[TFL] CHAMPVA
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- Date: Mon, 22 Aug 2011 20:25:25 -0500
Overview
--------
The Civilian Health and Medical Program of the Department of Veterans Affairs
(CHAMPVA) is a comprehensive health care program in which the VA shares the cost
of covered health care services and supplies with eligible beneficiaries. The
program is administered by Health Administration Center and our offices are
located in Denver, Colorado.
Due to the similarity between CHAMPVA and the Department of Defense (DoD)
TRICARE program (sometimes referred to by its old name, CHAMPUS) the two are
often mistaken for each other. CHAMPVA is a Department of Veterans Affairs
program whereas TRICARE is a regionally managed health care program for active
duty and retired members of the uniformed services, their families, and
survivors. In some cases a veterans may look to be eligible for both/either
program on paper. However, if you are a military retiree, or the spouse of a
veteran who was killed in action, you are and will always be a TRICARE
beneficiary, you can´t choose between the two.
Eligibility
-----------
To be eligible for CHAMPVA, you cannot be eligible for TRICARE/CHAMPUS and you
must be in one of these categories:
1. The spouse or child of a veteran who has been rated permanently and totally
disabled for a service-connected disability by a VA regional office, or
2. The surviving spouse or child of a veteran who died from a VA-rated service
connected disability, or
3. The surviving spouse or child of a veteran who was at the time death rated
permanently and totally disabled from a service connected disability, or
4. The surviving spouse or child of a military member who died in the line of
duty, not due to misconduct (in most of these cases, these family members are
eligible for TRICARE, not CHAMPVA).
An eligible CHAMPVA sponsor may be entitled to receive medical care through the
VA health care system based on his or her own veteran status. Additionally, as
the result of a recent policy change, if the eligible CHAMPVA sponsor is the
spouse of another eligible CHAMPVA sponsor, both may now be eligible for CHAMPVA
benefits. In each instance where the eligible spouse requires medical attention,
he or she may choose the VA health care system or coverage under CHAMPVA for
his/her health care needs. If you have been previously denied CHAMPVA benefits
and you believe you would now be qualified, please submit an application
following the guidelines as listed on the "How to apply" section.
? CHAMPVA Program (01-04)
http://www.va.gov/hac/factsheets/champva/FactSheet01-04.pdf
Benefits
--------
In general the CHAMPVA program covers most health care services and supplies
that are medically and psychologically necessary. Upon confirmation of
eligibility, you will receive program material that specifically addresses
covered and non-covered services and supplies in the form of a CHAMPVA handbook
<http://www.va.gov/hac/forbeneficiaries/champva/handbook.asp>.
General Exclusions
------------------
Like all health programs there are certain services and supplies that are not
covered by our program, some of these are:
? Services and supplies obtained as part of a grant, study, or research
program.
? Services and supplies not provided in accordance with accepted professional
medical standards or related to experimental/investigational or unproven
procedures or treatment regimens.
? Care for which you are not obligated to pay, such as services obtained at a
health fair.
? Care provided outside the scope of the provider's license or certification.
? Services or supplies above the appropriate level required to provide the
necessary medical care.
? Services by providers suspended or sanctioned by any federal agency.
? Services provided by a member of your immediate family or person living in
your household.
? CHAMPVA Mental Health and Substance Use Disorder Benefits (01-01)
<http://www.va.gov/hac/factsheets/champva/FactSheet01-01.pdf>
For a complete listing of non-covered services and supplies please consult the
CHAMVPA handbook <<http://www.va.gov/hac/forbeneficiaries/champva/handbook.asp>
or visit the CHAMPVA web site at
http://www.va.gov/hac/forbeneficiaries/champva/champva.asp
Medicare Impact
---------------
CHAMPVA is always the secondary payer to Medicare. If you are eligible for
CHAMPVA, under age 65 and enrolled in both Medicare Parts A&B, SSA documentation
of enrollment in both Parts A&B is required.
For your benefits to be extended past age 65, you must meet the following
conditions:
? If the beneficiary was 65 or older prior to June 5, 2001, and was otherwise
eligible for CHAMPVA, and was entitled to Medicare Part A coverage, then the
beneficiary will be eligible for CHAMPVA without having to have Medicare Part B
coverage.
? If you turned 65 on/or before June 5, 2001, and have Medicare Parts A and B,
you must keep both Parts to be eligible.
? If you turned 65 on or after June 5, 2001, you must be enrolled in Medicare
Parts A and B to be eligible.
? You are not required to enroll in Medicare Part D in order to become or
remain CHAMPVA eligible.
Related CHAMPVA Links
---------------------
? How to Apply <http://www.va.gov/hac/forbeneficiaries/champva/apply.asp>
? How to File a Claim <http://www.va.gov/hac/forbeneficiaries/champva/claim.asp>
? Brochures <http://www.va.gov/hac/forbeneficiaries/champva/brochure.asp>
? CHAMPVA Inhouse Treatment Initiative (CITI)
<http://www.va.gov/hac/forbeneficiaries/champva/citi.asp>
? Pharmacy Benefits
<http://www.va.gov/hac/forbeneficiaries/champva/pharmacy.asp>
? Other Health Insurance (OHI)
<http://www.va.gov/hac/forbeneficiaries/champva/ohi.asp>
? Your Health Magazine / Customer Newsletter
<http://www.va.gov/hac/forbeneficiaries/champva/champva_customer_newsletter.asp>
? Phone, Chat, Etc., Center
<http://www.va.gov/hac/forbeneficiaries/champva/phonecenter.asp>
------
SOURCE: CHAMPVA Web Site at
http://www.va.gov/hac/forbeneficiaries/champva/champva.asp
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