Lynn Neil is the business office manager at the Church of the Incarnation, an Episcopal Church in Dallas, Texas, with about 3,600 congregants and 55 employees, including 20 who work in the church’s day care, preschool and kindergarten programs.

Until 2011, the church offered its employees a standard benefit package, including major medical coverage with a modest deductible, life insurance, and optional group dental and vision coverage. But it wasn’t cheap. The church’s last annual premium increase, Neil says, was just over 50 percent of the previous year’s premium.

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