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Section 125 plan document template

Section 125 plan document template 2026

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The document outlines the application process for a Section 125 Premium Only Plan, which allows employees to pay insurance premiums and Health Savings Account (HSA) contributions on a pre-tax basis. It emphasizes the benefits of tax savings for both employees and employers, details the setup process with FlexBank, Inc., and includes necessary information for employers to complete the application. Additionally, it notes restrictions on certain business owners regarding pre-tax contributions.

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Click ‘Get Form’ to open the Section 125 Plan Document Application in the editor.
Begin by entering your Legal Employer Name, State Incorporated, and Street Address in the designated fields. This information is crucial for identifying your business.
Fill in the City, State, Zip, Phone, Fax, and Employer Federal EIN. Ensure accuracy as this data will be used for official documentation.
Indicate whether this is a restatement by selecting 'Yes' or 'No'. If applicable, provide the Desired Effective Date for the plan.
Complete the Health Insurance Renewal section by answering if your health insurance plan is self-funded and providing relevant dates and plan numbers if applicable.
Answer questions regarding Health Savings Accounts (HSA) and any taxable incentives offered to employees who waive coverage under your group health plan.
Provide details about any affiliated employers if necessary. You can attach an additional page for this information.
Finally, enter your Printed Contact Name/Title/Email Address, Date, and Signature to complete the form.

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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 much does a Section 125 Plan cost?

How much does a Section 125 plan cost? Setting up plan documents and forms for your Section 125 plan is vital. If you use an attorney or tax advisor, costs are typically between $100 and $600, depending on your third-party administrator (TPA), broker, insurance agent, or tax advisor.

What does a section 125 plan look like?

A Section 125 plan typically lets employees use pretax money to pay for health insurance premiums for medical, dental, and vision. Other options include retirement deposits, supplemental life or disability insurance, Health Savings Accounts, and various medical or dependent care expenses.

How much does a section 125 plan cost?

Setting up plan documents and forms for your Section 125 plan is vital. If you use an attorney or tax advisor, costs are typically between $100 and $600, depending on your third-party administrator (TPA), broker, insurance agent, or tax advisor.

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.

Who prepares the section 125 plan?

To set up a section 125 benefits plan, employers have to draft a document that outlines the benefits offered, contribution limits, participation rules and other information required by the IRS.

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Who can set up a section 125 plan?

Section 125 of the IRS Code requires an employer have a written plan document in place whether the plan covers 1 or 100,000 employees. Setting up a Section 125 plan for small employers is a lot of paperwork for just one employee. Not at all. Its as easy as sign, copy, and file.

Is a Section 125 Plan a good idea?

Section 125 plans offer valuable tax benefits for both employers and employees, making them a smart choice for any organization. By allowing pre-tax contributions for health insurance premiums, FSAs, and other qualified expenses, these plans help reduce taxable income and save on taxes.

Does a Section 125 Plan need to file a form 5500?

There is currently no annual filing requirement for Section 125 Plans. However, the underlying benefits may be required to file a Form 5500 if they are considered a Health Welfare Plan.

Section 125 plan document template 2026

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How to use or fill out section 125 plan document template with our platform

See more section 125 plan document template versions

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Got questions?

How much does a Section 125 Plan cost?

What does a section 125 plan look like?

How much does a section 125 plan cost?

How do I create a Section 125 Plan document?

Who prepares the section 125 plan?

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People also ask

Who can set up a section 125 plan?

Is a Section 125 Plan a good idea?

Does a Section 125 Plan need to file a form 5500?

section 125 premium only plan document template

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