“Employers are asking employees to become partners in controlling health-care costs and getting the most value from the health-care dollar,” says Mike Murphy, a member of the Society for Human Resource Management Total Rewards/Compensation & Benefits Special Expertise Panel.

Some human-resources professionals say coverage from health maintenance organizations is on the way out in favor of preferred-provider-organization plans. Because they are driven by co-pays, a low flat fee for services, HMOs don't give employees a good idea of health-care costs. On the other hand, PPOs have a deductible and co-insurance, in which employees pay a percentage of the bill.

“We don't expect HMO to last forever,” says Stacey Frederiksen, director of human resources at San Diego-based Pat & Oscar's, which offers HMO and PPO plans. “We've got to be prepared for the more consumer-driven plans, which have a high deductible. Gone are the days where regardless what the doctor does, you pay $10.”

To get employees thinking about the true cost of health care, many companies offer medical savings accounts to help pay for out-of-pocket medical expenses.

For example, 150-unit, Austin, Texas-based Carino's Italian offers health reimbursement accounts and flexible spending accounts. HRAs are funded by employers, not employees. Although the funds roll over to the next year, employees forfeit them when they leave their companies. FSAs allow employees to contribute money into accounts tax free. However, if they don't use all the money within the year, they lose it.

With health savings accounts, employees and employers may contribute funds into the employee's account. Employees may take the money when they leave their jobs, and the funds roll over into the next year. But to qualify for an HSA, employees must enroll in a high-deductible plan.

San Diego-based Garden Fresh Restaurant Corp., parent of 34-unit Souplantation and 69-unit Sweet Tomatoes, will transition to a high-deductible PPO tied to an HSA in three years. “It's a friendly alternative to managed care,” says Director of Compensation and Benefits Lisa Sorce. “It allows everything to be transparent online with regards to the cost for medical services, the cost of prescription drugs.”

Wellness programs that emphasize prevention and health are another way to reduce costs. They usually include programs such as smoking cessation, paying for preventative care, and reimbursement of health-club memberships.

“We are definitely trying to push wellness because we believe that wellness prevents disease and disease is what's expensive,” says Devona Haslam, senior director of human relations at 114-unit, Tulsa, Okla.-based Mazzio's Italian Eatery, which offers health-club reimbursements and is looking into other wellness programs.

While salaried employees have access to these plans, hourlies usually don't. Instead, many chains offer them limited-benefit health plans. These low-cost, controversial plans cover routine medical care such as doctor visits, lab tests and prescriptions, but they don't offer catastrophic coverage and have low liability caps.