|
|
| Beginning July 1, 2009, Minnesota law requires employers that 1) do not offer health insurance benefits to their employees and 2) have 11 or more full-time equivalent employees to establish and maintain a Section 125 plan to allow their employees to purchase health coverage with pre-tax dollars.
Employers may “opt-out” of this requirement by certifying to the Commissioner of Commerce that they have received education and information on the advantages of Section 125 plans and have chosen not to establish such a plan. (Minnesota Statutes, Sec. 62U.07)
|
|
Fields in red are required.
|
| |
|
CERTIFICATION:
|
I/we certify to the Commissioner of the Minnesota Department of Commerce, on behalf of the following employer, that I/we have received education and information on the advantages of Section 125 plans.
YES NO
|
|
CERTIFICATION:
|
I/we certify to the Commissioner of the Minnesota Department of Commerce, on behalf of the following employer, that I/we choose to Opt-Out of the requirement to establish a Section 125 plan.
YES NO
|
|
Company:
|
|
|
Address:
|
|
|
City:
|
|
|
State:
|
ZIP: |
|
Phone:
|
|
|
E-Mail:
|
|
|
Re enter E-Mail:
|
|
|
Responsible Contact Name:
|
|
|
Responsible Contact Title:
|
|
|
The remainder of these questions are optional
|
|
To help us better understand your decision to opt-out of the requirement to establish a Section 125 Plan for your employees and guide future public policy, please answer the following questions:
|
- Please provide the reason(s) for choosing not to establish a Section 125 Plan for your employees. (Check any that apply)
|
|
|
- What was the source of the education and information that you received regarding the advantages of Section 125 Plans? (Check any that apply)
|
|
|