"We pay for employees' health insurance, the whole hundred percent," owner Shannon Nakamura said.

Hawaii Medical Service Association's proposed double digit rate hike for it's Preferred Provider Plan would cost the company an additional $300 a month. That's big money for a small operation.

"HMSA's goal is to keep the rates as low as we can," said Cliff Cisco, senior vice-president.

The health insurance provider said the rate adjustment is necessary because of pressure from hospitals to increase their reimbursements.

In 2006, HMSA raised rates 3.8 percent. In 2007 rates climbed 6.7 percent. The 12.8 percent requested increase for 2007 is HMSA's biggest in a decade.

"We've been trying to keep the rates down but even with that the pressure to increase rates to the providers has caused us to have this double digit rate increase," Cisco said.

More than 11,000 small businesses in Hawaii get health coverage through HMSA. They're counting the cost.

"Every time a health provider says the 'average prices,' we in small business find that that average price is higher for us,' Small Business Hawaii's Sam Slom said.

Rather than pay the higher premium, Elite Imaging shopped around and found a cheaper deal.

"I'm not sad to see HMSA go," Nakamura said.

HMSA realizes if the rate hike is approved by the State Insurance Commissioner it could cost the company other clients. With fuel prices and other costs going up, business owners are looking for every bargain they can find.

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