CHAMPVAVHA Office of Community Care-Thomas Paulus, Deputy Chief,Healthcare Reimbursement-Luke Davis, Operation Specialist,Eligibility, Enrollment & Verification

CHAMPVA Civilian Health And Medical Program of theDepartment of Veterans Affairs– Program Eligibility– Caregiver Program– Foreign Medical ProgramVETERANS HEALTH ADMINISTRATION

CHAMPVA-Eligibility Veteran must be rated P&T– be permanently and totally disabled– have died from a service connected condition– been P&T at the time of death– Not just 100% rating Must not be eligible for TRICARE, beneficiariescannot choose between the two.VETERANS HEALTH ADMINISTRATION

CHAMPVA-Eligibility Children– Through age 18, if in school fulltime, age 23(CHAMPVA does not follow the ACA age of 26.)– If permanently disabled and VARO determineschild is a “Helpless Child” they maintainCHAMPVA for the duration of their life or untilthey get married or lose “Helpless Child Status.”VETERANS HEALTH ADMINISTRATION

CHAMPVA-Eligibility Spouses until divorce, NO EXCEPTIONS! Widow(er): until remarriage– If remarriage ends (by death, divorce orannulment, beneficiary may be entitled toreinstatement) Survivor remarried age 55 and older keepsCHAMPVAVETERANS HEALTH ADMINISTRATION

CHAMPVA- Eligibility If the CHAMPVA beneficiary is Medicare eligibleat any age, she/he must be enrolled in Parts Aand B and must maintain enrollment in Part B tomaintain CHAMPVA eligibility. If the CHAMPVA beneficiary is not eligible forSocial Security/Medicare, she/he must present aletter to Office of Community Care in Denverstating such.VETERANS HEALTH ADMINISTRATION

CHAMPVA-Eligibility - Retirement A CHAMPVA beneficiary whose sponsoringveteran earns a NG or Reserve retirement willhave to switch to Tricare when the retirementis activated. There is no option to keep CHAMPVA onceTricare eligibility is established. If a Tricare widow(er) remarries after 55,she/he loses Tricare but can apply forCHAMPVA.VETERANS HEALTH ADMINISTRATION


Caregiver program & CHAMPVA Currently for OIF & OEF (Iraq and Afghanistan) veteransonly. Caregiver must not have any other health insurance. Must have completed all training from VAMC. Entitled to all of the same benefits as any CHAMPVAbeneficiary. Stipend is based on regional competitive salaries forsimilar work and may vary state to state.VETERANS HEALTH ADMINISTRATION

Application Process Application must include:––––Application (VA Form 10-10d)OHI Certification Form (10-7959c)Copy of Medicare card (if on Medicare)School Cert of full-time enrollment (ages 18-23) Application may include copy (never an original) of:––––Rating decisionMarriage licenseBirth certificate/adoption papersDD214 or Report of SeparationVETERANS HEALTH ADMINISTRATION

Application Process After eligibility is determined, verified againstDEERS -- beneficiary does NOT have to updateDEERS (weekly process.) Information verified with Veterans AffairsRegional Office.– Benefits backdated to date of qualifying event i.e,when the sponsoring Veteran was rated P&T Cards, handbook, etc. mailed.VETERANS HEALTH ADMINISTRATION

CHAMPVA Benefits Major medical plan based on BC/BS but is not aninsurance. Annual deductible 50 (each ind)/ 100 max (family). Shares cost 75% -- user pays 25% of the allowableamount (Medicare rate) unless care provided by VA.– Very rare a Beneficiary is treated by VA.VETERANS HEALTH ADMINISTRATION

Contact Information Phone Center (Customer Service)– 800-733-8387– Mon-Fri, 8:05 AM- 7:30 PM (Eastern) Preauthorization– 800-733-8387 Same HoursVETERANS HEALTH ADMINISTRATION

Contact InformationWeb site: informationEmail: [email protected] Box 469063Denver CO 80246-9063VETERANS HEALTH ADMINISTRATION

Foreign MedicalProgram

FMP-Eligibility Veterans, not family members Veteran must be living or traveling overseas Rules are different for Canada – use of theCanadian Veterans healthcare systemVETERANS HEALTH ADMINISTRATION

FMP-Application Process Veteran sends registration to HAC– Verify SC conditions with VARO– If veteran includes rating decision,registration can be immediate Benefits Authorization sent to veteranexplaining what conditions will be coveredVETERANS HEALTH ADMINISTRATION

FMP-Benefits Every Country except three No cost share Covers service connected conditions orconditions aggravated by service connecteddisability Without regard to percent of disability Most overseas providers require paymentfrom the veteranVETERANS HEALTH ADMINISTRATION

FMP-Benefits Treatments must be FDA approved Can be used in tandem with othergovernment healthcare programs such asTricare May be applied after the episode of care Can use DoD medical facilities if available -always space available, very limited Pays for VA Comp and Pen exams overseasVETERANS HEALTH ADMINISTRATION

FMP-Benefits Phone: 303-331-7590Toll-Free: 1-877-345-8179Fax: ams/veterans/fmpVETERANS HEALTH ADMINISTRATION