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Employers

 


Welcome and thank you for allowing us to service your Section 125 Cafeteria Plan. Please use the following link,  https://piopacer.lh1ondemand.com, to access the Employer Portal and download Account Balance and other reports, terminate employees, and make other changes to employees. 

• ACH Debit Form

Change in Status

• COBRA form
• COBRA form- sample

Current IRS Indexed Figures

• Current PIOPAC W-9 Form

• Debit Card Benny Visa Application
• Direct Deposit Agreement

• Employee Enrollment – Change Form

FSA Handbook

• FSA/HRA Reimbursement Request form

    • Reimbursement Request - addendum

Insurance Claim Form
• NOTICE OF PRIVACY PRACTICE - Protected Health Information
Notice of Termination
• PIOPAC FIDELITY HIPAA PRIVACY COMPLIANCE STATEMENT
• PIOPAC FIDELITY PRIVACY POLICY AND PROCEDURES

• Salary Redirection Agreement (SRA) - Trans/Parking Only

• Salary Redirection Agreement (SRA) - Trans/Parking

• Salary Redirection Agreement (SRA) – FSA Only
Trans/Park Reimbursement Request Form

If you participate in the Debit Card program, refer to the frequently asked questions.

 

Participants can submit requests for reimbursement by utilizing “PIOPAC” Mobile app, logging onto secured website and uploading receipts directly into software, scanning and emailing to FSAclaims@piopac.com, or faxing to (808) 536-0430, or by mail to 1132 Bishop Street, #2101, Hon., HI 96813.  Claims received via the U.S. Postal Service should have all receipts itemized and taped to a full letter size sheet of paper in order to avoid claim denial and to speed up reimbursement.

 

We highly encourage Direct Deposit as the most efficient method for participants to receive reimbursement. If a participant elects to receive a check and it is lost or not cashed within 60 days, there will be a $28.00 service fee to replace it.

 

 

NEW Secured website

 

https://piopacee.lh1ondemand.com

 

Initialize your account today!

Get your balance

and submit claims online

 

Download your NEW “PIOPAC”

Mobile App below:

 

 

Mobile App
for iPhone/iPad

 

Mobile App
for Android

 

 

“PIOPAC” Mobile App – download today!  Submit claims and receipts by using the camera on your smart phone.  Access your available balances on your iPhone*, iPad*, and Android powered phone.  Also, receive account balances and other selected alerts via text messages on your mobile device.

 

 
     

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