Last modified: May 3, 2023
What is the CCPU Health Care Fund?
The CCPU Health Care Fund is a trust, a legal entity created to provide Eligible Providers reimbursement for covered health care costs.
Does CCPU’s Health Care Fund provide health insurance?
No, the CCPU Health Care Fund does not provide health insurance and is not a Qualified Health Plan. It is a reimbursement plan that works with your Qualified Health Plan. In fact, you cannot enroll in the CCPU Health Care Fund unless you have a Qualified Health Plan. If you are not insured, you will need to enroll in a Qualified Health Plan available to you. Please click here for help enrolling in a Qualified Health Plan.
When can I sign up? Where can I learn more?
Applications for the CCPU Health Care Fund are now available. Sign up to get updates via text or email on www.ccpuhealth.org. Be sure to enroll in a Qualified Health Plan during open enrollment to ensure you are eligible for the CCPU’s Health Care Fund benefits.
What is a premium?
A premium is the amount a provider pays for a health plan each month, whether or not the plan was used.
What are covered Qualified Health Plan Reimbursable Expenses?
Reimbursable Health Plan expenses are dollars you pay for your share of the Qualified Health Plan’s cost of health care services, such as deductibles, copayments, and coinsurance.
Are there any fees associated with signing up for the Health Care Fund?
No, there are not any fees to apply for the CCPU Health Care Fund. However, providers need to meet the initial eligibility requirements of working with a subsidized child for 3 out of 6 months, be enrolled in a Qualified Health Plan, and complete a CCPU Health Care Fund application.
What is a subsidized child?
A subsidized child is a child for whom a family receives government-sponsored financial assistance expressly intended to pay for childcare. For providers, this means their fee to care for a child is reimbursed in whole or in part through a government assistance program. The subsidy must come from a qualified state-funded program. Please note that local or county-funded assistance programs do not count toward qualifying for the benefit.
What do I need to complete the application for the CCPU Health Care Fund?
To complete your application, you will need the following information:
- Profile information about you as the provider
- Information about your medical health insurance plan
- A copy of your health plan proof of coverage *
*This documentation should provide details that verify your name as the policy holder, your health care plan name, and the coverage period.
What is the deadline to apply for the January 1, 2023 initial eligibility period?
The deadline to apply is June 30, 2023, for an eligibility start date of January 1, 2023. Due to the launch of the program, the application deadline for the first quarter of January-March was extended. This means if you meet the initial eligibility requirements, you will be able to be reimbursed for covered expenses from January 2023 forward. To maintain eligibility as of April 1, 2023, you are required to be paid for work with a subsidized child for 1 out of 3 months in October 2022-December 2022.
Will I have to pay taxes on benefits I receive from the CCPU Health Care Fund?
No. The CCPU Health Care Fund’s reimbursement of Qualified Health Plan Out of Pocket Expenses and reimbursement of your Qualified Health Plan premium cost on your Qualified Health Plan is not taxable income to you. However, any cash benefit that is not used for reimbursement of medical expenses, however, will be taxable.
What benefits are available if I am eligible for an employer group health plan as an employee?
If you are enrolled in your employer group health plan as an employee, you are eligible for two types of benefits: up to $8,750 in reimbursement of Health Plan out-of-pocket expenses and up to $100 per month in premium reimbursement.
What benefits are available to providers who are eligible for an employer group health plan as a spouse or child (dependent of an employee)?
Providers eligible for an employer group health plan as a dependent are eligible for two options for CCPU Health Care Fund benefits. If you choose to enroll in that employer group health plan, you will receive up to $8,750 in reimbursement of Qualified Health Plan out-of-pocket expenses and up to $100 per month in premium reimbursement. If you choose to enroll in Cover California as your Qualified Health Plan, you will receive up to $8,750 in reimbursement of Qualified Health Plan out-of-pocket expenses and full reimbursement of your premiums for your Silver HMO plan.
What benefits are available to Medi-Cal enrollees?
If you are on Medi-Cal and meet the eligibility criteria, you are eligible to receive a benefit of $100 per month for Reimbursable Expenses.
What are Permissible Health Expenses for Medi-Cal?
Permissible Health Expenses if you are enrolled in Medi-Cal are health care expenses that are not covered by your Medi-Cal plan.
I am on a family plan through Covered California. What expenses are reimbursable?
The CCPU Health Care Fund will reimburse eligible providers for expenses like medical copays and deductibles, pharmacy copays and deductibles, and Qualified Health Plan monthly premiums. These expenses are only reimbursed for you (the enrolled provider); expenses for other family members are not covered.
Are dental and vision benefits available?
Dental and vision benefits are not available; however, the CCPU Health Care Fund is looking to enhance the benefits available for future plan years if feasible.
Do the CCPU Health Care Funds roll over to the next plan year?
No, the CCPU Health Care Funds do not roll over. The benefits will reset each plan year if you meet the eligibility criteria.
Qualified Health Plans
Who can help me enroll in a qualified health insurance plan?
Click here to see how to get help enrolling in a qualified medical plan.
Why does the CCPU Health Care Fund cover only HMO plans and not PPO plans?
HMO plans are the most cost-efficient plans and provide the maximum value of benefits to the most people to fit within the CCPU Health Care Fund’s budget.
Why does the CCPU Health Care Fund cover only Silver-level HMO plans on Covered California?
Silver-level plans are the most cost-efficient plans and maximize the cost assistance available and allow the CCPU Health Care Fund to provide the richest benefits to the most people.
What is an employer-sponsored health plan as an employee, spouse or dependent?
This is a health insurance plan provided by employers for their employees, and potentially, their dependents. For instance, you could have a second job and receive coverage through your employer; or you could be a dependent on your spouse’s or parents’ employer-sponsored health plan.
How will I know if I meet the CCPU Health Care Fund eligibility by being a part of the child care subsidy program?
Eligibility will be verified following an enrollee’s completion of the CCPU Health Care Fund enrollment application. Please check www.ccpuhealth.org for the latest information and updates.
What if there are multiple providers on one license? For example, if I have three people under my license – my daughter, my assistant, and myself. Who is eligible?
Currently, the CCPU Health Care Fund covers only one provider per license. If you have multiple individuals listed on your license, like the example shown above, benefits will be extended on a “first come, first served basis” – that means that the first provider on that license to apply for benefits is the only one eligible to enroll.
Do I have to join a labor union to receive the funds?
No, you are not required to be a member of the Union to receive benefits from the CCPU Health Care Fund.
Do I qualify if I am an undocumented worker?
If you are not a legal resident of the United States, are above the income threshold to qualify for Medi-Cal, and are not eligible for Covered California, you are still eligible for up to $8,750 in reimbursement of health insurance out-of-pocket expenses and up to $100 per month in premium reimbursement if you enroll in a Silver-level HMO.
Is my family eligible for expense reimbursement through the CCPU Health Care Fund?
No, your family is not covered through the CCPU Health Care Fund. We do encourage you to sign up your family through the Affordable Care Act because it is likely that you can find affordable insurance for them.
How do I submit a reimbursement request? How do I get reimbursed for out-of-pocket expenses?
Providers can be reimbursed for eligible out-of-pocket expenses that were incurred during their eligibility period where they spent their own money upfront or received a bill for eligible services. This means we will reimburse you for any monies you paid or are required/responsible to pay after your insurance has paid their portion.
You can submit the request via paper or via the online portal.
To submit your reimbursement request via paper, please visit Resources – CCPU Health and select the Reimbursement Request Form in your preferred language.
Complete the form with the required information and be sure to attach a copy of your receipt. The receipt should show:
- The dollar amount of your request,
- Date of service, and
- Date of payment, if applicable
You can submit the completed form via:
Email: [email protected]
CCPU Health Care Fund
P.O. Box 57027
Irvine, CA 92169
To submit your reimbursement request via the online portal, please access the CCPU Health Care Fund Consumer Portal QuickStart Guide (English) or (Spanish) to learn how to submit a reimbursement request electronically.
How do I get my first premium paid? I can’t afford to pay it up front.
If you need assistance making your initial premium payment for your Qualified Health Plan, please submit a Reimbursement Request Form with your initial premium bill and ensure it contains the following information: Your Name, the name of the plan, the effective date, the premium amount and the Advance Premium Tax Credit applied, if applicable. It is preferable to make this request at the same time you apply for this program, and you are encouraged to submit as soon as possible to ensure your plan isn’t cancelled by the provider.
You can submit the request with your initial application by:
- Accessing Step 3- Proof of Coverage, selecting the “Add Another Upload” button.
- From the drop down, select “Premium Billing Statement” and upload the appropriate documentation.
- After, selecting the “Add Another Upload” button, and selecting ‘Other’ from the drop down and uploading your completed Reimbursement Request Form.
Can I be reimbursed for pharmacy costs? What about braces? Dental expenses?
Yes, this program benefit will reimburse you for any out-of-pocket expenses or for eligible permissible expenses* (for Medi-Cal enrollees) incurred from covered pharmacy expenses. It does not cover over-the-counter medication costs that don’t have an associated co-pay, coinsurance, or deductible. Dental and vision benefits are not under this program, which includes orthodontia.
*For a sample list of permissible expenses, please visit Overview – CCPU Health and review the “Medi-Cal Reimbursement Sample List” section.
What do I need in order to be reimbursed for an approved expense?
In order to have an out-of-pocket or premium expense reimbursed, log into the portal and submit the reimbursement request electronically by selecting the “Reimbursement Request” button. The system will walk you through the required information to make the request, which includes a receipt that shows the dollar amount of your request, when the service occurred, and the date of payment.
You can also submit the request via mail or email by submitting a completed Reimbursement Request Form with signature and a receipt that shows the dollar amount of your request, when the service occurred, and the date of payment.
What do I do if a reimbursement claim is denied, and I think it’s wrong?
If you believe a Reimbursement Request was denied in error, you can request we do a 2nd review. Please submit the request to customer service, along with any additional information to be considered, at (833) 714-6028, or via email at [email protected].
When submitting a reimbursement request for premiums, should I select the Premium Expense account, or the Out-of-Pocket Expense Account?
When submitting expenses for premium reimbursements, Providers should select the Premium Expense account, even if it shows $0.00 dollars available.
How do I cancel a reimbursement claim I submitted?
Providers can deny their own reimbursement request through the Reimbursement Accounts Consumer Portal or call (833) 714-6028 to have us remove the reimbursement request.
To cancel via the portal, the provider will:
- Log into the Reimbursement Portal.
- Select “claims” under the Account tab,
- Select the claim they would like to cancel, and
- Select “cancel claim” link.
How long will it take me to receive my reimbursement?
It can take up to 30 days, but we are processing claims faster than that now, 7-10 business days.
Can I use the card prior to submitting receipt?
Yes, you may use your card at the time of service to pay for covered services.
And how long do I have to turn in receipt?
You have 10 days to upload receipts. It is highly encouraged to upload your receipts as soon as possible.
Does premium come out of Premium bucket or OOP?
When submitting expenses for premium reimbursements, Providers should select the Premium account, even if it appears empty.
Can you use the debit card to a premium ahead of time?
Yes, but only after your first premium is paid. We need your monthly premium billing statement so that we can load the correct amount on your card ((check timing of premium bucket loading))
How long does it take to get a debit card after approval?
Once your application is approved it will take about 7-10 days to receive your debit card in the mail.
If I have a hospital bill, can I pay with the card the balance due?
It is important to remember that this program works with your insurance plan. Your insurance carrier will tell you what your portion of a medical procedure is your responsibility. You can pay your portion/responsibility with your debit card. You should not attempt to pay more than your eligible expense to avoid claim denial.
If my dentist prescribes RX can the card be used to pay for the RX at pharmacy even though dental is not covered?
No, dental expenses are not covered by this program.
What is the turnaround time for suspensions to be lifted?
The turnaround time is ~7business days.
If I have the Medi-Cal Permissible benefit, can I purchase things that are on this list on stores such as Amazon?
Yes, however providers are still responsible to submit a receipt to substantiate the request.
How long before the direct deposit function will work where it may ask for my Banking information for future reimbursements?
Direct deposit of reimbursement is a coming feature. We will let you know when it’s available.
If I’m not enrolled in a QHP now is there a deadline to change my current plan to be in a QHP?
Covered California is currently allowing CCPU providers to enroll throughout 2023. We highly encourage all eligible providers to enroll as soon as possible to gain access to these benefits.
How long does the application take to get approved?
The turnaround time for application processing is 3 business days. Depending on the exact case, eligibility determinations can take additional days (additional documentation needed, QHP enrollment assistance, etc).
How long will it take to receive the debit card?
Providers will receive their debit card in 7 to 10 days after enrollment is complete.
What is the CCPU Health Care Reimbursement Fund Consumer Portal?
This one-stop portal gives you 24/7 access to view information and manage your Reimbursement Accounts. It enables you to:
- File a reimbursement online
- Upload receipts and track expenses
- View up-to-the-minute account balances
- View your account activity, reimbursement request history and payment history
- Report a lost/stolen Card and request a new one
- Change your login ID and/or password
- Download plan information, forms and notifications
How do I login to the CCPU Health Care Reimbursement Fund Consumer Portal?
- Go to www.ccpuhealth.org/card
- Enter your login ID and password (both provided by CCPU Health Care Reimbursement Fund).
- Your username is your CCPU Health Care Reimbursement Fund ID. This can be found on the Welcome Letter you received.
- Your password is your first name initial, your last name, and your date of birth (DDMMYY) i.e., MGarcia010293.
- Click Login
What is the CCPU Health Care Reimbursement Fund Debit Card?
You can use this CCPU Health Care Reimbursement Fund Debit Visa® Card to pay for your out-of-pocket expenses, such as health plan premiums and permissible health care expenses, when applicable. The card will come from Bancorp Bank.
How do I activate the debit card?
To activate your card, follow the instructions on the card sticker. For activating, you will need your member ID and to sign the back of your card. Your member ID is your CCPU Health Care Reimbursement Fund ID. You should wait one business day after activation before using your card.
How does the debit card work?
The value of your account is stored on the CCPU Health Care Reimbursement Fund Debit Visa®. When you have eligible expenses at a business that accepts debit cards, you simply use your payment card. The amount of the eligible purchases will be deducted automatically from your account and the funds will be electronically transferred to the provider/merchant for immediate payment.
Is the debit card just like other Visa® Cards?
Your CCPU Health Care Reimbursement Fund Debit Visa® Card works just like a regular debit card, except:
- Your card is limited in use, meaning you can only use it for covered medical expenses based on your health plan.
- You can’t use your card at an ATM or to get cash back when making a purchase.
- You will not receive monthly bills, and you will not accrue interest.
How many debit cards will I receive?
You will receive one card.
In what ways can I use my CCPU Health Care Reimbursement Fund Debit Visa® Card?
Providers with approved and qualified medical health plans can use this debit card for monthly premiums (see exceptions below) out-of-pocket expenses, and permissible health expenses, when applicable. These expenses include the deductible on your approved medical health plan, copayments, and coinsurance expenses, including covered prescriptions.
- If you are on Medi-Cal or both Medi-Cal and Medicare, also known as a Medi-Medi Plan, you are not eligible for premium reimbursement.
- If your family is included on your medical health insurance policy, you may still use the debit card for out-of-pocket expenses, but not for premium payments. You will need to submit a Request for Reimbursement Form to [email protected] for payment of your individual premium.
For additional information on the benefits that are covered based on your medical health plan, please click here.
Will I receive a new debit card each year?
No, you will not receive a new CCPU Health Care Reimbursement Fund Debit Visa® Card each year. If you meet the eligibility requirements for the following plan year and you used the payment card in the current plan year, you will simply keep using the same debit card. The card will be loaded with the amount allowed based on your medical health plan and your eligibility start date.
What if the debit card is lost or stolen?
Call customer service at (833) 714-6028 or email at [email protected]. You should report a card lost or stolen as soon as you realize it is missing so the CCPU Health Care Reimbursement Fund can turn off your current card and issue a replacement card. Please note that you will not be charged for your initial replacement card, but there will be a $10 fee for any subsequent card replacements.
What dollar amount is on the debit card when it is activated?
The dollar amounts vary based on your health plan. There are two separate accounts on your CCPU Health Care Reimbursement Fund Debit Visa® Card: one for paying your premiums, if applicable, and one for covered out-of-pocket expenses. The 2023 debit card allowance for covered out-of-pocket expenses is $8,750.
For Medi-Cal, you will not be eligible for premium and out-of-pocket expense reimbursements but will have $100 a month available in your account to be used for permissible health expenses. The funds will roll over to the next month if unused but will reset at the end of the plan year.
For Medi-Cal and MediCare, also known as a Medi-Medi Plan, you will not be eligible for premium reimbursement but will have two separate accounts on your CCPU Health Care Reimbursement Fund Debit Visa® Card: one for paying for covered out-of-pocket expenses and one for permissible health expenses. The 2023 debit card allowance for covered out-of-pocket expenses is $8,750. You will also have $100 a month available in your account to be used for permissible health expenses.
It is important to keep track of your account balance to avoid debit card declines at point of service.
Where may I use the debit card?
For out-of-pocket expenses, debit cards may be used at participating medical and pharmacy facilities. For permissible health expenses, debit cards may be used at participating medical and pharmacy facilities, as well as wholesale clubs, discount stores, department stores, retail food stores and supermarkets.
Are there places the debit card won’t be accepted?
Yes. The payment will not be accepted at locations that do not offer the eligible goods and services, such as hardware stores, restaurants, bookstores, gas stations and home improvement stores.
If asked, should I select “Debit” or “Credit”?
If you have elected to use a PIN (Personal Identification Number) with your CCPU Health Care Reimbursement Fund Debit Visa® Card, you should select “Debit” and enter the PIN when prompted. If you are not using a PIN with your debit card, you should select “Credit.” You will be asked to sign for the debit card purchase. As a reminder, you can’t get cash back with this debit card.
Why do I need to save all itemized receipts?
You will be required to submit proof of all your eligible expenses for both debit card swipes and paper form requests for reimbursements, so be sure to keep all your Explanation of Benefits (EOBs) and itemized receipts. Each receipt must show: the merchant or provider name, the service received or the item purchased, the date, and the amount of the purchase.
What if I am asked for the CVV when paying for the balance due or when placing an order by phone or online? What is this and where is it found?
CVV stands for “Card Verification Value.” It is a 3-digit number that can be found on the back of your card to the right of the signature panel.
How do I know how much is in my account?
You can visit your personal Account Summary page at www.ccpuhealth.org/card to view your account activity and current balance. You should always review your account balance before making a purchase with your payment card.
What if I have an expense that is more than the amount left in my account?
When incurring an expense that is greater than the amount remaining in your account, you may be able to split the cost at the register. We recommend you check with the merchant at point-of-sale. For example, you will need to tell the clerk to use the debit card for the exact amount available in your account and then pay for the remaining balance.
What are some reasons that the debit card might not work at point of sale?
The most common reasons why a payment card may be declined at the point of sale are:
- The card has not been activated.
- The card has been used before the 24-hour period after activation is over.
- You have insufficient funds in your account to cover the expense.
- Non-eligible expenses have been included at the point-of-sale. (Retry the transaction with the eligible expense only.)
- The merchant is encountering problems (e.g., coding or swipe box issues).
- The point-of-sale location cannot verify eligible items at checkout.
Who do I call for questions about the card?
You can call customer service at (833) 714-6028 or email [email protected].
What happens if you fail to submit receipts to verify a charge?
If receipts are not submitted as requested to verify a charge made with the debit card, then the card may be suspended until receipts are received. You may be required to repay the amount charged.