Get Flexbank Section 125 Premium Only Plan Document Application 2021-2025

Completing the FlexBank Section 125 Premium Only Plan Document Application online can streamline the process for employers who wish to offer pre-tax benefits to their employees. This guide provides clear, step-by-step instructions to ensure users can fill out the form effectively and accurately.

Follow the steps to complete the application with ease.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred document editor.
2. Begin by entering the legal employer name in the designated field. This should accurately reflect the business name registered with the IRS.
3. Next, input the employer's federal EIN (Employer Identification Number). This is crucial for tax identification purposes.
4. Fill in the street address of the employer's main location, followed by the city, state, and zip code.
5. Provide the contact person's name and their email address. This individual will be responsible for further communications about the application.
6. Indicate the incorporated state as well as the type of corporation (C Corp, S Corp, Partnership, etc.) by selecting the appropriate option.
7. Answer whether the health insurance plan is self-funded by checking 'Yes' or 'No' in the respective box.
8. Fill in the health insurance renewal date and the number of eligible employees.
9. If the employer has been holding deductions pre-tax, specify the original effective date of the Section 125 document and the original plan number.
10. Provide the date of the first pay date after the plan effective date and indicate the number of pay periods.
11. Clarify if taxable wages are offered for employees waiving the group health plan and outline any conditions that apply.
12. If applicable, list any affiliated employers and their details in the additional section provided.
13. Finally, include the desired effective date, sign and date the application, and provide information on who referred you to this service.
14. Once the application is completed, save your changes. You can then choose to download, print, or share the form as necessary.

Complete your FlexBank Section 125 Premium Only Plan Document Application online today!