Cafeteria Plan Modification and Deferred Compensation

To submit this form, ensure all required fields are accurately filled out. Send the completed form to your HR department via email or fax. Keep a copy of the submitted form for your records, and consult your HR team for any inquiries regarding the submission process.

Important dates for submitting cafeteria plan modifications may vary, but it is advisable to review submissions early in the year. Typically, plans are amended before the end of the current plan year. For the years 2024 and 2025, ensure compliance by reviewing regulatory updates and deadlines.

The purpose of this form is to provide clear guidelines for modifying cafeteria plans in compliance with IRS regulations. It aims to clarify how unused benefits can be utilized during the grace period. By providing detailed instructions, it helps employers understand their responsibilities and facilitate employee benefit management.

• 1. Employee Name: The full name of the employee participating in the cafeteria plan.
• 2. Employer Name: The name of the employer offering the cafeteria plan.
• 3. Benefit Options: A list of benefits that employees can choose from.
• 4. Election Amount: The amount elected by the employee for each benefit.
• 5. Signature: A signature field for the employee to confirm their selections.

Failing to submit this form can lead to loss of benefits or delays in the enrollment process. It is crucial for employees to submit their elections accurately and on time to avoid issues with benefit access.

• Loss of Unused Benefits: Without timely submission, employees may lose unused contributions or benefits.
• Compliance Issues: Employers could face compliance issues if the form is not submitted.
• Delays in Enrollment: Failure to submit could delay employee enrollment in preferred benefit options.

• 1. During Enrollment Period: Use this form to enroll in the cafeteria plan when first offered.
• 2. To Modify Benefits: Employers can modify benefits selections using this form.
• 3. For Grace Period Claims: Employers must use this form to process claims during the grace period.