Section 125 Premium Only Plan Document Application 2025

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The document outlines the application process and benefits of a Section 125 Premium Only Plan (POP), which allows employees to pay for group insurance premiums and health savings account contributions on a pre-tax basis. It details the tax savings for both employees and employers, provides a checklist for application submission, and answers frequently asked questions regarding eligibility, participation, and plan requirements.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your Legal Employer Name and Employer Federal EIN in the designated fields. This information is crucial for identifying your business.
Fill in your Street Address, City, State, Zip, and Phone Number to ensure accurate communication.
Provide the Contact Name and Email Address for any follow-up questions regarding the application.
Indicate your business structure by selecting from options such as C Corp, S Corp, Partnership, etc. This helps define eligibility under IRS guidelines.
Answer questions about your health insurance plan and previous deductions. Be sure to specify if you have been holding deductions pre-tax and provide relevant dates.
Complete any additional sections regarding affiliated employers or extra compensation conditions as necessary.
Finally, review all entries for accuracy before signing and submitting the application along with the required fee.

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Versions	Form popularity	Fillable & printable
2021	4.1 Satisfied (52 Votes)
2013	4.7 Satisfied (47 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I set up a section 125 plan?

How To Start a Section 125 cafeteria plan Choose a plan administrator. You will need to choose a plan administrator to manage your cafeteria plan. Determine which benefits to offer. Set up your plan documents. Communicate the plan to your employees. Monitor and administer the plan.

How do I create a Section 125 Plan document?

Section 125 plan documents should include information about the plan year, available benefits, eligibility, and the process for making pre-tax elections. Working with a third-party administrator or tax advisor can help ensure compliance with plan document requirements and avoid penalties.

Is a section 125 plan worth it?

The Bottom Line This can save workers 20% to 40% in taxes per year but these plans offer employers some tax-saving benefits as well.

How much does a Section 125 Plan cost?

Employers of every size are eligible for the plan with the requisite written plan document in place. It is not going to cost the company to procure the plan document because the employer FICA tax reduction on only one employee will more than make up for the $99 cost of a Core 125 plan document package.

How are premiums on a Section 125 plan paid?

Section 125 Premium Conversion Plan. This plan allows employees to pay for eligible benefits using either before-tax or after-tax dollars. Those who choose to participate will have their benefit premiums deducted from their salary before taxes are calculated.

What is a section 125 premium only plan document?

A premium only plan (POP) is the most basic and most popular type of Section 125 Cafeteria Plan that allows employer-sponsored premium payments to be paid by the employee on a pre-tax basis instead of after-tax.

What is the Section 125 admin fee?

PayChex Charges $480 Every Year for Section 125 POP Administration. Paychex payroll clients have reported spending up to $40 a month for Section 125 Premium Only Plan (POP) administration.

Section 125 Premium Only Plan Document Application 2025

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How to use or fill out Section 125 Premium Only Plan Document Application