Following is a compilation of ideas expressed by CEB members on this issue.

1. Managed Care (PPO)
   This is one of the best ways to significantly reduce health care costs.  Employees are supplied with a list of preferred providers and given economic incentives to use one of the preferred providers.  For example, employees may have to pay for the difference between the fee of the preferred provider and the fee of the provider of their choice.
   
   
2. Self-insurance
   Many smaller companies are significantly reducing health care cost by self-insuring.  Make certain you have stop loss insurance that limits your liability for each individual employee or for the aggregate of your work force.
   
   
3. Raise the deductible and implement Health Savings Accounts
   The increased liability of a higher deductible can be offset with employee Health Savings Accounts. See E-Briefing #1 -- Health Savings Accounts
   
   
4. Refund deductible to employees
   If you have a $500 deductible for example, you can give $500 to each employee who does not have a claim during the year.
   
   
5. Shop insurance companies
   Many companies find they must continually shop for the best price and service for their health care insurance.  This option will be limited if you have unusually high claims.
   
   
6. Offer wellness programs
   High quality wellness programs are often available through local health care providers such as hospitals and clinics.
   
   
7. Offer wellness discounts
   If you are self-insured you can give discounts to employees who are non-smokers, those who weigh within certain recommended limits, and those who reduce blood pressure and cholesterol levels.
   
   
8. Encourage employees to take spouse’s insurance
   You might encourage employees to take their spouse’s insurance by:
   ·        giving them a one-time payment to do so
   ·        raising the amount of co-pay for family plans
   ·        giving them a percentage of the savings from the change
   
   
9. Exclude coverage for certain high risk activities
   Exclude coverage for automobile accidents off the job and accidents from such activities as sky diving, scuba diving, etc.
   
   
10. Emergency room exclusions
    Many employees use the emergency room unnecessarily.  To discourage such use, pay for emergency room visits only when they lead to admittance to the hospital.
    
    
11. Limit the amount you will pay
    Establish a maximum amount your company will pay per employee for health insurance.  Any premium costs exceeding this maximum must be paid by the employee.
    
    
12. Get a good third party administrator
    TPA’s differ in how good they are at containing health care costs.  Find out the experiences other companies are having with their TPA and make any necessary changes.
    
    
13. Require pre-approvals
    Make certain non-emergency claims have approval before the service is provided.
    
    
14. Share in savings
    Encourage employees to check their medical bills by sharing with them any savings that result from finding errors in the bills.
    
    
15. Encourage good health care habits
    Make certain your employees receive good health care.  For example, make certain pregnant employees receive good care early in their pregnancies.  This can prevent many expensive complications later on.
    
    
16. Join a group
    Insurance brokers can quote rates for companies with as few as 3 employees through groups such as trade associations, professional societies and credit unions.