Rather than a flat-screen TV or a new car, the most coveted gift for many Americans this holiday season could be health-insurance and retirement benefits. In recent months, a growing number of companies have cut or eliminated this protection for their employees and retirees.

Some companies are adding inequity to injury by continuing to reimburse top executives for their medical expenses -- even when they have been dismissed -- while slashing employee coverage. US Airways Group eliminated health coverage for 28,000 employees and 10,800 retirees late last year. But the financially ailing airline had already guaranteed departing CEO David Siegel and his family medical coverage for life. Roughly one in eight U.S. employers offers executive-medical-expense reimbursement plans, according to Hay Group, the consulting firm.

But some companies think special coverage for top bosses is unfair. They're continuing to offer health benefits to all employees while seeking ways to contain rising health-care costs. Such an approach requires innovative thinking, careful research and lots of communication with employees to get them to become savvier health-care consumers. It also requires top executives who understand that providing health benefits can help the bottom line by fostering employee productivity and loyalty.

"Health care is essential for our employees, and I live with the same plan as everyone else," says Tom Wolf, chief executive of STS Consulting, Vernon Hills, Ill., a consulting engineering firm with 600 employees in 14 states. With health costs rising, the company is trying new approaches to "maintain a plan that offers more and is less costly to employees than is typical in our industry," he adds.

STS's director of human resources, Raylana Anderson, encourages employees to spend at least as much time learning about their coverage and choosing physicians as they spend shopping for TVs or sofas. She says she has researched numerous insurers to find carriers "who have real data about medical costs in Peoria and other Midwestern towns where we operate." To pare costs, the company has switched insurers and offered employees a choice of coverage options. Rather than just announcing the changes, Ms. Anderson met with small groups to help them choose the best plan, find the best doctors in their region and get prompt reimbursement.

"No one likes change, so my first message was 'yes, it will be different, but no, it won't be worse -- and we're all in this together,' " says Ms. Anderson. She met first with employees she thought might complain the most to address individual concerns. "There was the single parent who had particular needs, versus the married guy with seven kids," she says. She also showed employees how to log onto insurers' Web sites to find out the reimbursement for different procedures, and urged them to "shop around" and then ask doctors they liked to accept the payment their plan offered.

"We didn't just offer these meetings. We told employees they needed to come so they would know how to take advantage of their benefits," says Ms. Anderson. The result: "We got a buy-in from employees on the changes, and they weren't in my office complaining," she says. And while STS's health costs are still rising, the increases have been contained to single digits.

Acuity, a property and casualty insurer in Sheboygan, Wis., pays about 80 percent of the cost of health-care premiums for its 780 employees and last year saw just a 3 percent rise in its health-care costs. That's mostly because the company has negotiated steep discounts with physicians in its insurance network and steers many employees to them.

In addition, Acuity offers a range of "wellness" programs aimed at keeping employees healthy. Along with free on-site flu shots, cholesterol screening and blood-pressure checks, it covers the cost of annual physicals and cancer-screening tests such as mammograms and colonoscopies. Acuity also has a fitness center at its new headquarters, and it offers free fitness, nutrition and smoking-cessation programs.

"We've got the same health plan for everyone, top to bottom, and we think paying for the bulk of it is one way to show respect and caring for employees," says John Signer, vice president of human resources. That, in turn, he believes, has helped Acuity boost revenue an average 16 percent annually for the past four years, more than twice the industry average.

Analytical Graphics, an Exton, Pa., company that designs software for the aerospace, defense and intelligence industries, also spends time educating employees about what to ask doctors and how to choose between the two health plans it offers. The company also offers a range of wellness programs to its 240 employees. When a few employees decided to try to lose weight by having a weight-loss contest, the company offered to hire a nutritionist to provide diet tips. Now 90 employees have signed up for the program.

Such benefits have helped keep employee turnover at 5 percent annually, compared with the industry average of 20 percent, executives say. "Some CEOs ask me how can we afford all this, and my answer is 'how can we not?' " says CEO Paul Graziani. "Our assets are our employees' minds, and we have to protect that."