Six in 10 companies offered health benefits to their workers this year, while 21% of those firms say they reduced the scope of benefits provided or increased their employees’ share, a new study finds.

But among firms employing three to nine workers, 46% offered employees health coverage this year, according to the 2009 Employer Health Benefit Survey, sponsored by the Kaiser Family Foundation and the Health Research & Education Trust.

The annual report adds fodder to the ongoing debate among Congress and President Barack Obama over the best approach to expand coverage to those who either cannot afford or obtain insurance.

The survey reveals that a growing number of workers who are covered by their employer are facing high deductibles in their plans in addition to contributing to the premiums for their coverage.  In 2009, 22% of covered workers must pay at least $1,000 out of pocket annually for single coverage before their plan generally will start to pay a share of their health care bills, up from 18% last year and 10% in 2006.

The increase in covered workers with high deductibles stems from changes at large employers (200 or more workers), though workers at smaller firms remain significantly more likely to face high deductibles. Among covered workers at large firms, 13% now face deductibles at or above $1,000; at small firms (three to 199 workers), 40% face deductibles at or above $1,000—including 16% with deductibles at or greater than $2,000.

Preferred Provider Organizations continue to dominate the employer market, enrolling six in 10 covered workers. Health Maintenance Organizations cover 20% of workers, with an additional 10% in Point-of-Service plans, and 8% in consumer-directed plans, which are high-deductible plans that also include a tax-preferred savings options such as a Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA).

“As in the past, we’re seeing many businesses struggling with ways to curb their health care costs, including offering high-deductible plans for workers, though relatively few expect to drop health benefits altogether,” said Kaiser Vice President Gary Claxton, lead author of the study and director of the Foundation’s marketplace research.

Meanwhile, family health insurance premiums rose about 5% this year, more than five times the rate of inflation and nearly twice as much as wages. General inflation was put at 0.7%, lowered by falling energy costs, while wages rose 3.1% this year.

Family coverage under employer-sponsored health insurance rose to $13,375 this year, as employees paid an average of $3,515 and employers paid $9,860,

Since 1999, premiums have gone up a total of 131%, far faster than workers’ wages, which rose just 38%, and inflation, which increased 28%.

The study’s authors note that for the past few years, the annual rise in premiums has been more moderate than the double-digit growth experienced earlier this decade.

When asked about their plans for next year, 21% of offering firms say they are “very likely” to raise workers’ premium contribution, and 16% say they are “very likely” to raise deductibles.  Just 4% say they are “very likely” to restrict eligibility for coverage, and 2% say they are “very likely” to drop health coverage altogether.

The vast majority of covered workers face a three- or four-tier system to determine their cost-sharing for drugs.  For workers in such plans, the average copayments this year are $10 for first-tier drugs, $27 for second-tier drugs, and $46 for third-tier drugs. Copayments for fourth-tier drugs, which may include costly biological agents and lifestyle drugs, averaged $85.

Among covered workers with a copayment for in-network physician office visits, the average copayment is $20 for primary care and $28 for specialty physicians—up slightly from the 2008 averages.

More than half (58%) of employers offering health benefits offer at least one of the following wellness programs: weight loss program, gym membership discounts or on-site exercise facilities, smoking cessation program, personal health coaching, classes in nutrition or healthy living, web-based resources for healthy living, or a wellness newsletter.

Among firms offering coverage, 16% give their employees the option of completing a health risk assessment to help employees identify potential health risks.  Within this group, 11% offer financial incentives such as lowering the worker’s share of premiums or offering merchandise, gift cards, travel, or cash to their workers.  Large firms are more likely than small firms both to offer assessments and to offer financial incentives.

This year, 29% of large firms (200 or more workers) that offer health coverage also offer retiree health benefits, similar to the 31% who did so last year but less than half the 66% who did so in 1988.