For years, U.S. employers have been looking for ways to save money on healthcare costs by having their employees' high-ticket procedures done far more cheaply offshore. Those who have attempted this, to date, have made the overseas travel entirely voluntary, and have even offered their employees a cut of what can be very substantial savings. While some employees--and unions--have argued that this could be a "slippery slope" leading to forced overseas care, many have liked the idea.

Now, under pressure from both employers and patients, health plans are very slowly starting to get into the act, too. A small but increasing number of health plans are beginning to pay for medical tourists who travel abroad to get expensive procedures done, with some even paying bonuses to patients who agree to do so. This certainly makes economic sense when, say, open-heart surgery that costs $100,000 in the U.S. can be done at an accredited Indian hospital for $8,500. Plans are covering heart surgeries, hip and knee replacements and other pricey surgical procedures.

Some plans are actually going into the medical tourism business with both feet, in fact. Blue Cross & Blue Shield of South Carolina has created a subsidiary for medical tourism that maintains an international network of doctors and hospitals covering Thailand, Costa Rica, Ireland, Turkey and other destinations. Others are partnering with employers to offer such plans. For example, Anthem Blue Cross & Blue Shield, a unit of WellPoint, will roll out a medical-travel benefit with Serigraph Inc. of Wisconsin in January. Serigraph's 700 workers will get incentives to travel to a hospital in India for certain elective surgeries.