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Required Documents

These are the documents you need to prove you have health coverage or that you paid for an eligible health care service.

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
  • Premium: We need to see the premium being paid for plans eligible for premium reimbursement
    • Note: For CCA plans, we also need to see APTC applied in order to calculate provider premium eligible for reimbursement if on a family plan.

 

Acceptable Documentation Proof of Coverage (English/Spanish)

Acceptable Document Eng
Acceptable Proof of Coverage (English)
PDF • Application Guide
Acceptable Documents Span
Acceptable Proof of Coverage (Spanish)
PDF • Benefits Guide
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

Acceptable Documentation Reimbursements (English/Spanish)

Acceptable Documentation Proof of Coverage (English)
Acceptable Documentation Reimbursement Receipts (English)
PDF • Reimbursement Guide
Acceptable Documentation Proof of Coverage (Spanish)
Acceptable Documentation Reimbursement Receipts (Spanish)
PDF • Reimbursement Guide

Acceptable Documentation Permissible Expenses (English/Spanish)

Acceptable Documentation Proof of Coverage (English)
Acceptable Documentation Reimbursement Receipts (English)
PDF • Reimbursement Guide
Acceptable Documentation Proof of Coverage (Spanish)
Acceptable Documentation Reimbursement Receipts (Spanish)
PDF • Reimbursement Guide

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].