For anyone who has gone through the tedious process of getting a referral for anything other than a simple visit to their primary doctor, a new trend may bring some relief.

Recently, several health plans have made moves to eliminate the gatekeeper requirement and will offer only open access plans that allow a specialist visit without a referral; this gives members more control over access to health care and providers.

There are pros and cons to this development, of course. Gatekeeper plans have been traditionally less expensive than their open access counterparts. Without the option to choose, where will cost savings be found? You can increase cost shifting by raising prescription, hospital and office co-payments, including a "split" office co-payment - a higher co-payment to see a specialist. Also, higher out-of-network deductibles and coinsurance are sure ways to save. On the positive side, your employees will now be able to enjoy more freedom and ease in seeing health care providers.

When renewal time rolls around, it is a good time to take a second look at your prescription plan. Rising prescription costs now account for a significant portion of premium increases. This can be attributed to the growth in direct to consumer marketing, which in turn, increases demand and usage.

In the past, prescription plans were 2-tier, meaning 2 co-pay levels - a low dollar amount for generic, and a higher co-pay for a brand name drug. These older plans are now significantly more expensive than their newer 3-tier counterparts. By switching to a 3-tier plan - broken out as generic, formulary and non-formulary drugs - you can reduce renewal premiums by as much as 4-5%.

In another cost cutting measure, some insurance companies are also moving to a mandatory generic program. This simply means that if a member requests a prescription for a brand name drug, and there is a generic version, the member will pay the brand name copay, as well as the difference in cost between the generic and brand name. This ensures that members are making prudent decisions, and are better able to educate themselves on the true cost of these drugs.

If you've been reluctant in the past, it's worth revisiting now.