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Minnesota Section 125 Opt-Out Form


Beginning July 1, 2009, Minnesota law requires employers that 1) do not offer health insurance benefits to their employers 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.

Small business employers may "opt-out" of the requirement to provide a Section 125 health plan for their employees 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)

You will need to fill out the form below to complete the "opt-out" process.

Minnesota Section 125 Opt-Out Form
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:

  1. Please provide the reason(s) for choosing not to establish a Section 125 Plan for your employees. (Check any that apply)
Employees not interested
Administrative costs
Compliance issues
Need more information and technical assistance
Other (explain below)
  1. What was the source of the education and information that you received regarding the advantages of Section 125 Plans? (Check any that apply)
Insurance agent/broker
Internet search
State or Federal government agency
Tax accountant, tax attorney and/or employee benefits expert
Other

Thank you for using our electronic reporting form.