Our resources page provides a variety of supplementary materials to help you navigate the process of determining your eligibility. Please click on each item to download the file.
Application Form
- CCPU Health Care Fund Application Form (English)
- CCPU Health Care Fund Application Form (Spanish)
- CCPU Health Care Fund Application Form (Chinese)
Reimbursement Request Form
- CCPU Health Care Fund Reimbursement Request Form (English)
- CCPU Health Care Fund Reimbursement Request Form (Spanish)
Authorization Form to Release Protected Health Information
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.
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
April 15th, 2023 Webinar
- CCPU Health Care Fund Introduction (English/Spanish)
- CCPU Health Care Fund Introduction Process (Simplified Chinese)
March 4th, 2023 Webinar
- CCPU Health Care Fund Reimbursement Process (English/Spanish)
- CCPU Health Care Fund Reimbursement Process (Traditional Chinese)
February 4th, 2023 Webinar
- CCPU Health Care Fund Application Process (English/Spanish)
- CCPU Health Care Fund Application Process (Traditional Chinese)
December 17th, 2022 Webinar
Consumer Portal Quickstart Guide
- CCPU Health Care Fund Consumer Portal Quickstart Guide (English)
- CCPU Health Care Fund Consumer Portal Quickstart Guide (Spanish)
Mobile App Consumer Guide
Please visit our YouTube channel for all instructional videos and webinar recordings.