Small employers providing group medical insurance to their workforce experienced premium cost increases well into the double digits during the past six months, but all sizes of employers were hit by substantially higher group medical costs, according to the fall Employee Benefits Market Survey by The Council of Insurance Agents & Brokers. Benefits consultants responding to the survey said the cost of group medical care increased for 86 percent of their small accounts, those with 50 or fewer employees. Of those respondents, 47 percent saw small account premiums go up by 11 to 15 percent over the first six months of this year, and 19 percent reported premium rates 16 to 20 percent higher. The benefits consultants said 79 percent of their medium accounts, those with 51 to 500 employees, experienced premium increases of from 6 to 15 percent, with 44 percent falling in the 11 to 15 percent range. Large accounts, those with 501 or more employees, also saw rates go up but to a lesser extent. The benefits consultants said 45 percent of their large accounts experienced premium increases in the 6 to 10 percent range, with 17 percent of the accounts increasing 11 to 15 percent. Only a handful of the benefits brokers reported account group medical premiums holding steady or decreasing, regardless of the size of the employer. Despite the rising medical care expenses, few employers are eliminating that benefit, the survey showed. Rather, they are using higher deductibles and co-pays and increasing the employee share of premium costs to help them continue the health care benefit. Another common workplace response to the rising premium prices is using a prescription drug co-pay, survey respondents said. Although assessing an up-front hospital and outpatient co-pay is gaining some support among employers to control costs, that option still is not being widely embraced. High-deductible health plans coupled with either a health reimbursement account (HRA) or a health savings account (HSA) also have been used by some employers to control costs, but those options still are not being offered in a large number of workplaces. Most of those employers who do offer HSAs are including them as a plan option rather than replacing the existing plan, and the most common employer contribution to an HSA is $500 to $749, although a handful of employers are contributing $750 to $1,000 or more. The survey showed group life insurance premium rates are holding steady or up slightly for small accounts, with premiums for medium and large accounts roughly steady or down slightly. Benefits consultants responding to open-ended questions in the survey said the market remains competitive but there were no major changes in market conditions.