For Operators with an Existing Cafeteria Plan

Already have a Section 125 plan?
You may be missing $681+/employee.

By David Newman · Referral Partner, Section 125 Savings · San Pedro, CA · Last reviewed May 2026

About 30% of small businesses run a basic Premium-Only Plan (POP). They're technically “on Section 125” — but only for pre-tax health insurance. The full Preventive Care variant adds a structural ~$72/paycheck employee raise and full $681.60/employee/year employer FICA savings on top of whatever POP you already have. Find out which version you're running.

  • POP plans handle pre-tax health insurance only — no employee paycheck raise
  • Preventive Care variant adds wellness-reward layer (~$1,000/month per employee)
  • Full Section 125 saves $681.60/W-2 employee/year net of all fees
  • Plus 30-60% Workers' Comp reduction at next audit
  • Verified by CBIZ Advisors LLC + HitesmanLaw P.A. in 2025

Upgrade Assessment

one question · find out what your current plan is missing

Do your employees currently receive extra money in their paycheck from your cafeteria plan — beyond the pre-tax health insurance deduction?

IRS Section 125 — Federal Law Since 1978
No New Insurance Required
No Changes to Current Benefits
ACA · ERISA · COBRA · HIPAA Compliant
Live in 30–60 Days

The three tiers of Section 125 plan, ranked by what they capture

Tier 1 — No plan at all

An estimated 50%+ of small businesses with 10+ W-2 employees do not run any Section 125 cafeteria plan, despite the fact that IRC § 125 has been federal law continuously since 1978. The result: every dollar of employee health insurance premium gets paid with after-tax dollars, employer FICA is calculated on full gross wages, and the Workers' Comp premium base is undiscounted. The math is simple — they pay full freight. For a 50-employee operation, the unrealized savings is approximately $34,080/year in FICA + an industry-specific Workers' Comp reduction. None of which is recoverable retroactively.

Tier 2 — Premium-Only Plan (POP)

About 30% of small businesses run a Premium-Only Plan. A POP handles one specific function: it lets employees pay their share of group health insurance premiums with pre-tax dollars. That captures the FICA savings on the premium portion (~7.65% × the annual premium amount, typically $200-$400/employee/year of FICA savings depending on coverage tier). It's real, useful tax structure. But it's a fraction of what's available — and the employees see no paycheck change, no wellness benefits package, no Workers' Comp reduction, and no structural raise. For most operators on a POP, the question isn't whether the plan is correctly structured. It's whether they're aware that the Preventive Care variant exists and adds a substantially larger savings layer on top.

Tier 3 — Full Section 125 Preventive Care

The complete program adds a HIPAA-compliant participatory wellness program funded by an additional $1,200/month pre-tax salary reduction per W-2 employee. Total FICA-taxable wages reduction: $14,400/year per employee. Employer FICA savings: $1,101.60/year per employee. Net of the program's $35/month admin fee: $681.60/employee/year. Plus the structural ~$72/paycheck raise to every employee. Plus the wellness benefits package (24/7 telemedicine, 400+ free generic medications, dental savings up to 60%, mental health counseling). Plus the 30-60% Workers' Comp reduction at the next audit cycle. See the full POP vs Preventive Care comparison →

Why most operators on POP don't know about the upgrade

Standard benefits brokers handle group health insurance and don't typically introduce or operate Preventive Care variants — it's outside their carrier appointment scope. CPAs know about Section 125 but cannot operate one (it requires a plan administrator, wellness platform, licensed indemnity carrier, and $500K legal-protection backing — none of which CPA firms hold). The result: the upgrade exists, the math is mechanical, and most POP operators have never had it presented. The first time they see it is when a referral partner like David Newman, or a specialty broker, brings it directly. Why your CPA hasn't mentioned it →

Real-world: the upgrade math at common operator sizes

10-employee POP operator:upgrading to Preventive Care nets $6,816/year in additional FICA savings + a Workers' Comp reduction at your industry rate. 10 employees take home an additional $863/year each.

50-employee POP operator: upgrade nets $34,080/year in FICA + WC reduction. 50 employees take home $863/year each. On a 5% WC industry, the WC reduction layer adds approximately $18,000/year. Total combined: ~$52,000/year.

100-employee POP operator: upgrade nets $68,160/year in FICA + WC. 100 employees take home $863/year each. On a 9% trucking-rate classification, the WC reduction approaches $65,000/year. Total combined: ~$133,000/year.

How to verify the upgrade before signing

Three primary sources, all public: IRS.gov — Cafeteria Plans (the law in the IRS's own words), the federal statute at 26 U.S.C. § 125, and the 2025 HitesmanLaw P.A. opinion + CBIZ Advisors LLC review (both share-able PDFs available on your free 15-minute analysis call). Bring the documentation to your CPA — they'll confirm the structure works mathematically and won't create audit risk.

Legal & Accounting Proof

Verified by the Best in the Country

Skepticism is the right response. We don't ask you to take our word for it — we bring institutional proof that convinced CPAs, CFOs, attorneys, and insurance brokers to enroll their own companies.

Darcy L. Hitesman, J.D.

HitesmanLaw P.A. · Minneapolis, MN

35+ years as an Employee Benefits attorney specializing in IRC Section 125, ERISA, HIPAA, and the ACA. Her May 5, 2025 opinion letter concludes: “In this firm's opinion, the Program described satisfies applicable IRS requirements.”

She specifically reviewed the IRS Chief Counsel Advice memoranda on "double-dip" arrangements — the exact schemes the IRS has flagged — and concluded this program is built differently and compliantly.

Named a Super Lawyer every year since 2000. AV-rated (highest possible rating) in Martindale-Hubbell since 1998.
Co-author: ERISA Compliance for Health & Welfare Plans (Thomson Reuters/EBIA) — the national compliance standard manual since 1999.
Member, Technical Advisory Group — Employers Council on Flexible Compensation. She helps set the industry standards for Section 125 plans nationally.

CBIZ Advisors LLC

Top-7 U.S. Accounting Firm · Cleveland, OH · 135,000+ Clients

CBIZ independently reviewed the program against IRC §§ 125, 105, and 106, plus ERISA, ACA, and COBRA requirements. Their August 22, 2025 letter concludes: “If operated per its provisions, the Program appears to satisfy the requirements of ERISA, the ACA, and COBRA as well.”

This review was commissioned by Affinity Hospice's CEO before enrolling his nationwide organization — and the CFO (himself a CPA) shared the letter publicly in his testimonial.

Top-7 U.S. accounting firm. 10,000+ employees across 100+ offices. Serves 135,000+ clients nationally.
Review covers: IRC §125 cafeteria plan, §105/106 wellness benefit rules, ERISA plan asset treatment, ACA integration, and COBRA obligations.
$500,000 legal protection per enrolled employer · $10,000 per employee participant · Insurance-backed.
🏛️

Direct From the U.S. Government

Section 125 has been in the Internal Revenue Code since 1978. Congress wrote it there specifically to encourage employers to fund preventive healthcare for American workers. This is not a loophole — it is the precise, intended use of a 47-year-old federal law, grounded in IRS Revenue Ruling 69-154, the specific published ruling supporting the benefit payment structure.

→ Verify on IRS.gov — Section 125 Cafeteria Plans ↗
Upgrade Questions

What POP operators ask before upgrading

Three quick checks. (1) Look at Box 14 of a typical employee's W-2 — POP plans typically show ~$2,400-$5,000/year (just the health insurance premium portion); a full Preventive Care plan shows ~$14,400/year. (2) Check a recent paystub for a 'wellness reward' or similar post-tax line worth roughly $1,000/month. (3) Ask HR: 'Are we on a Section 125 Preventive Care wellness plan, or just a Premium-Only Plan?' One yes/no question gets the answer.
No. The Preventive Care wellness layer coexists inside the same cafeteria-plan document as your existing POP structure. Your current plan administrator (or your benefits broker, if they handle it) keeps the health-insurance side. The Preventive Care plan administrator (Virginia Fish, CPA at ACA Solutions Hub) layers the wellness component on top.
Almost never. Their gross salary stays exactly the same; their take-home pay increases by ~$72/paycheck; they gain access to 24/7 telemedicine, 400+ free generic medications, dental savings, and mental health counseling. Most employees see this as a meaningful benefit upgrade. Communication during enrollment matters — the plan administrator handles the rollout messaging.
6-8 weeks from a signed agreement, same as a fresh enrollment. The plan administrator handles all documentation, payroll-code adjustments, and employee enrollment communications. The first payroll cycle after go-live reflects the increased pre-tax reduction and the post-tax wellness reward.
$35/employee/month admin fee, netted against the gross FICA savings. Net employer savings on the Preventive Care layer: $681.60/employee/year. There is no setup fee, no per-employer subscription, no separate fee for the upgrade vs. a new enrollment.
Yes. HitesmanLaw P.A. (Super Lawyer-rated ERISA attorney) issued an 8-page formal opinion in May 2025 confirming the Preventive Care variant satisfies applicable IRS requirements. CBIZ Advisors LLC (Top-7 U.S. accounting firm) independently reviewed the program in August 2025 and confirmed compliance with IRC §§ 125, 105, 106, ERISA, ACA, and COBRA. The program also carries $500K of insurance-backed legal protection per enrolled employer.

Content reviewed by Virginia Fish, CPA — tax and employer benefits specialist with 10+ years in financial reporting and payroll tax strategy.

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Verified: CBIZ Advisors LLC (Aug 2025) · HitesmanLaw P.A. (May 2025)
$500K legal protection per enrolled employer · IRS Section 125 · Federal law since 1978