If you have applied for or are enrolled in Reimbursement benefits, you’ll need to submit the documents below so we can verify your health plan and process your reimbursement requests.
Proof of Coverage
What is required to be accepted?
- Name of Provider: We need to associate the document with the provider seeking benefits
- Effective Date of the Qualified Health Plan: This impacts the potential CCPU Reimbursement Fund benefit start date
- The Name/Type of Qualified Health Plan: This program has a specific set of plans that are eligible and we have to confirm the provider is enrolled in one. We’ll confirm its eligible.
- Premium: We need to see the premium being paid for plans eligible for premium reimbursement
- Note: If you are enrolled through Covered California and have a family plan, please also provide your APTC (Advance Premium Tax Credit) amount.
Acceptable Documentation Proof of Coverage (English/Spanish)
Reimbursement Receipts
What is required to be accepted?
- Name of Provider: We need to associate the document with the provider seeking reimbursement
- Date of Service/Goods Purchased: We must confirm payment is for services that were incurred in the current plan year and on or after the benefit effective date for the provider
- What the monies were paid towards: This program has a specific set of eligible expenses depending on the type of benefits you have. We have to have proof the provider paid for services/goods covered by their health insurance plan.
- Note: We NEVER need your medical diagnosis. We do need to see that charges were for an eligible expense: Covered Rx, Copay, Coinsurance, Deductible, etc.
- Amount: We need to see the amount needed for reimbursement
Reminder: These documents are only required if you have Reimbursement Program benefits. You’ll continue to enjoy access to other benefits (like dental, vision, life insurance, and more) without submitting them.
