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Merritt Personal Lines Manual: Chapter 8 Cafeteria Plans

Congress first authorized so-called cafeteria plans in 1978, as part of the Internal Revenue Code (Section 125).

The term "cafeteria" refers to the way in which you can spend proceeds from the account -- on any specific needs which may arise, like choosing dishes in a cafeteria line. Since we're talking about health coverage, this is an unfortunate image. Cafeteria plans are also known as "flexible-spending accounts" and "Section 125 plans."

Any company can set up a cafeteria plan for its employees. This allows the employees to pay for a full menu of medically oriented expenses with pre-tax dollars.

This not only reduces taxable income for employees -- making the benefits virtually free -- it also reduces taxable payroll for the employer.

You can use the money from a cafeteria plan to pay for various deductible expenses. These can include:

  • health insurance premiums,
  • unreimbursed medical expenses (including co-payments for doctor visits or prescription drugs),
  • dependent care expenses,
  • alternative medical treatments (including acupuncture and chiropractic),
  • treatment of alcoholism,
  • programs to lose weight or quit smoking,
  • vision care (eye doctor visits, glasses, contacts, etc.),
  • birth control pills (which some health plans do not ordinarily cover),
  • special schooling and care for people with disabilities (from wheelchairs and crutches to artificial limbs and Braille books),
  • dental fees, dentures and orthodontia,
  • psychiatric care and
  • hearing aids.

If your employer offers a cafeteria plan, you choose the amount you would like to have withheld from each paycheck. If you typically spend $200 a month on child care and another $50 on prescription co-payments, for example, you might elect to have $250 a month withheld from your paycheck. If you also have annual expenses for glasses, co-payments for checkups, dental visits and so on, you can have an additional amount deducted each month to cover these costs, as well.

This money is placed into an escrow account. Whenever you have a medical cost that is not covered by your insurance, you submit a claim to the company that manages your employer's cafeteria plan and that firm debits your account and sends you a check.

A cafeteria plan can be a very good way to save money on health care costs. However, the key is to avoid having too much money deducted from your paychecks. Whatever money you put into a cafeteria plan each year must be used for health care costs. If there is money left over, it cannot be rolled over into the account for the next year or returned to you. As far as you're concerned, it's gone.

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