A typical cafeteria plan allows employees to "redirect" part of their salary to purchase benefits from a "menu" of benefits. These amounts are redirected before an employee’s wages are subject to Federal or State income tax or Social Security taxes (FICA). An employer may also make contributions to the plan on behalf of its employees. These employer contributions are not taxable to the employee if the employer money is used for "qualified" benefits.
Employee participation in a cafeteria plan also reduces the employment taxes paid by an employer. Employee redirections are not subject to FICA or FUTA employment taxes.
Allowable benefits include flexible spending accounts such as dependent care assistance (day care), medical reimbursement (out-of-pocket medical expenses not covered by a group medical plan), and insurance premium reimbursement for employer approved group plans (life, medical, and disability insurance). Non-spending benefits include premium conversion that allows employees to pay premiums for employer sponsored group plans using pre-tax earnings.
Cafeteria plans provide employees valuable benefits, while increasing disposable income, reducing taxes, and reducing your employment taxes. Contact Employee Benefit Resources, LLP to find out more.
CAFETERIA PLAN FORMS
For out-of-pocket medical care, dependent care, and insurance premium expenses. Participants may print forms from our web site and prepare their reimbursement requests.
Dependent Care Claim Form (pdf) – Use this form to claim qualifying dependent care expenses such as daycare. Also remember to use the Dependent Care Worksheet below when preparing for the upcoming plan year, and to confirm what is and is not covered in this area.
Medical Care Claim Form (pdf) – This claim form is used any time you have out of pocket qualifying medical expenses to be submitted for reimbursement.
Insurance Premium Reimbursement Claim Form (pdf) – This form is used to claim insurance premiums from other plans – such as a spouse plan
Qualifying Expense Listings - whether during enrollment or when submitting expense reimbursement claims, sometimes participants need help in identifying qualifying medical care and dependent care expenses. These listings include samples of qualifying and non-qualifying expenses, and links to Internal Revenue Service publications which provide further information and examples.
Participant Savings Estimate(pdf)- check out the savings available when you participate in your employer's cafeteria plan. These calculations demonstrate the difference in an employee's take home pay based on whether or not they participate in the plan.
Change in Status Form (pdf)- Generally, participants may not change their cafeteria plan elections in the middle of the plan year. However, in certain situations, the IRS does allow mid-year election changes (refer to your plan document as not all plans allow mid-year election changes).
Authorization For Disclosure Of An Individual’s Health Information(pdf)- Under HIPAA, EBR may only discuss medical expense claim information with the individual for whom the claim is being submitted. If you wish to allow EBR to discuss your claim information with another individual, this authorization will need to be completed and submitted to EBR.
Request For Alternative Confidential Communication(pdf) – Under HIPAA, EBR allows participants to request that EBR communicate confidential information with them by methods and at locations that will ensure their privacy. If you wish to make such a request, please complete and submit this form to EBR.
Whether or not a participant may make a cafeteria plan mid-year election change can be difficult to determine. EBR has updated the cafeteria plan Change in Status form to be more participant and employer friendly. The rules for change of status are different for premium, dependent care, and medical accounts. A two-step test is utilized to determine whether an election change is permitted. There must first be a qualifying event and second, the requested change in election must be consistent with the event. Any change of status must meet the regulations issued by the Department of Treasury. Completion of a change of status form does not guarantee the approval of an election change request.
Contact EBR for more information regarding qualifying events and to determine if you are eligible to make a mid-year election change.
Allowable Providers for the Benny Card
Services and Expenses Eligible For Reimbursement Under the FSAFEDS Program
Cafeteria Plan Participant Direct Deposit Authorization Form(pdf)
You may choose to receive your spending account reimbursements as a direct deposit to your checking or savings account. Complete this form and submit it to EBR with a copy of a check (checking account) or deposit slip (savings account) to establish direct deposit.
Expense Worksheets
These worksheets will help participants estimate annual medical care and dependent care assistance costs. These are valuable tools during re-enrollment, when participants are calculating elections for the upcoming plan year.
Medical Care Expense Worksheet (pdf)
Dependent Care Expense Worksheet (pdf)
