ChampVA

Am I eligible for ChampVA?

 

The Permanent and Total Disabled Veteran is not eligible. ChampVA is a healthcare benefit extended to the dependents of a veteran rated as Permanent and Totally Disabled Veteran by the Department of Veterans Affairs. If you are rated total and permanently disabled by the Department of Veteran Affairs in your disability compensation rating you are eligible.


I am the veteran and I've been rated Permanent and Totally Disabled by the Department of Veterans Affairs, who is eligible for ChampVA benefits:


( a ) Children until age 18;


( b ) Children until age 23 if in school fulltime;


( c ) A child that has been deemed a Helpless Child by the Veterans Affairs Regional Office (VARO), will be have

the benefit for their lifetime;


(d) Spouse until divorce;


(e) Widow(er) until remarriage;


( 1 ) If the remarriage ends, the benefit may be reinstated;


( 2 ) If remarried at age 55 or older, keep CHAMPVA.


( f) If under age 65 and MEDICARE eligible, must be enrolled in Parts A and B;


( g ) If age 65 or older and MEDICARE eligible;


( 1 ) before June 5, 2001, must keep Part B if you had Part B;


( 2 ) on and after June 5, 2001, must enroll in Parts A and B;



What are the ChampVA Benefits include?


( a ) Major medical plan, Inpatient, Outpatient, Mental Health, substance abuse, prescription medication (includes

those on MEDICARE) & hospice;


( b ) Annual deductible $50/$100 max;


( c ) Share cost 75% --user pays 25% unless care is provided by the Veterans Affairs;


( 1 ) CITI;


( 2 ) Meds by Mail;


( 3 ) DME;



( d ) $3,000 annual catastrophic cap;


( e ) No network of providers or provider contracts;


( f ) Complete freedom of choice to see who you prefer;


( g ) You do NOT need to see a VA doctor- CHAMPVA covers you when you see a private provider.



What does the ChampVA Benefits NOT cover?


( a ) Routine dental;


( b ) Routine vision, unless disease;


( c ) Chiropractic;


( d ) Routine exams except school physicals;


( e ) Custodial/Domiciliary Care (nursing homes, long term care).



What about Prescriptions?


There are three different ways to get your medication. They are:


( a ) Local Pharmacy-ANY pharmacy;


( b ) Annual deductible;


( c ) 25% cost share;


( d ) In rare cases you may have to pay and file a claim with ChampVA.


( e ) Medical Matrix Network (http://www.medicalmatrix.com) or (800) 880-1377


( 1 ) No other prescription coverage;


( 2 ) 45,000 pharmacies;


( 3 ) Must pay annual deductible;


( 4 ) 25% cost share;


( 5 ) No claim to file.


( f ) Meds by Mail


( 1 ) No other prescription coverage;


( 2 ) No deductible;


( 3 ) No cost share;


( 4 ) Mailed to your home;


( 5 ) Generic Medication;


( 6 ) Routine, not urgent meds.



Does ChampVA cover Durable Medical Equipment?


( a ) If rent/cost is $2,000 or more, need pre-authorization.


( b ) NO cost share the Veterans Affairs Hospital obtains the item.



What happens if my dependents have Medicare benefits?


ChampVA benefits do not change with Medicare. However, MEDICARE pays first and ChampVA pays second. In fact, ChampVA pays after Medicare, Medigap or any other insurance. Outpatient prescriptions are covered however you will have a 25% cost share unless you use Meds by Mail in which case they would be free. In MOST cases, ChampVA and Medicare combined results in NO out of pocket expenses. For example:


ChampVA pays Medicare inpatient and outpatient copayment.


However, ChampVA does not pay deductibles or Part B premiums. For other issues regarding how Medicare benefits affect your ChampVA benefits.


What happens if I use ChampVA overseas?


You still have the same benefits as you do in the United States. If you have Medicare, ChampVA becomes the first payer. However, payment to the health care provider is paid upfront in most cases.


So my dependents can use the VA Hospital?


VA Hospitals are not equipped to care for young children. Young children must see outside care. Wether or not a VA Hospital accepts ChampVA is not up to ChampVA itself, however the decision is solely up to the respective Veterans Affairs Medical Center Director. Approximately ninety six of the Veterans Affairs Hospitals accept ChampVa. Thirty two Veterans Affairs clinics accept ChampVA. There is no cost share for going to the VA Medical Center with ChampVA.


What are the steps and information for filing a claim with ChampVA?


( a ) Follow these steps to filing a claim with ChampVA:


( 1 ) Follow the instructions on the VA Form 10-7959A;


( 2 ) Make sure your name is the same as the one on you ChampVA Authorization Card;


( 3 ) Make sure YOUR social security number is on the form NOT the veteran's social security number;


( 4 ) Include a copy of the OHI explanations of benefits;


( 5 ) Remember that separate claim forms are required for each patient/beneficiary/dependent;


( 6 ) Provide a COPY of the provider's itemized billing statement;


( 7 ) Make sure to send forms UB-92 and HCFA 1500;


( 8 ) Send all claims to: VA Healthcare Administration Center, CHAMPVA, PO BOX 65024, Denver, Colorado

80206-9024;


( 9 ) DO NOT send certified/registered mail (causes long delay) use Delivery Confirmation.


What are the steps and information for filing a Pharmacy Claim with ChampVA?


( a ) Follow the steps listed above, but make sure your Pharmacy Invoice/Billing statement includes the following:

( 1 ) Name, address and phone number of the pharmacy;

( 2 ) Name of the prescribing physician;

( 3 )  Name, strength, quantity for each drug;

( 4 ) National Drug Code for each drug;

( 5 ) Charge for each drug;

( 6 ) Date prescription was filled;

( 7 ) The sales receipt ( cash register receipt ) with date and dollar amount.


How do I get a hold of ChampVA?


( a ) E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.


( b ) Website: www.va.gov/hac


( c ) Letter Correpondence: Letter, ChampVA, PO Box 65023, Denver, Colorado 80206-9023


( d ) Phone: ( 800 ) 733-8387 M-F 8:05am - 7:30pm (EST)


( e ) Preauthorization: ( 888 ) 820-1756