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  • CCPU Health Care Fund
  • CCPU Health Care Fund
  • CCPU Health Care Fund

© 2026 CCPU Health Care Fund administered by Pinnacle Claims Management, Inc.
All rights reserved.

Eligibility

How to Access the CCPU Health Care Fund Benefits

Becoming part of the CCPU Health Care Fund opens the door to a wide range of benefits that support you and your family’s well-being.

Start Your Journey to Full Health Care Fund Benefits

Getting access to the CCPU Health Care Fund is simple. Providers must complete just two steps:

  1. Receive Subsidized Payments
    Work with a state-subsidized child, in accordance with eligibility requirements.

  2. Submit an Application
    Complete and submit your eligibility application to the Fund.

Once these steps are completed and eligibility is confirmed, you are enrolled in the Fund.

Click the button below to learn more about the programs benefits!

Program Benefits
Annual Eligibility Criteria

Eligibility is now determined once per year, rather than quarterly!

For providers, this means less paperwork and longer eligibility periods to ensure you’re benefits are there to support you and your health.

Review the information below for additional information.

Eligibility Look Back Period

The table below shows which months we review to decide if you qualify for benefits.
For each possible benefit start month, we look back at your payment history to see if you were paid for caring for a subsidized child in at least 3 months during the required period.

Find the month you want your benefits to start, then check the months listed — those are the months that count toward eligibility.

Month Look Back Period
January Previous October – September
February Previous November – October
March Previous December – November
April Previous January – December
May Previous February to January
June Previous March to February
July Previous April to March
August Previous May to April
September Previous June to May
October Previous July to June
November Previous August to July
December Previous September – August

Example: For January 2026 eligibility, the Fund will review October 2024 – September 2025 to assess if a provider has 3 or more months of payments.

Annual Eligibility & Review — Quick View
What Happens How It Works
Eligibility Cycle Eligibility is reviewed once per year and is tied to your individual benefit start date.
Initial Eligibility Requirement You must show payment for caring for a state-subsidized child in at least 3 months during the applicable 12-month look-back period.
Why We Review 15 Months Payment data is delayed. We review a 15-month window to accurately evaluate 3 months of payments within a 12-month period.
Once You’re Approved Your benefits stay active for the entire year, even if your work with subsidized children changes during that time.
Annual Review Timing You are reviewed 45 days before your benefit anniversary date.
If You Don’t Qualify at Review The Fund will re-evaluate eligibility monthly as new payment data becomes available
When Eligibility Starts Your annual eligibility begins on your Core Benefit start date. Reimbursement benefits will be effective the same day your Core benefits are effective, as long as your QHP effective date begins on or before this date. If the QHP is effective after this date, the Reimbursement benefits will be effective beginning that date.
Reimbursement Program Review To continue Reimbursement Benefits, you must show 3 of 12 months of payments and verify an active Qualified Health Plan (QHP).
Loss of Eligibility Eligibility may end only at your annual review if requirements are not met.
Leaving the Fund You may exit at any time by requesting termination.
Annual Eligibility Review (Ongoing Eligibility)

Each provider is reviewed once per year, based on their individual benefit start date.

To continue your Core Benefits for another year, you must show that you were paid for caring for a state-subsidized child in at least 3 months during the applicable 12-month look-back period.

Review the FAQs below for additional information.

Explore the Full Scope of Health Care Fund Benefits

To access the full range of Fund benefits—including Health Care Reimbursement for premiums, copays, deductibles, and prescriptions—visit our Reimbursement Benefits information page.

This program adds valuable financial support to your benefits package, including:

  • Reimbursement for qualified health insurance premiums

  • Reimbursement for out-of-pocket medical expenses (like copays, deductibles, and prescriptions)

Applying for Reimbursement Benefits

Eligibility FAQs

How do the Look-Back Periods work with Annual Eligibility?

We look at your past payments to make sure you worked with a state-subsidized child in at least 3 months during a 12-month period. Because payment information takes time to be reported, we review a slightly longer window to make sure nothing is missed.

Here’s how it works:

  • The Fund reviews a 15-month window to find 3 months of payments within a 12-month eligibility period.

  • This extra time allows for a short administrative delay in receiving payment data from the state.

Example:
If you want benefits to start on January 1, 2026, we will review your payment history from:
October 1, 2024, through September 30, 2025.

  • The months of October–December 2025 are not reviewed yet because payment data for those months is not available at the time of review.

  • If you show payment for at least 3 months during the reviewed period, you meet the eligibility requirement.

What if I don’t meet eligibility for the current lookback period? Do I have to wait a whole year to try to get into the program?

If you don’t meet eligibility during your first review, don’t worry — your opportunity doesn’t end there.

Here’s what happens next:

  • The Fund will continue reviewing eligibility every month as new payment data becomes available.

  • If you meet the requirement later (for example, once a new month of subsidized payment is reported), you can be approved in a future month and begin receiving benefits at that time.

  • When eligibility is granted, your annual eligibility period starts on your Core Benefit start date — not the original review date.

  • Going forward, your eligibility will be reviewed once each year, about 45 days before that anniversary date.

What this means for you:
Even if you don’t qualify right away, the Fund keeps checking so eligible providers can join as soon as the data supports it.

What happens if I don’t meet the requirements when my annual review date is reached?

Eligibility is reviewed once per year, at your annual review date.

At that time, you may lose eligibility only if the review shows that:

  • You do not have payment for caring for a state-subsidized child in at least 3 months during the required 12-month look-back period to continue Core Benefits, and/or

  • You do not have 3 months of payments and an active, verified Qualified Health Plan (QHP) to continue Core and Reimbursement Program Benefits.

What’s important to know:

  • Providers will no longer be evaluated quarterly for eligibility – once you’re approved, you’re in for a full year.

  • If eligibility is not renewed at your annual review, you may regain eligibility in the future once requirements are met and payment data supports approval.

  • The Fund continues to monitor eligibility and works to bring providers back into the program when possible.

What about grace periods?

There are no grace periods, as eligibility is now annual, instead of quarterly.

What if I share a license with another provider?

At this time, the CCPU Health Care Fund covers only one provider per license—on a first-come, first-served basis. That means the first provider listed on the license to apply and meet the eligibility requirements will be the only one eligible to enroll in the program. We understand that some providers may have multiple individuals listed on their license, and we’re working to expand the program to cover more providers in the future.  You can switch benefits to the other provider at the beginning of a program year, before any claims or program benefits have been utilized. This can only occur once per year, and at the beginning of the year.

What if I lose eligibility in the Fund’s programs? Do I lose my health coverage too?

Losing CCPU Health Care Fund benefits does not mean that you are losing your medical insurance coverage. However, if you no longer meet eligibility at your annual review date, your debit card will be turned off, and you will be responsible for paying your own premiums and out-of-pocket medical expenses until you re-qualify to gain access to the Fund.

We understand that circumstances may change, and we want to ensure that you’re aware of the requirements to remain eligible for the program. If you have any questions or concerns about maintaining your eligibility or accessing the CCPU Health Care Fund benefit, our dedicated customer service team is available to assist you. Please don’t hesitate to contact the PRC at (888) 583-2278 or send an email to: English – [email protected]  Spanish – [email protected]

What if I don’t want all of the Core Benefits? Can I opt out, or choose different benefits for my family?

At this time, Core Benefits are offered as a single, bundled package. This means:

  • You cannot select individual Core Benefits or opt out of specific ones.

  • If you are approved for the Fund, you receive the full Core Benefits package.

  • Your eligible dependents receive the same Core Benefits as you, with one exception: Basic Group Term Life Insurance, which applies only to the provider.

This approach helps the Fund offer comprehensive coverage and keep benefits consistent for all participating providers and families.

Am I eligible for CCPU Heathcare Reimbursement Fund benefits?

Answer these simple questions to determine your potential program eligibility.

Get Started

2026 CCPU Health Care Fund administered by Pinnacle Claims Management, Inc. All rights reserved.

To complete your application online, you’ll need proof of coverage for your health plan (a document showing your name as the policyholder, the name of your insurance plan, the coverage period, and the amount you pay for coverage).

If you don’t have an account for the CCPU Health Care Fund portal, you can sign up now with your email address and mobile phone number.

Complete Your Application

Questions? Call the PRC at (888) 583-CCPU(2278) or Email: [email protected]