Small businesses have faced a complicated pricing structure in selecting health benefit plans for their employees in the wake of the passage of the 2010 Patient Protection and Affordable Care Act. One of the first provisions of the act to go into effect was the creation of a 35% tax credit on health insurance premiums for small businesses with fewer than 50 employees. (In 2014, that credit is set to jump to 50%.)

In the meantime, however, healthcare costs are, on average, rising 18% annually, the cost of individual health insurance is up about 8 percent nationwide, and employees covered by health plans are paying about $250 more for the same coverage they were receiving before the reform law was enacted.

Small business health insurance plans are the biggest benefit expense faced by owners. During the Great Recession and beyond, cost cutting has been a primary focus in the name of marketplace survival. The problem for many small businesses, however, is that they tend to enjoy a more intimate relationship with their employees, so there are more personal issues attendant with putting together a health benefits package.

It’s important to remember, however, that if the business can’t stay afloat, the employees won’t just be without health coverage — they’ll be without a job.

Obviously a scenario in which the employer pays for the health insurance entirely is best for the employee, but that’s hardly practical for most businesses. Rather than simply dropping coverage altogether, review the existing benefits package or carefully examine the proposed package against real needs and use.

If some benefits are never (or rarely) used, negotiate with the insurer to eliminate those items or reduce their levels. Remember that insurers are also in the business of keeping clientele, and are often willing to customize benefit plans.

If some employees receive coverage as a benefit of their spouse’s health insurance, offer incentives for them to opt out of their own provided plan. Make sure the plan, in turn, rewards discounts per number of employees covered. If only one person is willing to opt out, the savings might not be significant, but if five or more agree, will the health premiums drop appreciably?

Plans in which the employer and employee share the premium costs are the most affordable for the business owner. They may not, however, be cost effective for the employee. Consider offering younger, more healthy employees a smaller health benefits package paired with the option of contributing to a health savings account, which is a tax-free vehicle to put money aside for future medical expenses.

Small businesses will do better in providing workable and affordable coverage for their employees if they actually talk to their workers and make a realistic assessment of needs. In this tight economy, no one wants to pay for benefits they will never use. This, coupled with choosing an insurer willing to negotiate plan options, can go a long way toward keeping the price of health benefits down for small businesses.