Program Overview: A Two-Step Path
| Step | What You Unlock | What’s Next? |
|---|---|---|
| Step 1: Core Benefits | Dental & vision, basic group life insurance, provider assistance, optional voluntary life insurance | Automatically available once your application is approved and eligibility is met |
| Step 2: Reimbursement Program Benefits | Reimbursement for premiums, copays, deductibles, prescriptions, and other medical expenses | Requires proof of enrollment in a qualified health plan and submission of supporting documents |
Tip: You don’t need to jump straight to Step 2 — you can remain at Step 1 and still receive essential coverage. But completing Step 2 gives you more financial support tied to your health care plan.
Core Benefits (Step 1)
Once your eligibility is confirmed, you’ll receive access to:
- Dental & vision coverage
- Basic group life insurance
- Provider assistance services
These are your foundational benefits. You don’t need to be enrolled in a health insurance plan to get them — only to move into the reimbursement side.
Reimbursement Program (Step 2)
To access the full scope of benefits, enroll in a Qualified Health Plan and submit proof with your application (or shortly thereafter). Once approved, the Fund can reimburse you for:
- Monthly health plan premiums
- Out-of-pocket medical expenses (copays, deductibles, coinsurance)
- Prescription costs
How it works:
- Enroll in a qualified health insurance plan (e.g. via Covered California, employer plan, Medicare, Medi-Cal, etc.).
- Submit proof of coverage and associated documentation.
- File claims with receipts or use your Fund-issued debit card (where applicable).
- The Fund reviews and reimburses eligible expenses, up to program limits.
Example limits: Up to $9,800*/year for many plans (see plan-specific details below).
