The law gives employers up to three months and considerable discretion to decide how to spend the employees’ money, so long as it is eventually used to benefit insurance plan participants. And while some employers are returning the money directly in paychecks, or planning “premium holidays” that increase take-home pay, others are weighing different options, benefits consultants said, like reducing next year’s premium, or spending the refund on so-called wellness programs that reward workers who lose weight or quit smoking.

“What they’re doing right now is trying to figure out what to do with the money,” said J. D. Piro, a health benefits specialist with Aon Hewitt, which handles human resources administration for companies around the country, including some that received hefty six-figure checks in late July. “It came as a surprise to many employers.”

In New York State, $76.8 million was returned to large employers — more money than in any other state. Most of it — $49,652,329 — was paid out by Oxford, part of UnitedHealthcare, which sent out letters about the refund to more than 439,000 employees working for about 2,300 companies in the state, all large group policyholders with more than 50 employees.

Maria Gordon-Shydlo, a spokeswoman for UnitedHealthcare, said the money averaged out to $113 per covered employee. Six other insurers, including Cigna, Aetna, Nippon Life Benefits and the United States Life Insurance Company in the City of New York, also made refunds to large employers in the state.

The federal health care law required the refunds because the insurers had spent more than 15 percent of the premiums they collected last year on overhead like salaries and advertising, and less than 85 percent on health care. Nationwide, rebates to large employers reached $37.8 million in the District of Columbia, $30.5 million in Pennsylvania, $25.6 million in Florida and $18.1 million in Texas, but were under $12 million in many other states, including California, New Jersey and Connecticut.