© 2024 CCPU Health Care Fund administered by Pinnacle Claims Management, Inc.
All rights reserved.
As a child care provider in California who works with a state-subsidized child, you could receive up to $9,450 per year for reimbursement of your health plan expenses such as doctor visits, medications, lab tests, and more.
Plus, you can get additional money to pay the premiums for your health insurance coverage.
Your immigration status does not matter. Undocumented providers are eligible to apply.
Depending on the type of qualified health plan you are enrolled in, your Health Care Fund benefits could cover monthly premiums, out-of-pocket medical expenses, and other permissible reimbursements. Each section below provides details based on your health plan.
For providers enrolled in Covered California, the Fund will reimburse 100% of your provider-only medical insurance premium and cover up to $9,450 per year in health plan expenses. This includes reimbursement of out-of-pocket medical and pharmacy expenses, such as copays, deductibles, and coinsurance.
Fund benefits are only available if you are enrolled in a Silver-level HMO plan.
If you have a second job that offers medical insurance, you must be enrolled in that plan to receive Fund benefits.
If you have access to an employer plan as a dependent through your spouse, you can enroll in either the employer plan or a qualified Covered California plan and receive Fund benefits.
*If no HMO plans are available in your area, the lowest-cost EPO/PPO option will be considered a qualified health insurance plan.
If you have a second job that offers employer-sponsored medical insurance, the Fund will reimburse your medical insurance premium up to $100 per month and cover up to $9,450 per year in health plan expenses. This includes reimbursement of out-of-pocket medical and pharmacy expenses, such as copays, deductibles, and coinsurance.
If you are enrolled in Medicare, the Fund will cover up to $9,450 per year in eligible health plan expenses. This includes reimbursement of out-of-pocket medical and pharmacy expenses, such as copays, deductibles, and coinsurance. Medicare expenses also include reimbursement of Medicare Part B premiums up to $174.80 per month and Medicare Part D premiums up to $50 per month.
If you are enrolled in Medi-Cal, the Fund will cover $100 per month for permissible health care expenses. Permissible health care expenses include many over-the-counter medications, acupuncture, physical therapy, wheelchairs, and more.
The permissible health care expense benefit is only available to providers who are enrolled in Medi-Cal. It is not available to providers who are enrolled in one of the other qualified medical insurance plans.
This benefit is different from other qualified health plans because Medi-Cal often pays 100% of premiums and out-of-pocket expenses.
If you are enrolled in both Medi-Cal and Medicare, the Fund will cover $100 per month for permissible health care expenses. Permissible health care expenses include many over-the-counter medications, acupuncture, physical therapy, wheelchairs, and more.
In addition, the Fund will cover up to $9,450 per year in eligible health plan expenses. This includes reimbursement of out-of-pocket medical and pharmacy expenses, such as copays, deductibles, and coinsurance.
The permissible health care expense benefit is only available to providers who are enrolled in Medi-Cal. It is not available to providers who are enrolled in one of the other qualified medical insurance plans.
If you do not have a social security number or TIN* and you purchased an insurance plan directly through an insurance carrier, the Fund will reimburse your medical insurance premium up to $100 per month and cover up to $9,450 per year in health plan expenses. This includes reimbursement of out-of-pocket medical and pharmacy expenses, such as co-pays, deductibles, and co-insurance. Fund benefits are only available if you are enrolled in a Silver-level HMO equivalent plan.
*A SSN or ITIN/TIN is required to participate in this program due to dental and vision benefits administered through MetLife.
If you are enrolled in Veterans Affairs Health Care benefits, the Fund will cover up to $9,450 per year in eligible health plan expenses. This includes reimbursement of out-of-pocket medical and pharmacy expenses, such as copays, deductibles, and coinsurance.
If you are enrolled in TRICARE, reimbursement benefits differ by plan type.
If you are enrolled in TRICARE Prime, TRICARE Select, TRICARE Reserve Select, or TRICARE Retired Reserve, the Fund will reimburse your medical insurance premium up to $100 per month and cover up to $9,450 per year in health plan expenses. This includes reimbursement of out-of-pocket medical and pharmacy expenses, such as copays, deductibles, and coinsurance.
If you are enrolled in TRICARE for Life, the Fund will reimburse your Medicare Part B premium up to $174.80 per month.
Our Fund can help reduce—or in some cases eliminate—your out-of-pocket health care expenses.
Using Your Benefits
The CCPU Health Care Fund works with the health insurance you already have (or that you enroll in) and reimburses you for your out-of-pocket costs like doctor visit copays, prescription drug copays, and in most cases, the monthly premiums.
The Fund does not replace your health insurance. In fact, to be eligible for Fund benefits, you must be enrolled in a qualified health insurance plan. Fund benefits can only be used to reimburse your own expenses—you can’t be reimbursed for your family members’ expenses.
How to Use Your Benefits
It’s important to remember that this program works with your insurance plan. Your insurance carrier will tell you what your portion of a doctor’s office visit or 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.
Once you have been approved, it’s easy to get the most out of your benefits.
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 your name, the name of the plan, the effective date, the premium amount, and the advance premium tax credit applied (if applicable).
You can submit the request with your initial application:
You can be reimbursed for any out-of-pocket expenses incurred at a covered pharmacy or medical provider. Note: There is no coverage for over-the-counter medications that don’t have an associated copay, coinsurance, or deductible unless you have a permissible benefit.
Just visit your provider as you normally would and pay for services with your Fund-provided debit card. If you need to pay with your own card or cash, submit a reimbursement request.
You have 30 days to upload receipts. It is highly encouraged to upload your receipts as soon as possible.
At this time, dental and vision expenses are not eligible for reimbursement.
The Trustees are partnering with MetLife to offer dental and vision coverage to child care providers already enrolled in the CCPU Health Care Fund. Read more here.
Our Eligibility Questionnaire will help you determine if you meet the requirements to apply for benefits.
Answer these simple questions to determine your potential program eligibility.
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].