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Get the free Application for Section 125 “Cafeteria” Premium-Only Plan Grant

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This document is an application form for employers seeking a grant from the Minnesota Department of Employment & Economic Development for establishing a Section 125 'Cafeteria' Premium-Only Plan.
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How to fill out application for section 125

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How to fill out Application for Section 125 “Cafeteria” Premium-Only Plan Grant

01
Gather necessary documentation such as your employer information and eligibility criteria.
02
Download the Application for Section 125 'Cafeteria' Premium-Only Plan Grant form from the official website.
03
Fill in your employer's legal name and address in the designated fields.
04
Provide the Tax Identification Number (TIN) of your organization.
05
Indicate the number of eligible employees and details of the benefits offered under the plan.
06
Attach any required supporting documents, such as plan descriptions and enrollment information.
07
Review and verify that all information is accurate and complete.
08
Sign the application form and date it.
09
Submit the application by mailing it to the designated authority or through the online portal, if available.

Who needs Application for Section 125 “Cafeteria” Premium-Only Plan Grant?

01
Employers looking to establish a Section 125 'Cafeteria' Premium-Only Plan for their employees.
02
Business owners who want to offer flexible benefit options to their workforce.
03
Human Resources professionals managing employee benefits.
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The Application for Section 125 'Cafeteria' Premium-Only Plan Grant is a form that organizations submit to request approval for a premium-only plan, which allows employees to pay their insurance premiums with pre-tax dollars.
Employers wishing to establish a Section 125 Cafeteria Plan for the purpose of allowing employees to pay premiums for insurance benefits on a pre-tax basis are required to file this application.
To fill out the application, employers need to provide their business information, details about the health insurance plan(s) offered, and the type of premium-only plan they intend to implement, ensuring accurate and complete entries.
The purpose of this application is to gain approval to implement a premium-only plan that provides tax benefits to employees by allowing them to pay for their insurance premiums with pre-tax income.
The application must report the employer's name and address, the type of benefits provided, the eligibility criteria for employees, and specifics regarding the premium payments being made under the plan.
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