Benefits

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 $200 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 $185 per month and Medicare Part D premiums up to $100 per month.

If you are enrolled in Medi-Cal, the Fund will cover $200 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 $200 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.

*If you are an undocumented provider, you do not need a SSN/TIN/ITIN to purchase health insurance directly through a carrier, however, you must have an ITIN/TIN to participate in the HealthCare Fund. A SSN is not required.

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 $200 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 $185 per month.

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:

• Under Step 3 of the application > Proof of Coverage > select “Add Another Upload.”
• From the drop-down, select “Premium Billing Statement” and upload the appropriate documentation.
• Select “Add Another Upload” > “Other” from the drop-down and upload your completed Reimbursement Request Form.

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.