Worksheet for Code § 105(h) Nondiscrimination Tests Now Available

December 17, 2010


For Plan Years beginning after September 23, 2010, nongrandfathered insured health plans must pass the nondiscrimination tests under Code Section 105(h) or the employer may be penalized. These tests include a Benefits Test and an Eligibility Test.

In order to conduct these tests, the employer must collect information regarding the insured health plans offered to employees, individuals employed. employees covered, the details of various plan features, employees excluded from coverage and the businesses included in its controlled group.

Code Section 105(h) Nondiscrimination Testing Worksheet

To assist in collecting all of the above information and conducting the Benefits Test and the Eligibility Test, I have created a nine page worksheet that creates a guide in what information is needed and how to conduct the tests. It also provides step by step directions with a series of questions and answers.

The completion of this Worksheet is important because it provides evidence of the completion of the tests in case of an IRS audit. It also provides an early warning of any problems in passing the tests.

This worksheet will be updated at no cost when the IRS provides any new guidance. In addition, if you order the worksheet, I will answer any questions.

How do I order?
Call me at 708-717-9638 and pay by credit card.
Just send me a check for $149 to:
Larry Grudzien
Attorney at Law
708 So. Kenilworth Ave.
Oak Park, IL 60304

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Revised Compliance Notice Forms Package Now Available

May 12, 2009

As a result of the American Recovery and Reinvestment Act of 2009, your COBRA notices and forms will have to be revised to reflect the COBRA Premium Assistance Subsidy. I revised my COBRA Notice Compliance Forms Package to reflect these new changes and to add new required forms.

My revised COBRA Notice Compliance Forms Package includes the following notices,

forms and explanations:

  • An Explanation of the COBRA rules,
  • A Sample Initial COBRA Notice,
  • A Sample COBRA Insert for Summary Plan Description,
  • A Sample Election Notice, Election Form and Attachments,
  • A Sample Application for the COBRA Premium Assistance Subsidy with Attachments,
  • A Sample Notice of Eligibility for Other Group Insurance Coverage or Medicare,
  • A Sample COBRA Premium Assistance Subsidy Waiver Notice Form,
  • A Sample Notice of Qualifying Events from the Employer,
  • A Sample Notice of Qualifying Events from Covered Employees and Qualified Beneficiaries,
  • A Sample Notice of Unavailability of COBRA Coverage, and
  • A Sample Notice of Termination of COBRA Coverage.

The entire revised COBRA Notice Compliance Forms Package is available now for only $400.  To order, please follow the directions contained below.

Questions and Order Information

Please contact me at or 708-717-9638 with any questions or samples.

Click here to download and print the ORDER FORM