You can apply online or by downloading a printable form. Completing the application requires just a few simple steps:
- Step 1: Complete your personal information, including your name, address, and provider license number, if you have one.
- Step 2: Fill out information about your current medical insurance plan.
- Step 3: Upload your proof-of-coverage documents, including a copy of your health insurance plan information (this documentation should include your name to verify you are the policy holder, your health insurance plan name, and the coverage period).
- Step 4: Review your information and submit the application.
To apply online, you will need to log in to the CCPU Health Care Fund portal. If you don’t have an account, you can sign up with your email address and mobile phone number.
| Application submitted by: | For work with a subsidized child (at least one day a month for three months): | Will result in benefits coverage retroactive to: |
|---|---|---|
| March 31, 2025 | April – September 2024 | January 1 – March 31, 2025 |
| June 30, 2025 | July – December 2024 | April 1 – June 30, 2025 |
| September 30, 2025 | October 2024 – March 2025 | July 1 – September 30, 2025 |
| December 31, 2025 | January – June 2025 | October 1 – December 31, 2025 |
Initial applications are reviewed each quarter for benefits that begin January 1, April 1, July 1, or October 1.
