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PIOPAC Fidelity

1132 Bishop Street
Suite 2101
Honolulu, HI 96813
Toll-free: 800-777-0284
Fax: 808-536-0430

• HIPAA Privacy Compliance [doc]

• Privacy Policy and Procedures [doc]

• Notice of Privacy Practices (EE) [doc]

• Frequently Asked Questions about the take care® Visa® Flex Benefits Card. [doc]

• COBRA Notice & Election Form
  Click here for a blank COBRA Form. [doc]
  Click here for a sample of a completed COBRA Form with instructions. [doc]

• Notice of Termination Form [doc]
  Use this form to notify PIOPAC of an employee's termination.

• Employee Direct Deposit Form [doc]
  This form is to be used to deposit claim reimbursement funds directly into an employee's bank account.

• IRS W-9 Form [pdf]

• PIOPAC News Bulletin [pdf]