For millions of Americans it's about that time of year again — time to think about which kid might need braces, consider what new health benefits are available or dive into the alphabet soup of HSAs, HRAs and FSAs.

It's open-enrollment season and employees are looking hard at their options, many of which are trimmed down in coverage, but up in price as employers try to ease the pain that the rising cost of health care has on the bottom lines.

For years, health premiums have risen steadily. From 2000 to 2010, average premiums for family coverage increased 114 percent, according to the Kaiser Family Foundation and the Health Research & Educational Trust annual review of health coverage. Employers are expected to continue shifting a greater burden of health care costs onto employees in 2012.

"Virtually all employees will see increased cost-sharing pretty much across the board," says Helen Darling, president and CEO of the National Business Group on Health.

There will be higher deductibles and higher co-payments, but some will see more introductions of value-based design benefits and incentives to get people to think about their health care use, says Paul Fronstin, director of the health research and education program at the Employee Benefit Research Institute.

"We know certain diseases have treatment protocols that are standard — diabetes, asthma, hypertension — and we know that people who go untreated tend to wind up in the hospital," Fronstin says. "So what employers and insurance companies are doing is making sure people who have these diseases are doing the things they're supposed to do to manage the diseases."

More companies are following the one-ounce-of-prevention rule.

"The big thing that's happening right now is that employers are taking a lot of steps to try to provide financial incentives to choose and live healthy lifestyles," Darling says.

On-site wellness centers are becoming more popular. Joe Perkins, a benefits consultant at MJ Insurance in Indianapolis, says companies are developing wellness programs that "have a lot more accountability and more teeth in them."

There's also an increased interest in consumer-directed health care options such as flexible spending, health savings and health reimbursement accounts. The National Business Group on Health annual survey of its corporate members found that 73 percent of the employers will offer at least one consumer-directed health plan in 2012, compared with 61 percent in 2011.

Companies also are rolling out more specialized plans. "What I think we're going to see more of is a movement away from a one-size-fits-all benefit plan," Fronstin says.

The belt-tightening changes don't necessarily mean companies will reduce the type of services they'll cover. Instead, experts say the cutbacks will come in shrinking the size of networks.

"What we're seeing is the employers offering this full menu of options that involves excluding and limiting where you can go for care and then increasing the cost-sharing associated with that, and then the employees are jumping in with both feet," says Nathan Kaufman, managing director of Kaufman Strategic Advisers, a consulting company.