Filing a Piggyback Claim

How Are Claims Filed?

A claim must be submitted to the CCPOA Benefit Trust Fund no later than one year after the date the primary carrier paid the original claim.

All claims must have the following information:

  • Participant’s name
  • Last 4 of SSN,
  • Patient’s name,
  • Date of service,
  • Services rendered,
  • Charges for each service.

Claims need to be mailed to:

CCPOA Benefit Trust Fund,
2515 Venture Oaks Way, Suite 200
Sacramento, CA 95833-4235

The following is a brief description of how to submit a claim:

Dental Claims: You or your dentist must submit an itemized claim and an itemized primary insurance statement (EOB) to the CCPOA BTF for reimbursement.

Vision Claims: Ask your eye care provider for an itemized statement of your out-of-pocket expenses and submit the statement to the CCPOA BTF for reimbursement.

Active: Piggyback Vision Claim Form

Retired: Piggyback Vision Claim Form

Hearing Aid Claims: Once an attending physician writes a prescription for the hearing aid device and the device has been purchased, submit a copy of the itemized statement and copy of the prescription to the CCPOA BTF for reimbursement.