1. Increasing employee insurance contributions. The most direct way of coping with higher premiums is to pass them on to your employees. There's no way such a strategy is going to be popular, but higher individual premiums are still better than losing access to a group health plan altogether. According to Hewitt Associates, a human resources consulting firm, the average employee contribution will be 23% in 2004, up from 21% in 2003, as well as 27% for dependent coverage, up from 25% in 2003.

2. Adjusting co-pays. According to Hewitt Associates, this process is already well under way. The consulting firm says that 24% of companies surveyed in 2001 required employees to make a $15 co-payment for doctors' appointments. Three years earlier, such a requirement was implemented by only 11%. At the same time, the percentage of businesses requiring a co-payment of more than $50 for an office visit doubled, from 7% to 14%.

3. Cutting "extras." The gold standard for health insurance is still a plan that includes coverage not just for ordinary illnesses and doctors' visits but also for dental care, eye care and other add-ons often not included in a basic policy.You'll save money if you pull back on those coverages. Again, it's not fun, but reduced coverage is better than none at all. (As it is, many people get rude surprises when they need such dental procedures as implants and they learn that the work is considered cosmetic and thus isn't covered by insurance.)

4. Doing some comparison shopping. Insurance companies' charges and offerings can vary widely from year to year. Don't assume that the information you gathered five years ago is still relevant. Get out there (or have your insurance agent get out there) and break some eggs to determine whether you're getting the best combination of cost and coverage that's available to you.

5. Switching drug coverage plans. Prescription drugs command an increasing portion of the health-care dollars; consequently, coverage for drug costs also is going up. Companies are responding by having employees pick up a larger portion of their drug costs, and taking policies with larger co-pays. Some 40% of the companies included in Hewitt's 2002 study were having employees make a co-payment of $10 on generic prescription drugs, up from 27% the year before.

6. Set up a flexible spending account (FSA) plan. FSAs allow employees to pay for part of their co-payments and other non-reimbursed medical expenses with pretax dollars. The money they have set aside in their own FSA accounts isn't subject to personal federal income tax, thus reducing their real after-tax cost of medical care. For more on FSAs, visit MyCafeteriaPlan.com.

7. Considering a consumer-driven care plan. These relatively new plans involve you, as the employer, contributing a preset amount to an employee's health resources or personal care account. The money you put into the plan can be used against out-of-pocket medical expenses, and employees can also roll over the money in an account from year to year when their costs are less than the amount set aside.

8. Contacting your U.S. senator or representative, and pushing for reform. We're talking a longer-term process here, obviously. But whether you want a system in which the government is the "single payer," a system where employers receive additional incentives for providing coverage, a campaign to rein in insurance companies and/or medical practitioners, or some other alternative, you've got to make your views known if you want to see change.