12.4 Section 125 / Cafeteria Plans and Self-Funding
Key Takeaways
Section 125 cafeteria plans let employees pay qualified benefits with pre-tax dollars, lowering taxable wages.
Health FSAs are generally use-it-or-lose-it; pre-tax savings equal the tax rate times the elected amount.
Self-funded plans pay claims directly (often via a TPA) and use specific and aggregate stop-loss to limit risk.
ERISA preempts state insurance law for self-funded single-employer plans, but not for self-funded MEWAs.
ERISA still mandates an SPD, Form 5500 filing, and fiduciary duties regardless of funding method.
Section 125 Cafeteria Plans
A Section 125 cafeteria plan (named for the Internal Revenue Code section) lets employees choose between taxable cash and qualified pre-tax benefits. Premiums and contributions run through payroll before income and FICA taxes are calculated, lowering taxable wages. The "cafeteria" name reflects that employees select from a menu of benefits.
Common Cafeteria Plan Components
| Component | What It Does |
|---|---|
| Premium Only Plan (POP) | Pays the employee's health-premium share pre-tax |
| Health FSA (Flexible Spending Account) | Pre-tax dollars for medical expenses; use-it-or-lose-it |
| Dependent Care FSA | Pre-tax dollars for childcare/elder care |
| Full flex plan | Employer credits employees spend across choices |
Trap: A health FSA is generally use-it-or-lose-it — unused funds are forfeited at year-end (a plan may allow a limited carryover or a short grace period, but not both).
Eligibility, Nondiscrimination, and the HSA Distinction
Section 125 is an employer-sponsored arrangement; only employees (and in some designs their spouses through the employee's election) participate. Self-employed individuals, partners, and more-than-2% S-corporation shareholders generally cannot participate on a pre-tax basis. The plan must also pass nondiscrimination tests so it does not disproportionately favor highly compensated or key employees; failing the test makes their benefits taxable.
Do not confuse a Health FSA with a Health Savings Account (HSA). An FSA is use-it-or-lose-it and is not tied to a specific plan design. An HSA requires enrollment in a qualifying high-deductible health plan (HDHP), the funds roll over year to year, and the account is owned by the individual — it travels with them after employment ends.
Trap: Exam items pair "use-it-or-lose-it" with HSA to bait you. Forfeiture is the FSA feature; rollover and portability belong to the HSA.
Worked Numeric: Pre-Tax Savings
Pre-tax elections reduce the wages on which tax is calculated. Suppose an employee earns $4,000/month and elects $400/month of health premium through a Section 125 POP, with a combined income + FICA tax rate of 30%.
Without Section 125:
Taxes on full $4,000 = $1,200; then pay $400 premium with after-tax dollars
Net pay = $4,000 − $1,200 − $400 = $2,400
With Section 125 (pre-tax):
Taxable wages = $4,000 − $400 = $3,600
Taxes = $3,600 × 30% = $1,080
Net pay = $3,600 − $1,080 = $2,520
The pre-tax election saves $120/month — the 30% tax that would have applied to the $400 premium. Over a year that is $1,440 in tax savings, with no change in the benefit received.
Self-Funding, Stop-Loss, and ERISA
Instead of paying premiums to an insurer, a self-funded (self-insured) plan has the employer pay claims directly, usually administered by a third-party administrator (TPA). The employer assumes the claims risk but buys stop-loss insurance to cap catastrophic exposure.
Two Kinds of Stop-Loss
| Type | Protects Against |
|---|---|
| Specific (individual) stop-loss | A single person's claims above a set limit (e.g., $100,000) |
| Aggregate stop-loss | Total plan claims above a set level (e.g., 125% of expected) |
ERISA Preemption — the Key Distinction
| Plan Type | State Insurance Laws? |
|---|---|
| Self-funded single-employer plan | Exempt (ERISA preempts state law) |
| Fully insured plan | Subject to state insurance law and mandates |
| Self-funded MEWA | Subject to state regulation (exception to preemption) |
Exam tip: ERISA preemption means a self-funded single-employer plan escapes state benefit mandates — but a self-funded MEWA does not. ERISA still requires a Summary Plan Description (SPD), Form 5500 filing, and fiduciary duties.
Why Employers Self-Fund, and the Role of the TPA
Large employers self-fund to capture several advantages while controlling risk:
- Cash-flow timing — the employer holds reserves and pays claims as incurred rather than prepaying premium to an insurer.
- No insurer profit/risk margin — only actual claims plus administration are paid.
- Plan-design flexibility — benefits are customized without state mandate constraints (single-employer plans).
- Data transparency — the employer sees exactly where claims dollars go.
The third-party administrator (TPA) processes claims, manages the provider network, handles eligibility, and issues explanations of benefits, but the TPA does not assume risk — that stays with the employer up to the stop-loss attachment points. An administrative-services-only (ASO) arrangement is the common contract under which an insurer or TPA performs these functions for a fee.
Trap: Self-funding does not mean the employer keeps unlimited risk. Specific and aggregate stop-loss are what make self-funding viable for mid-size employers.
An employee earns $5,000/month and elects $500/month of health premium pre-tax through a Section 125 plan. If the combined tax rate is 25%, how much does the employee save in taxes each month versus paying with after-tax dollars?
$25
$75
$125
$500
A large employer self-funds its single-employer health plan and buys stop-loss coverage. Regarding state insurance regulation, which statement is correct?
The plan is fully subject to all state insurance benefit mandates
The plan is generally exempt from state insurance laws due to ERISA preemption
Stop-loss coverage makes the plan a fully insured plan subject to state law
Self-funded plans are prohibited under ERISA
FSA Use-It-or-Lose-It and the Health FSA Limit
A health FSA inside a Section 125 plan is funded by pre-tax salary reductions but carries the use-it-or-lose-it rule: unspent funds are forfeited at year-end, subject to an optional $640-range carryover or a 2½-month grace period (an employer may offer one, not both). This contrasts sharply with an HSA, where the balance is owned by the employee and rolls over indefinitely.
| Account | Ownership | Rollover | Requires HDHP |
|---|---|---|---|
| Health FSA | Employer plan | Limited carryover/grace | No |
| HSA | Employee | Unlimited | Yes |
| HRA | Employer | Employer's discretion | No |
| DCAP (dependent care) | Employer plan | Use-it-or-lose-it | No |
Self-Funding, Stop-Loss, and Who Bears Risk
In a self-funded plan the employer pays claims from its own assets and buys stop-loss insurance to cap exposure: specific stop-loss limits the loss on any one claimant, while aggregate stop-loss caps the plan's total annual claims. Because ERISA preempts state insurance regulation for self-funded plans, they escape state mandated benefits and premium taxes — the principal reason large employers self-fund, with a TPA administering claims.
Sections you finish are checked off in the contents.