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Alert: The CCPU Reimbursement portal is down due to the CrowdStrike outage – There is currently no ETA on resolution. This impacts providers and staff. Please check back Monday! Until then, we are available to answer eligibility and non-claims related questions. No impact to CCPU debit card usage or CCPU application portal.

Forms

Find the forms you need here.

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Apply English
English
CCPU Health Care Fund Application Form (English)
PDF • Application Form
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Apply Spanish
Spanish
CCPU Health Care Fund Application Form (Spanish)
PDF • Application Form
Read
Apply Chinese
Chinese
CCPU Health Care Fund Application Form (Chinese)
PDF • Application Form
Read
Reimbursement English
English
CCPU Health Care Fund Reimbursement Request Form (English)
PDF • Reimbursement Request Form
Read
Reimbursement Spanish
Spanish
CCPU Health Care Fund Reimbursement Request Form (Spanish)
PDF • Reimbursement Request Form
Read
Auth Form - English
English
CCPU Health Care Fund Authorization Form (English)
PDF • Authorization Form
Read
Auth Form-Spanish
Spanish
CCPU Health Care Fund Authorization Form (Spanish)
PDF • Authorization Form
Read

Am I eligible for CCPU Heathcare Reimbursement Fund benefits?

Answer these simple questions to determine your potential program eligibility.

CCPU Health Care Fund

By signing up, you agree to our privacy policy and terms of use.

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.

Questions? Call (833) 714-6028 or email [email protected].