CHAMPVA offers health options

Spouse and children of disabled or deceased veterans may be eligible for healthcare coverage through the CHAMPVA program.

The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program in which the Department of Veterans Affairs (VA) shares the cost of covered health care services and supplies with eligible beneficiaries.

Due to similarities between CHAMPVA and the Department of Defense (DoD) TRICARE program the two are often mistaken for each other. 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 Veteran may appear to be eligible for both or 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 and cannot choose between the two programs.

To be eligible for CHAMPVA, you cannot be eligible for TRICARE (previously known as CHAMPUS) and you must be in one of these categories:

• 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

• the surviving spouse or child of a veteran who died from a VA-rated service connected disability, or

• the surviving spouse or child of a veteran who was at the time of death rated permanently and totally disabled from a service connected disability, or

• 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).

CHAMPVA and the Affordable Care Act The Affordable Care Act (ACA) is a health care law that was created to expand access to affordable health care coverage for all Americans, lower costs, and improve quality and care coordination. Under the health care law, people will have health coverage that meets a minimum standard (called 'minimum essential coverage'). The health care law designates CHAMPVA as fulfilling the minimum essential coverage requirement. For additional

Benefits Pharmacy Benefits

information, view the ACA information on the VA website.

If you are enrolled in CHAMPVA, you do not need to take additional steps to meet the health care law coverage standards. CHAMPVA will send IRS Form 1095-B, Health Coverage, annually. The ACA does not change CHAMPVA benefits or out-of-pocket costs.

In general, CHAMPVA covers most health care services and supplies that are medically and psychologically necessary. Upon confirmation of eligibility, you will receive a CHAMPVA Guide that specifically addresses covered and non-covered services and supplies. For a complete listing of non-covered services and supplies please consult the CHAMPVA Policy Manual available online.

Meds by Mail: Meds by Mail is a voluntary service that provides a safe, easy and cost-free way for eligible CHAMPVA and Spina Bifida beneficiaries to receive nonurgent maintenance medications delivered right to your door.

OptumRx (formerly Catamaran) Retail Pharmacy Network: OptumRx electronically processes pharmacy claims nationwide, including Puerto Rico, Guam, and the Virgin Islands. Beneficiaries are serviced through a network of more than 82,000 retail pharmacies. When you use a OptumRx pharmacy, the pharmacy may collect a 25 percent cost share (after the annual deductible has been met) before submitting the claim – saving you time. To apply for CHAMPVA benefits, you must submit the following documents:

• Application for CHAMPVA Benefits, VA Form 10-10d

• Other Health Insurance (OHI) Certification, VA Form 10-7959c (Spanish version available)

• For individuals who are eligible for Medicare for any reason, we need a copy of your Medicare card.

• If you are age 65 or older and not entitled to Medicare, you must send documentation from the Social Security Administration that confirms you are not entitled to Medicare benefits under anyone's social security number.

You may contact the Taylor County Veterans Service Office to get started with applying for benefits. Information on how to apply is also available online at www.va.gov/communitycare/index.asp or by calling 1800-733-8387.

Required Documents