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LANE COMMUNITY COLLEGE ? SECTION 125 EMPLOYEE ENROLLMENT FORM SUBMIT FORMS TO: 4000? E?30th? Ave., Eugene, ?OR?97045?OR Fax (541)?463?3970? ? Plan? Administered?by? Polestar? Benefits, Inc.? EMPLOYER?

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What is section 125 enrollment form?

Section 125 enrollment form is a document used to enroll employees in a cafeteria plan, also known as a flexible spending account (FSA) or a premium-only plan (POP).

Who is required to file section 125 enrollment form?

Employers are required to provide section 125 enrollment forms to their employees who wish to participate in a cafeteria plan. Employees then complete and submit the form to their employer.

How to fill out section 125 enrollment form?

To fill out a section 125 enrollment form, employees need to provide their personal information such as name, address, and social security number. They also need to indicate the benefits they wish to enroll in, such as healthcare or dependent care flexible spending accounts. Employees should consult their employer or benefits provider for specific instructions on filling out the form.

What is the purpose of section 125 enrollment form?

The purpose of a section 125 enrollment form is to allow employees to choose and enroll in the benefits offered under a cafeteria plan. It helps employers administer employee benefits and payroll deductions related to flexible spending accounts.

What information must be reported on section 125 enrollment form?

The information that must be reported on a section 125 enrollment form includes the employee's personal information, election of benefits, and any dependent information required for the chosen benefits. This may vary depending on the employer's specific cafeteria plan.

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