sample health and dependent care flexible savings …

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1、SAMPLEHEALTHANDDEPENDENTCAREFLEXIBLESAVINGSPLANDOCUMENTFORPRESBYTERIANCHURCH(U.S.A.)EMPLOYERSINSTRUCTIONSANDLEGALDISCLAIMERThissampleplandocumentforaSection125HealthFlexibleSpendingArrangement(“FSA”)withaDependentCareSpendingAccount(“DCSA”)hasbeenpreparedbyTheBoardofPensionsofthePresby

2、terianChurch(U.S.A.)aspartofaninformationkitforemployerswhowanttoofferaplanthatwillenableemployeestopayanydues-sharerequiredforMedicalPlanparticipationonapre-taxbasis.Inproducingasampleplan,theBoardofPensionsintendsonlytosupplyemployingorganizationswithasampleofthedocumentationthatanem

3、ployingorganizationneedstopreparewhenadoptingsuchaprogram.TheBoardisnotpermittedtoprovidelegalortaxadvicetoemployingorganizationsandthesampleplanisnotintendedtosubstitutefortheadviceofyourlegalortaxcounsel.Ifyourorganizationelectstoadoptaplan,itmustprepareandadoptitsownplandocumentwith

4、theadviceofitsownlegalandtaxcounsel.TheBoardhasposted7sampleplandocumentsatpensions.org.Thisdocumentissample#6.1.Section125EmployeeDues-ShareOnlyPlan(ShortFormVersion)2.Section125EmployeeDues-ShareOnlyPlan(LongFormVersion)3.Section125EmployeeDues-ShareandHealthFlexibleSavingsPlan4.Sect

5、ion125EmployeeDues-Share,HealthandDependentCareFlexibleSavingsPlan5.Section125HealthFlexibleSavingsPlan6.Section125HealthandDependentCareFlexibleSavingsPlan7.Employer-fundedHealthReimbursementArrangementThissampleplandocumentprovidesforthereimbursementofqualifiedhealthcareexpensesandqu

6、alifieddependentcareexpenses.Anemployingorganizationmayelecttoofferthepaymentofothertypesofbenefits,includingemployeecontributionsforMedicalPlandues,otheremployerprovidedhealthinsurancepremiumsorotheradditionalbenefitsavailabletoitsemployees.Suchprogramswillrequireseparateplandocuments

7、.SeetheBoard’sEmployerGuideforProvidingTax-AdvantagedBenefitsavailableontheBoardofPensions’websiteformoreinformationontheothertypesofplansandbenefitsthatmaybeavailabletoanemployer.Anumberofprovisionsinthissampleplanincludeasuggesteddefaultoptionthatisfairlycommonintheadministrationof