1. VA Healthcare Benefits:
Business Office Manager
Good Day
Today’s presentation will cover Enrollment and Eligibility

2. Who is a Veteran? Served in the active military
Discharged or released under honorable conditions
including
Former or current Reservists and National Guardsman if activated or mobilized by Executive order AND served for the full period for which they were called (excludes training purposes)
All veterans are potentially eligible:
The term “veteran” means a person who served in the active military, naval, or air service, and who was discharged or released under conditions other than dishonorable. Reservists and National Guard members who were called to active duty by a Federal Executive Order or Title 10 may qualify for VA health care benefits.
Reservists injured while on reserve duty with an adjudicated SC disability are also eligible for VA treatment.
Veteran Eligibility
Eligibility for most VA benefits is based upon discharge from active military service under other than dishonorable conditions.
Active service means full-time service, other than active duty for training, as a member of the Army, Navy, Air Force, Marine Corps, Coast Guard, or as a commissioned officer of the Public Health Service, the Environmental Science Services Administration or the National Oceanic and Atmospheric Administration, or its predecessor organization, the Coast and Geodetic Survey.
Honorable and general discharges qualify a veteran for most VA benefits. Dishonorable and bad conduct discharges issued by general courts-martial may bar VA benefits. Veterans in prison and parolees may be eligible for certain VA benefits. VA regional offices can clarify the eligibility of prisoners, parolees and individuals with multiple discharges issued under differing conditions. VA benefits will not be provided to any veteran or dependent wanted for an outstanding felony warrant.
*Minimum Duty Requirement will be explained later.
Veterans who have multiple periods of service and more than one discharge:
If the veteran has an earlier period of service for which they received a discharge that was General, Honorable, or Under Honorable Conditions and later went back into the military and received a subsequent discharge of OTH or dishonorable they would still be eligible for care based on the first period of treatment as long as they met the minimum duty requirement.
If discharge under other than honorable the VA Regional Office must make an administrative decision.
Minimum Duty Requirement
*The veteran must have served one (1) day of active duty.
Defined Exceptions:
You do not have to meet the 24 continuous months of active duty service requirement if you:
Were a reservist who was called to Active Duty and who completed the term for which you were called, and who was granted an other than dishonorable discharge, or
Were a National Guard member who was called to Active Duty by federal executive order, and who completed the term for which you were called, and who was granted an other than dishonorable discharge, or
Only request a benefit for or in connection with a service-connected condition or disability; or treatment and/or counseling of sexual trauma that occurred while on active military service; or treatment of conditions related to ionizing radiation; or head or neck cancer related to nose or throat radium treatment while in the military.
Were discharged or released from active duty for a hardship , or
Were discharged with an “early out”; or  
Were discharged or released from active duty for a disability that began in the service or got worse because of the service; or
Have been determined by VA to have compensable service-connected conditions; or
Were discharged for a reason other than disability, but you had a medical condition at the time that was disabling, and in the opinion of a doctor, would have justified a discharge for disability (in this last case, the disability must be documented in service records)

3. Basic Veteran Statuses
Non service-connected: Veteran has no injuries or illnesses that incurred or were aggravated by their military service
Service-connected: Veteran has a disability that was determined to have been incurred or aggravated by their military service

4. Establishing Eligibility
To apply for VA health care
Application for Health Benefits – VA Form 10-10EZ
May apply
In person at VA clinic or medical center
By submitting a completed application to a VA clinic or medical center
Online at
Note: Appreciate DD214 with application but not required
VA Form EZ
Veterans can apply for enrollment in the VA health care system by completing VA Form 10-10EZ, APPLICATION FOR HEALTH BENEFITS. The application form can be obtained by visiting, calling, or writing any VA health care facility or veterans’ benefits office. Forms can also be requested toll-free from VA’s Health Benefits Service Center (HBCC) at VETS (8387) or accessed from our web site at
Completed applications must be signed and dated and may be returned in person or by mail to any VA health care facility. If the veteran applies in person at a VA health care facility, VA staff will assign the veteran to an initial priority group. After the application is processed, the VA Health Eligibility Center (HEC) in Atlanta will confirm the veterans enrollment status and priority group and will notify them of their enrollment status.
Financial information reported on the 10-10EZ is verified by matching data obtained from the IRS and the SSA. The Income Verification Match (IVM) program is used. The HEC coordinates the IVM program.
After the application is processed at the HEC, the veteran receives an enrollment letter indicating the assigned Priority Group.

5. VA Health Care Enrollment System
The Veterans’ Health Care Eligibility Reform Act was enacted 10/1/96
Law required implementation of an annual enrollment system to ensure treatment is timely and acceptable
Enrollment is managed in accordance with 8 specified priorities, with 1 being the highest priority
A standard Medical Benefits Package is available to all enrollees

6. Enrollment Priority Groups PG1 to PG8

7. Priority Group 1 - 3
PG 1 - Veterans with Service-Connected disabilities rated 50% or more diabling or Unemployable due to a VA SC condition
PG 2 - Service-Connected 30% or 40%
PG 3 - Service-Connected 10-20%, Purple Heart, Medal of Honor recipients, former POW’s

8. Priority Group 4 -5
PG 4 - Veterans receiving Aid & Attendance or Housebound, or determined by VHA to be catastrophically disabled
PG 5 - NSC & 0% SC non-compensable veterans with income below VA pension level, in receipt of a VA Pension/or eligible for Medicaid benefits

9. Priority Group 6 Compensable 0% service-connected veterans
Agent Orange Exposure – either in Korea(1968 or 69) and Vietnam
Veterans exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki
Any other recognized Environmental exposures

10. Priority Group 6 – cont’d
Veterans who served in a theater of combat operations after November 11, including:
Persian Gulf War Veterans – activated National Guardsman or Reservists – are eligible for enhanced benefits for 5 years post discharge

11. Priority Group 7
Veterans who agree to specified copays with income and/or net worth above the VA income threshold and income below the Geographic Means Test (GMT) income thresholds

12. Priority Group 8
Veterans who agree to specified copays with income and/or net worth above the VA Income threshold and the GMT thresholds
Subpriority a: Noncompensable 0% service-connected veterans enrolled as of January 16, 2003 and who have remained enrolled since then
Subpriority c: Nonservice-connected veterans enrolled as of January 16, 2003 and who have remained enrolled since that date
Subpriority e: Noncompensable 0% service-connected veterans applying for enrollment after January 16, 2003 (NOT eligible if over income threshold)
Subpriority g:: Non service connected veterans that are NOT eligible for care (based on income)
Effective January 17, 2003, VA no longer enrolls new veterans in Priority 8e or 8g. Veterans in Priority 8e are eligible for VA care of their service-connected conditions

13. What am I eligible for? Preventive Care Services Immunizations
Physicals Examinations (including eye and hearing examinations)
Healthcare Assessments
Screening Tests
Health Education Programs
VA Form EZ
Veterans can apply for enrollment in the VA health care system by completing VA Form 10-10EZ, APPLICATION FOR HEALTH BENEFITS. The application form can be obtained by visiting, calling, or writing any VA health care facility or veterans’ benefits office. Forms can also be requested toll-free from VA’s Health Benefits Service Center (HBCC) at VETS (8387) or accessed from our web site at
Completed applications must be signed and dated and may be returned in person or by mail to any VA health care facility. If the veteran applies in person at a VA health care facility, VA staff will assign the veteran to an initial priority group. After the application is processed, the VA Health Eligibility Center (HEC) in Atlanta will confirm the veterans enrollment status and priority group and will notify them of their enrollment status.
Financial information reported on the 10-10EZ is verified by matching data obtained from the IRS and the SSA. The Income Verification Match (IVM) program is used. The HEC coordinates the IVM program.
After the application is processed at the HEC, the veteran receives an enrollment letter indicating the assigned Priority Group.

14. Ambulatory (Outpatient /Inpatient) Diagnostic and Treatment Services
Medical
Surgical (including reconstructive/plastic surgery as a result of disease or trauma)
Mental Health
Substance Abuse
Thus far there have been 799,791 OIF/OEF veterans separated to date

15. Limited Benefits Ambulance Services Dental Care
Durable Medical Equipment
Eyeglasses
Hearing Aids
Home Health Care
Non-VA Health Care Services

16. General Exclusions Abortions and abortion counseling Cosmetic Surgery
Gender alteration
Health club or spa membership
In-vitro fertilization
Drugs and medical devices not approved by the FDA
Medical care for incarcerated veterans
Special private duty nursing
Combat veterans, while not required to disclose their income information, may do so to determine their eligibility for a higher priority status, beneficiary travel benefits and exemption of copays for care unrelated to their military service.
Enhanced Eligibility for Health Care Benefits181” titled the “National Defense Authorization Act of 2008” was signed into law. Section 1707 amended Title 38, United States Code (U.S.C.), Section 1710(e)(3), extending the period of eligibility for health care for veterans who served in a theater of combat operations after November 11, 1998, (commonly referred to as combat veterans or OEF/OIF veterans).
Under the “Combat Veteran” authority, the Department of Veterans Affairs (VA) provides cost-free health care services and nursing home care for conditions possibly related to military service and enrollment in Priority Group 6, unless eligible for enrollment in a higher priority to:
•Currently enrolled veterans and new enrollees who were discharged from active duty on or after January 28, 2003, are eligible for the enhanced benefits, for 5 years post discharge.
•Veterans discharged from active duty before January 28, 2003,who apply for enrollment on or after January 28, 2008, are eligible for the enhanced benefit until January 27, 2011.

17. Non-VA Emergency Care Benefit
The non-VA Emergency Care benefit applies to situations in which:
A delay in getting immediate medical attention would be hazardous to health or life; and
Veteran was unable to reach either a VA health care facility or a facility that routinely cares for VA patients under contract
Safety net for veterans who have no other health insurance
To qualify, veteran must be:
Enrolled in VA health care system
Seen by a VA health care provider within 2 years
Carry no health insurance coverage

18. What do I have to pay? Copayment Exemptions Catastrophically Disabled
Former POWs and Purple Heart recipients
Service-connected veterans 50% or more
Veterans service-connected less than 50% have to make copayment for medications

19. Copayments continuation
All others – payment is based on their financial ability to pay for their care
Must complete Financial Assessment - Means Test
Income is above $31,978 (if single) $38,375 (if married)

20. COPAYMENTS continuation
Outpatient Primary Care Visits - $15.00 each visit
Outpatient Sub-Specialty Visits - $50.00 each visit
Inpatient Care per diem (hospital care) - $10.00 per day
Inpatient Care - $ for first 90 days
Inpatient Care per diem (nursing home) - $5.00 per day
VA Health Care System
VA health care facilities provide a broad spectrum of medical, surgical and rehabilitative care.
In 2006, more than 5.5 million people received care in VA health care facilities and VA inpatient facilities treated 773,600 patients. VA’s outpatient clinics registered over 60 million visits.
VA operates more than 1,400 sites of care including:
Veterans Integrated Service Network (VISN): 21 across the US
Veterans Affairs Medical Center (VAMC): at least one hospital in the 48 contiguous states, Puerto Rico, District of Columbia.
Ambulatory Care / Community-based Outpatient Clinics (CBOC): associated with a Medical Center and provide primary health care (e.g., physicians, labs, x-rays, prescriptions.)
Veterans Centers: counseling centers not associated with VA Medical Centers; provide psychological counseling services for war-related trauma, community outreach, case management and referral activities plus supportive social services to veterans and family members; staff are social workers. Every year, the Vet Centers serve over 130,000 veterans and provide more than 1 million visits to veterans and family members.
Nursing homes: VA provides nursing home services through three national programs: VA owned and operated nursing homes, state veterans homes owned and operated by the state, and contract community nursing homes. Each program has its own admission and eligibility criteria.
Comprehensive home care programs (Hospice / Palliative Care): provide long-term primary care to chronically ill vets in their own homes; coordinated by an interdisciplinary treatment team.
Domiciliary care: residential rehabilitation program that provides short-term rehabilitation and long-term health maintenance to veterans who require minimal medical care as they recover from medical, psychiatric or psychosocial problems; domiciliary care emphasizes rehabilitation and return to the community.
VA may provide domiciliary care to veterans whose annual income does not exceed the maximum annual rate of VA pension (2007 base rate $11,181 for vet with no dependents) or to veterans who have no adequate means of support.

21. Medication Copayment
Generally outpatient veterans in Priority Groups 2-8 charged $8.00 copayment for each 30 day or less supply of medication provided by VA for NSC condition. Exceptions: Newly enrolled veterans pay $9.00
Amount of copayments payable in a calendar year is capped at $960 for priority groups 2-6. No cap for priority groups 7 and 8

22. Health Insurance
Veterans can maintain private health insurance and Medicare or Medicaid
VA obligated to bill health insurance carriers for care of non-service connected conditions
Collections help supplement funding

23. Stratton VAMC and CBOC’s
Stratton VAMC – Albany and
Community Based Outpatient Clinics – (primary care & limited behavioral health treatment)
Bainbridge
Catskill
Clifton Park
Saranac Lake/Westport
Fonda
Glens Falls
Kingston
Plattsburgh
Schenectady
Troy

25. QUESTIONS?