In order to provide pre-tax benefits under Code 125, a written Plan Document must be in place and adopted by the employer. As such, any subsequent changes to the Plan Document must be detailed in an Amendment and adopted as well. A person authorized by the corporate charter or bylaws must complete the designated section in each Plan Amendment.
Below are links to the most commonly requested Plan Amendments. Keep in mind, these Amendments are for changes that occur only after your Plan is in place and are completed at renewal time only.
To complete a Plan Amendment upon renewal:
Plan Amendment Instructions: (FX-4831) Download the Amendment instructions and complete as indicated.
Affiliate Employer: (FX-4802) An Amendment for a newly acquired employer to adopt your Plan.
Benefit Change: (FX-4819) Use to add or remove a qualified benefit to your Plan. (Please note, an HSA or SIMPLE health FSA can be removed via this Amendment only. To add one of those benefits refer to the individual Amendment below.) If you have an existing HSA and are changing a benefit other than the HSA, contact Customer Care to request the Benefit Change Amendment that includes the HSA benefit.
Medical FSA Carryover Amendment and Summary of Material Modification (SMM): (FX-4948)
Select this amendment to add the Carryover option to the Health FSA.
Medical FSA Carryover Opt-Out Amendment: (FX-4949)
To remove the Carryover option from your health FSA Plan, select this document.
Dependent Care Spend Down: (FX-4803) Allows terminated Dependent Care Participants to incur qualified expenses through the end of the Plan Year. The terminated employee’s eligibility end date must be manually set.
Eligibility/Participation: (FX-4818) Select this document to change your Plan's eligibility definitions.
Plan Sponsor Change (EIN or Tax ID Change): (FX-4821) Select this Amendment to update the Plan Document with a new Plan Sponsor employer identification number and name. Please note, if this reflects a merger or acquisition, you should submit takeover information to TASC. In addition, for changes in an address, phone number, or banking information, you must update your MyTASC account. Contact Customer Care for details.
Grace Period: Use to add a two and one-half month extension in which Participants may incur eligible expenses for the Health FSA (FX-4805), Dependent Care FSA (FX-4804), and Non-Employer Sponsored Premium (NESP) (FX-4817) benefits.
Heart Act: (FX-4806) Military cash out of the health FSA for Participants called to active duty.
Health FSA-Limited Health FSA Change: (FX-4823) This Amendment applies to employers with an existing HSA only. Select this document to modify an existing limited health FSA or to add a Full Health FSA to the existing Limited Health FSA at renewal. (To add an HSA, contact your Provider or Customer Care.)
Plan Year Change: (FX-4820) Use this Amendment to change existing Plan Year start and end dates. For example, when implementing a one-time short Plan Year.
SIMPLE FSA with Uniform Percentage: (FX-4477) Select this document for a SIMPLE Health FSA that uses the uniform percentage method to determine the employer contribution amount. Attach a copy of the completed Plan Amendment to your Plan Document and email a copy of the completed Amendment to email@example.com or fax to 608-661-9638.
NESP Mid-Year Benefit Addition Amendment: (FX-4970)
To add a Non-Employer Sponsored Premium (NESP) Benefit to your Plan mid-year, select this Amendment.
NEFSA Mid-Year Benefit Addition Amendment and Summary of Material Modification (SMM): (FX-4971)
To add a Non-Excepted Health FSA (NEFSA) to your Plan mid-year, select this Amendment. An employer with a NEFSA is subject to additional compliance requirements. Refer to the Plan Amendment Instructions for details of the required compliance.
Exchange Change in Status Amendment:(FX-5180) Select this Amendment to add the two new qualifying events for Exchange coverage to your Cafeteria Plan. This Amendment allows employees to revoke the employer group health plan to enroll in Exchange coverage.