About 49,000 Hawaii Medical Service Association members covered by small-business health insurance plans will see an average 2.1 percent rate hike July 1, the smallest increase since 2012.

Some groups could see higher or lower medical and drug premiums than the average approved by the state Insurance Division, which regulates health plan rates, depending on utilization and other factors. The rate increase affects about 5,400 small businesses.

“We’re always concerned about any increase, but given the upscale economy that most of our businesses are in, that’s not terribly out of line,” said Tim Lyons, executive director of the Hawaii Business League, an association that lobbies on behalf of 850 businesses throughout the state. “It’s always hard to tell how much cost shifting is going on. For once, that’s not altogether bad.”

The 2.1 percent increase is well below the average 8.2 percent increase over the previous three years.

HMSA Chief Executive Officer Michael Gold said the health plan is starting to see efforts to control costs working among its nearly 735,000 members.

“We’re starting to see early indicators that payment transformation, Blue Zones (a healthy lifestyle program), and other innovative HMSA programs are helping people live healthier lives, which is the key to keeping health care affordable,” Gold said in a statement. “There’s a lot more work ahead and we’re glad to collaborate with strong business, health, government and community partners.”

The state’s largest health insurer earned $25 million in the first three months of this year — compared with a $30.4 million loss a year earlier — and increased its reserve by more than $100 million to $446.5 million, or $608 per member, largely due to the absence of fees related to the federal Affordable Care Act, or Obamacare, according to its filing with the state Insurance Division.

Based on the the company’s financials, the state gave HMSA the green light on its rate increase.

“We looked at the loss data and determined that the rate increase was reasonable,” said Insurance Commissioner Gordon Ito.

In January HMSA raised rates 35 percent for about 20,000 individual members covered under Obamacare policies, citing a struggle to balance the pool of newly insured — many of whom haven’t had medical care in years — with the population of healthier members to control premiums. HMSA originally filed for a 43.3 percent rate hike for those individual policies, but the Insurance Division rejected its request.