However, after experiencing two years of cost increases in their health plans, many employers are now ready to make changes, and Frost expects to see more plan adjustments during the 2011 enrollment period.

"Now we're seeing employers make more plan changes, and that can be everything from taking their health plans out to bid to get better rates or changing the design," Frost says. "A traditional PPO is the most common plan design, but we're seeing clients offer that and also high-deductible health plans with health savings accounts and other types of plans that can save both the employer and employee a lot of money."

By making plan changes during enrollment, employees have more options, and employers can save health care costs in the long run, Frost says.

But a cautious attitude isn't the only reason Frost believes there will be more health plan changes during this year's enrollment period. When PPACA was first passed, President Obama assured the public they could keep their health insurance based on the clause that grants plans grandfathered statuses, but there was a stipulation: no changes could be made to those plans.

Now employers are more willing to accept some of PPACA's mandates in an exchange for flexibility, Frost says. While some mandate changes may increase costs, employers at least have the option to control costs in other areas.

"This year we're finding that potential cost of health care reform's increase is outweighed by other cost increases going on," Frost says. "Now they're saying, 'OK, well, now I'll take some of those other rules in order to have the flexibility to change my plan.'"

Some of the changes made during enrollment include changing carriers as well as increasing deductibles, copays or coinsurance, Frost says.

More dependents, higher costs

Last year employers were required to implement the PPACA mandate that says dependents are eligible for health insurance coverage up to age 26, but before that, most employers offered coverage to dependents up to age 23. Traditionally, dependents were expected to finish college, and then find health insurance through their employers, Frost says, but with the economy in such poor shape, the maximum age was expanded.

Of course, the additional number of dependents produces greater costs. According to Frost, across Aon Hewitt's 300 clients, there was a 15 percent jump in the number of covered dependents, which is a significant cost increase.

"This year employers are trying different strategies, so the dependents that need coverage are added, but their employees understand there is a cost to adding those dependents," Frost says. "We see a number of employers implementing a per-dependent pricing. If the employer covers one person, it's one cost, and then for each dependent that's added after that, it's an additional cost."

Frost estimates that approximately 10 percent of Aon Hewitt's client base is looking at a per-dependent pricing option.

Whatever changes are made during enrollment, communication is a key component, Frost says. With PPACA, the health insurance landscape is quickly changing, and open communication helps employees understand the changes made during enrollment.

"Some employers use one big push as the prime way to communicate enrollment changes," Frost says. "Communicate early and through digestible chunks in more frequent pattern. Give them an amount of information that they can grasp, and this will help employees understand and become more comfortable about the changes that are happening during enrollment."