Health Administration Center Programs for Veterans and Their Family Members Veteran Service Officer Training

Overview The CHAMPVA Program –Resources –Eligibility –Application process –Benefits

CHAMPVA Enrolled Beneficiaries

CHAMPVA- Eligibility Family members, not veterans Not eligible for TRICARE, beneficiaries can not choose between the two. Veteran must –be permanently and totally disabled –have died from a service connected condition –been P&T at the time of death

CHAMPVA- Eligibility Children –Through age 18, if in school fulltime, age 23 –If permanently disabled and VARO determines is Helpless Child

CHAMPVA- Eligibility Spouses until divorce, NO EXCEPTIONS! Widow(er): until remarriage –If remarriage ends (by death, divorce or annulment, beneficiary may be entitled to reinstatement Survivor remarried age 55 and older keeps CHAMPVA

CHAMPVA- Eligibility If under age 65 and Medicare eligible, must be enrolled in Parts A and B If over age 65 and Medicare eligible: –before June 5, 2001, must keep Part B if enrolled on June 5, 2001 –on and after June 5, 2001, must enroll in Parts A and B

CHAMPVA- Application Process VARO notifies beneficiary of eligibility –No notification to HAC Application required, information verified with VARO –May take a long time –Benefits backdated to date of qualifying event

CHAMPVA- Application Process Application must include: –Application (VA Form 10-10d) –OHI Certification Form ( c) –Copy of Medicare card (if on Medicare)

CHAMPVA- Application Process Application may include copy (never an original) of: –Rating decision –Marriage license –Birth certificate/adoption papers –DD214 or Report of Separation ALLOWS PROCESSING IN LESS THAN 30 DAYS- NO WAIT FOR VARO VERIFICATION

CHAMPVA- Application Process After eligibility is determined, verified against DEERS -- benie does NOT have to update DEERS (weekly process) Cards, handbook, etc. mailed.

CHAMPVA Benefits Major medical plan Annual deductible $50/$100 max Shares cost 75% -- user pays 25% unless care provided by VA –CITI –Meds by Mail –DME Inpatient, outpatient, mental health, substance abuse, prescription medication (includes those on MEDICARE), hospice

CHAMPVA Benefits No network of providers or provider contracts Complete freedom of choice! Benies do NOT need to see a VA doctor - CHAMPVA covers them when they see a private provider

CHAMPVA Benefits Not Covered –Routine dental –Routine vision, unless disease –Chiropractic –Routine exams except school physicals –Custodial/Domiciliary Care (nursing home, long term care)

CHAMPVA And Medicare For those with Medicare or over 65 Same program as for those not on Medicare or under 65 Used to be called “CFL “

Service Levels CHAMPVA claims processing time 21 days Mail opened in 1 days answered in 24 business hours OHI posted within 1 days Applications processing time: 4 days Calls answered in: 2.1 min

Resources , Web site (Forms, Information), Phone center –All information is in the trifold/handbook

Language Availability All CHAMPVA items –Spanish in stock CHAMPVA Handbook Only –Other languages and Braille upon request –3-5 weeks to translate Other Programs –On request –3-5 weeks to translate Phone Center –Any language –Hearing impaired

Access to Information Cannot provide information contained in a claim or application, i.e. what it was for, the amount paid, etc. Can provide only general status of an application or claim as to where it is in processing Power of Attorney required to provide specific information regardless of any other appointment letter or relationship to beneficiary

Summary HAC overview The Programs –Resources –Eligibility –Application Process –Benefits

Questions