PIOPAC Fidelity - Third Party Administration "Security, Integrity, Trust"

HRA Participants

Forms

• FSA Tri-fold Brochure
• HRA Frequently Asked Questions
• FSA/HRA Reimbursement Request Form
• Trans/Park Reimbursement Request Form
• Prescription Drug Claim Form
• Salary Redirection Agreement (SRA)
• HRA Brochure
• ACH Debit Form
• Employee Enrollment – Change Form
• Insurance Claim Form
• No Receipt Retailers for your take care® Debit Card

Do you have your
Debit Card?
Get it TODAY!

take care^® DEBIT

IMPORTANT CHANGE:

Effective 1/1/11, Over-the-counter drugs and medicines will no longer be considered ‘qualified expenses’ reimbursable under Flexible Spending Arrangements, unless prescribed by a physician. Please plan your future annual elections accordingly.

Click here for the current list of qualified OTC health care expenses.

A brand new way to pay qualified plan expenses.
It’s the take care® Debit Card. With it, participants won’t have to pay qualified expenses out of their personal funds and then wait for reimbursement.

An added benefit for the convenience of plan participants.
The take care® Debit Card is a proven way to increase participation rates in your Flex/Cafeteria Plan and save substantially on reduced FICA taxes.