Eligibility Requirements
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Is this plan the same as a cafeteria plan?

Premium Only Plans (POPs) are cafeteria plans without a flexible spending arrangement. Premium Only Plans only cover premiums.

When do employees enroll in the Section 125 POP plan?

Federal regulations say that employee elections must be made during an annual open enrollment period, within a specified period of time following date of hire, or the date an employee first becomes eligible under the plan.

Is an employee required to participate in his/her employer's Section 125 POP plan?

No. However, if an employee chooses not to participate, any premium contributions they make toward health care coverage will be on an after-tax basis.

Can any employees be excluded from the Section 125 POP plan?

Yes. The Health Reform Law allows employers to exclude one or more of the following classes of employees:

  • Employees under age 18
  • Temporary employees
  • Part-time employees who average fewer than 64 hours per month
  • Wait staff, service employees or service bartenders (as defined in M.G.L. c. 149, Section 152A) who earn, on average, less than $400 in monthly payroll wages
  • Students who are employed as interns or as cooperative education student workers
  • Seasonal Employees under a U.S. J-1 student visa or a U.S. H2B visa, and who are enrolled in travel health insurance

What happens if an eligible employee works for two or more employers?

Employees may only participate in one Section 125 POP plan. Employees working for two or more employers must select one employer's plan.