The best banks to work for shower employees with profit-sharing bonuses, funnel them into leadership training programs and otherwise keep them happy. But like all banks, they are hard-pressed to shield employees from the expense of health coverage.

"The cost of health care, the cost of benefits in general, is probably one of our biggest challenges," says Marie Reed, human resources director at Veritex Community Bank in Dallas.

Even after passage of the Affordable Care Act, that cost continues to climb. Though most banks are unlikely to scratch health insurance from the benefits menu, some are bound to begin talking about it, especially smaller ones that might have trouble managing the price tag, says Karen J. Hartnett, a human resources consultant in Houston who previously worked for regional banks in Texas.

"I fear it's going to come down to some very hard dollars-and-cents calculation, and the arithmetic is not necessarily our friend," Hartnett says. "I just don't know how we're all going to deal with it."

For now, more banks are dealing with it by adopting high-deductible health plans. The plans — which promise lower premiums but shift more of the cost of routine care to employees — are offered by half the institutions on American Banker Magazine's list of best banks to work for. In addition to slashing premiums, the plans will help banks avoid the so-called Cadillac tax, a levy expected to take effect in 2018 under the ACA. The tax will apply to plans that cost above a specific amount.

"For many of the banks, their costs are expected to exceed that threshold," says Erik Bagin, health and benefits consulting practice leader for Aon Hewitt in New York. "So they're very focused on strategies to avoid the tax."

Banks have been equally focused on strategies to ensure employees aren't dismayed by higher deductibles. Chesapeake Bank in Kilmarnock, Va., went slowly. The bank introduced high-deductible plans nine years ago, says Pat Lewis, its human resources director. But it continued offering traditional plans alongside them for two more years.When Chesapeake switched to high-deductible plans exclusively, it fully funded employees' health savings accounts up to the deductibles, Lewis says.

Over the ensuing years, Chesapeake slowly ratcheted down its contributions and now matches employee contributions up to $500 or $1,500 annually, depending on the deductible. "We would not have been a great place to work if we had made that change abruptly," Lewis says.

Banks also are beefing up wellness programs, in the hope that healthier employees will help offset rising premiums. "You've got to have a good benefits package, but you can't let the costs get out of line," says Terry Turner, president and CEO at Pinnacle Financial Partners in Nashville.

Pinnacle recently hired a full-time coordinator specifically to encourage participation in wellness activities. Among other tasks, the coordinator organizes events such as the bank's annual 5K run, and maintains a wellness section on Pinnacle's intranet.

In another cost-saving move, some banks have opened on-site health clinics, or contracted with third parties to offer clinics in off-site locations. The clinics are designed to make routine and preventive care more accessible to employees — and less expensive.

Centier Bank opened a clinic last year at its corporate headquarters in Merrillville, Ind., and has partnered with neighboring employers to offer clinics in other areas where it operates, says Chrisanne Christ, the bank's senior vice president of human resource development. Centier foots the bill for all employees and any dependents covered under the bank's insurance plans.

BankPlus in Mississippi considered opening an on-site clinic, but instead opted to work with the University of Mississippi Medical Center to create a telehealth option. Starting this fall, employees can use an office webcam to see doctors for ailments such as the flu, ear infections and poison ivy. Visits, as well as certain prescriptions, will be free for employees, and the option is expected to reduce time missed from work. "Education of our employees is going to be key to get them to use it," says Dianne Pepper, its human resources director. "Hopefully, next year at this time we will have some very impressive numbers to support our decision."

Like Centier, Veritex offers a high-deductible plan alongside other options. Veritex's health insurance costs have gone up about 5% a year since 2010, and Reed says it would be more cost-effective for Veritex to drop health insurance and pay the government penalty. But, she adds, "That's not the right thing to do, and that's not how we treat our employees."

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