As uncertainty about health reform persists, businesses in North Carolina and across the country continue to shift health insurance costs to employees, a new survey has found.

Sixty percent of N.C. employers surveyed said they will shift costs to employees next year by raising deductibles, co-pays, coinsurance or out-of-pocket maximums or by increasing the employee's share of premiums, according to the National Survey of Employer-Sponsored Health Plans, conducted annually by Mercer, a national human resources consulting firm.

Nationally, about half of all employers said they would shift costs to employees in 2012, the survey found.

This year's survey saw the biggest increase ever in employers offering high-deductible insurance plans. With those plans, employees have lower payroll deductions, and they are encouraged to put those savings into pretax health savings accounts that can be used to pay for health care until they meet the deductibles.

Thirty-six percent of N.C. employers offer such a plan, the survey found. Nationally, 32 percent of large employers offer such a plan, up sharply from 23 percent in 2010.

The popularity of such plans has grown. Five years ago, only 3 percent of employees enrolled in high-deductible plans, according to the national survey. Today, it's 13 percent.

"It's a consistent message. Employers are adopting more aggressive plan designs," said Steve Graybill, a senior benefits consultant in Mercer's Charlotte office.

For the second straight year, the Mercer survey showed an increase in employers offering incentives or penalties based on employee behaviors. Incentives can include lower premiums or cash payments to employees who try to stay healthy. Penalties include higher premiums for smokers or employees who are obese.

Thirty-three percent of companies offered incentives and penalties in 2011, compared with 27 percent in 2010 and 21 percent in 2009.

This is one reason it's important for workers to evaluate insurance offerings during open-enrollment periods, Graybill said.

"People need to take the time to read the material and evaluate the option that is right for them," he said. "The most expensive option is (not necessarily) the best option. ... Look at those incentives. Read them, understand them and realize if you don't comply with them, you're going to pay more."

In 2011, the average total health benefit cost per employee was $10,146 nationally, according to the Mercer survey. That's an increase of 6.1 percent over 2010 but down from the 6.9 percent jump in 2010 over 2009.

In North Carolina, the average total health benefit cost per employee in 2011 was $9,412, according to the survey. That's a 5.7 percent increase over last year. The survey did not include figures for South Carolina.