Section 125 Plan

What is Section 125 Plan

A Section 125 plan, also known as a Cafeteria Plan, is a benefit program outlined under Section 125 of the Internal Revenue Code (IRC). It allows employees to choose between receiving taxable compensation (like regular salary) or tax-free benefits, often referred to as qualified benefits. 

The official IRS documentation (such as Notice 2005-42) outlines the rules, requirements, and acceptable structures for Section 125 plans. 

Employers must maintain formal written plan documents that:

• Describe the benefits available under the plan
• Outline eligibility requirements
• Define procedures for elections and mid-year changes
• Ensure compliance with nondiscrimination rules

What Benefits Can Be Included in a Section 125 Plan?

A Section 125 plan, or cafeteria plan, allows employees to pay for specific, IRS-approved benefits using pre-tax income. This structure offers significant tax savings to both employees and employers. 

The qualified benefits under a Section 125 plan must be explicitly permitted by the Internal Revenue Code. These benefits are essential for employee health, family care, and financial planning.

Eligible Benefits Under a Section 125 Plan

1. Health Insurance Premiums

Employees can use pre-tax dollars to pay for employer-sponsored medical, dental, and vision insurance premiums.

2. Flexible Spending Accounts (FSAs)

FSAs allow employees to set aside pre-tax money to cover eligible out-of-pocket medical expenses, such as copays, prescriptions, and medical supplies.

3. Health Savings Accounts (HSAs)

Employees enrolled in a high-deductible health plan (HDHP) can contribute pre-tax income to an HSA to cover qualifying medical expenses, with funds that roll over year to year.

4. Dependent Care Assistance Programs (DCAPs)

Employees can allocate pre-tax funds (up to IRS limits) to pay for childcare or dependent care expenses, including daycare, preschool, and elder care.

5. Group-Term Life Insurance (up to $50,000 coverage)

Premiums for group-term life insurance are eligible for pre-tax treatment only up to $50,000 of coverage per employee. Anything beyond that is considered taxable.

6. Adoption Assistance

Pre-tax contributions can be used to reimburse qualified adoption expenses, such as adoption fees, court costs, and attorney fees, subject to IRS limits.

These benefits must be offered through a written cafeteria plan and must meet IRS eligibility and nondiscrimination requirements to retain tax-advantaged status.

Who Needs a Section 125 Plan?

Any employer who wants to provide pre-tax benefits to employees and their families should consider setting up a Section 125 plan, also known as a cafeteria plan. These plans allow employees to choose from a menu of tax-advantaged benefits, such as health insurance or dependent care, while helping employers reduce payroll taxes.

Employers Who Benefit from a Section 125 Plan

Corporations (C-Corps and S-Corps)

These employers can include a wide range of pre-tax benefits for employees.

LLCs and Partnerships

Can offer Section 125 plans to common-law employees, but not to partners or members who own the business.

Sole Proprietors

Can’t cover themselves, but may offer benefits to their employees and their families.

Nonprofits and Government Entities

Eligible to offer cafeteria plans to reduce taxable income and enhance benefit options.

Small Businesses

A Premium Only Plan (POP) under Section 125 is a simple and low-cost way to offer tax savings without complex administration.

Who Can Be Covered?

• Employees
• Spouses and Dependents of employees
• Children up to age 26 (even if not dependent for tax purposes)

Difference Between POP and Section 125 Plan

A Premium Only Plan (POP) is actually a simplified version of a Section 125 plan, focused exclusively on allowing employees to pay for insurance premiums with pre-tax dollars. In contrast, a full Section 125 cafeteria plan offers a broader range of tax-advantaged benefits, providing greater flexibility for both employers and employees.

How to Set Up a Section 125 Cafeteria Plan

While it may sound complex, even small businesses can implement these plans effectively with the right structure and documentation.

1. Determine the Right Type of Cafeteria Plan

Before anything else, decide what kind of Section 125 plan fits your business goals and team needs. There are three main options:

Premium Only Plan (POP)

The simplest and most common version. It allows employees to pay their share of insurance premiums (medical, dental, vision, and some life insurance) with pre-tax dollars.

Full Cafeteria Plan

Offers a broader suite of pre-tax benefits, including FSAs (Flexible Spending Accounts), Dependent Care Assistance, HSAs, and Adoption Assistance. 

Simple Cafeteria Plan

Specifically designed for small businesses with 100 or fewer employees. 

2. Draft the Required Written Plan Document

The IRS requires that all Section 125 plans be backed by a formal written plan document. Without this document, the plan is not legally valid, even if you are administering benefits correctly.

This document must include:

• A description of each benefit offered under the plan.
• Eligibility rules (who can participate and when).
• How and when employees can make elections.
• Rules for mid-year election changes.
• Nondiscrimination compliance language.

3. Define Employee Eligibility and Enrollment Procedures

Most employers define eligibility as full-time employees after 30 days of employment, but the specific terms are up to you.

You’ll also need to establish:

• Which family members are covered (usually spouses and dependents up to age 26).
• The open enrollment period.
• How employees make their benefit elections.
• Rules around qualifying life events (e.g., marriage, birth, job loss) that allow mid-year changes.

Once elections are made, they are generally irrevocable for the entire plan year, unless a qualifying event occurs.

4. Set Up Payroll Integration for Pre-Tax Deductions

To activate the tax benefits, the employee contributions must be deducted pre-tax from their payroll. Work with your payroll provider to:

• Set up appropriate deduction codes (medical, dental, FSA, etc.).
• Ensure deductions are properly calculated and withheld before taxes.
• Reflect the deductions correctly on employee pay stubs.
• Handle any reporting requirements (such as on W-2 forms).

Proper payroll integration is essential here.

5. Communicate the Plan to Employees

You must provide each eligible employee with a Summary Plan Description (SPD), which outlines:

• What benefits are available.
• How to enroll and make changes.
• How the plan works.
• Tax advantages and potential limitations (e.g., FSA “use-it-or-lose-it” rule).

Host information sessions, provide written materials, and offer assistance during enrollment.

6. Conduct Nondiscrimination Testing (If Required)

To maintain its tax-advantaged status, a Section 125 plan must pass IRS nondiscrimination testing, ensuring that it doesn’t favor highly compensated employees (HCEs), officers, or owners.

Three types of tests may apply:

• Eligibility Test: Ensures that all eligible employees have a fair chance to participate.
• Benefits Test: Verifies that the benefits offered are not disproportionately skewed toward HCEs.
• Contributions and Benefits Test: Confirms that contributions and benefit levels are equitable.

7. Maintain Records and Ensure Ongoing Compliance

Even after setup, ongoing compliance is key. 

Employers must:

• Keep the plan document and any amendments on file.
• Maintain election forms, payroll deduction records, and nondiscrimination test results.
• File any necessary IRS forms (such as Form 5500 for certain welfare benefit plans).
• Review and update the plan annually, especially before each open enrollment.

Also, stay informed of IRS updates and changes to contribution limits for FSAs, HSAs, and dependent care.