township has seen a migration of businesses choosing or planning for a move to self-funded plans, he said.

Under a self-funded plan, the company itself functions as the insurer, with a third party providing administration and access to provider networks. Businesses pay health care benefit costs from their own budgets and choose what percentage, if any, to collect from employees. Costs are dictated by actual health care claims, not by an outside insurance carrier.

Many of the midstate's large employers use self-funded plans, such as Giant Food Stores in Cumberland County and Farmers Pride Inc., which does business as Bell & Evans in Lebanon County.

After a series of double-digit rate increases, Bell & Evans switched to a self-funded plan in 2010, said Chief Financial Officer Daniel Chirico. The business in Bethel Township emphasizes preventative maintenance for the health of its 1,200 employees, he said.

Since the change, employees pay less than 15 percent of the total health care benefit costs, and the company is paying less overall as well, he said.

"We can manage our costs better than the insurance company can," Chirico said. "They're not really incentivized to keep health care costs down."

As midstate companies wrestle with keeping health care benefits affordable, they also want to remain competitive, said Chris Brand, spokesman for Giant Food Stores in Middlesex Township.

"For us, we take the approach to minimize employee-paid increases in order to ensure we remain an employer of choice in our industry," he said.

For 2012, the business applied a 2 percent increase to its employees, and retains a company cost much higher than the 64 percent that is average for the retail industry, he said.

Weighing the benefits and costs of health insurance plans continues to be challenging in the health care and economic environment, Smeltzer said.

"The options are few and far between," he said.