Enrollment growth at health coverage programs that include health savings accounts (HSAs) or health reimbursement arrangements (HRAs) has slowed to about 18% this year.

The growth rate at health account plans was about half of what it was in 2009, according to United Benefit Advisors (UBA), Indianapolis.

UBA, a benefits firm group, has published those figures in a summary of results from a survey of 11,413 U.S. employers.

A year ago, employers were telling UBA that health account plans were covering about 15% of their employees and health maintenance organizations were covering about 14%. This year, HMOs appear to be covering more employees.PPACA

Enrollment in traditional indemnity plans has fallen so low that UBA has stopped tracking that category of coverage.

Providers of health account plan programs try to give enrollees an incentive to take care of themselves, seek medical care only when necessary, and shop carefully for care by having them use the cash in the health accounts to pay for routine care. Account holders can keep unused assets in the accounts at the end of the year.

HSA programs require enrollees to use high-deductible health insurance arrangements, but the cash in the accounts belongs to the enrollees, and the account can be funded by an employer, an employee, or an individual who has set up a personal HSA arrangement.

Participants in HRA programs can have health coverage with any level of deductible, but the employers are the ultimate owners of the HRA assets. Only employers can contribute to the accounts.

The average employer contribution to an HRA increased to $1,481, from $1,310 in 2009, for a single employee, and to $2,857, from $2,502, for a family, UBA says.

The average annual increase in health coverage costs was

8% for all plan types; the average employee contribution was $113 for single employees and $443 for employees with families.

Congress included provisions for setting up health insurance distribution exchanges and health insurance cooperatives in the Affordable Care Act, the package that includes the Patient Protection and Affordable Care Act (PPACA), but those programs are not due to take effect until 2014, and benefits producers are skeptical about how well the exchanges and cooperatives will work for small and midsize employers.

“In spite of passage of health care reform legislation, health care costs will continue to increase,” says Bill Stafford, a UBA vice president. “There has been little coming out of Washington to date that addresses the underlying health care issues that can help control costs.