Money Magazine (New York) - Early mariners had a way with a phrase. "All souls on board" meant a full ship of passengers, ready to set sail. Similarly, consultants to the health-care industry often describe the size of an insurance plan by the number of "lives" it covers.

Has a bit more poetry than "plan participants," doesn't it?

If yours is one of the approximately 190 million lives currently enjoying employer-sponsored health-care coverage, this open-enrollment season might bring some surprises. In the attempt to contain escalating costs, many employers and insurers will be looking to shift the responsibility for decision-making, as well as some of the price increases, to you. Here's what to expect, and some tips for navigating the changes.

If you get your health insurance through your job, you may not have noticed the fast and furious run-up in health-care costs. Employers pass on only about 27 percent of insurance costs, on average, to their employees. During the '90s boom, companies struggling to find and retain top talent often absorbed the cost of rising premiums. Those days are over.

Open enrollment 2002 • Insurance: on the job • How to choose the best plan

"We estimate that from 2000 to 2003, health insurance premiums for employers will have increased by about 55 percent," warns Mark Goldberg, deputy executive director of the National Coalition on Health Care. "In today's tough job market, expect more of these costs to be passed on to the consumer."

Between spring 2001 and spring 2002, monthly premiums for employer-sponsored health plans rose 12.7 percent, according to the Kaiser Family Foundation's most recent Employer Health Benefits Survey. This is the second consecutive year of double-digit increases and the largest increase since 1990.

Looking ahead, don't expect the pace of increases to slow. Expenses are continuing to soar. "The cost of care is growing at eight times the rate of general inflation," Goldberg explains.

What's driving this? Prescription drugs are the fastest-growing category of health spending, and prices are projected to rise at an average annual rate of 11 percent through 2010, according to the Health Insurance Association of America.

A recent study by PricewaterhouseCoopers breaks down the increases in more detail. Beyond the growing demand for services, a few factors stand out. The medical breakthroughs and new technology we all want, from cardiac stents to state-of-the-art preemie care, added 22 percent to costs for 2001-02. Government-mandated coverage requirements accounted for another 15 percent. Malpractice litigation, including large awards to plaintiffs, legal bills and defensive medicine (the practice of prescribing unnecessary tests), was responsible for 7 percent of the increase.

Throw in a demographic time bomb--an aging population--and the stage is set for a decade of hikes, at least.