In limited circumstances, the U.S. Department of Veterans Affairs may provide health care coverage to the children and spouses of veterans. This health care program is known as the Civilian Health and Medical Program of the Department of Veterans Affairs, or CHAMPVA. Through this program, eligible beneficiaries receive comprehensive health care at low or no cost.
Eligibility
To be eligible for CHAMPVA, children must be younger than 18 or younger than 23 and enrolled as a full-time student. The benefits will be terminated if the child stops attending school full time, gets married or turns 23. Children must not be eligible for other government-sponsored health care programs, such as TRICARE or CHAMPUS. The veteran parent must also meet certain qualifying criteria for dependents to be eligible for CHAMPVA.
The veteran must be rated permanently and totally disabled due to a service-connected disability. Veterans can file claims with the Department of Veterans Affairs to establish a service-connected disability rating. A board of medical professionals will review the claim to evaluate the severity of the disability and determine service-connected status. Service-connected disabilities will be rated on a scale of 10 percent to 100 percent, and compensation will be awarded accordingly. Unfortunately, only veterans who receive a 100 percent disability rating are considered permanently and totally disabled.
Children of veterans who died from a VA-rated service connected disability are also eligible, even if the veteran was not rated 100 percent disabled due to that condition prior to death. The death of a veteran who was rated 100 percent disabled will render their dependents eligible for CHAMPVA regardless of the cause of death.
In most instances, children of military service members who died in the line of duty for reasons other than misconduct are eligible for TRICARE. In the rare circumstances that they are not eligible for TRICARE, they are accepted by CHAMPVA.
Coverage
CHAMPVA is a comprehensive health care coverage program that covers most health care services and supplies.
Medically necessary health care services and supplies are generally covered, although there are exceptions. Ambulance, surgery, family planning, maternity, hospice, mental health services, pharmaceuticals, transplants and other critical services are covered as long as they are provided by an authorized provider. Most preventative care, such as cancer screenings, colonoscopies, mammograms, immunizations, and physical exams, are also covered.
Some care that is not covered includes non-medically necessary abortions, artificial insemination, chiropractic services, dentures, hearing aids and weight loss medications.
Vision and dental care is very limited. In most cases, dental care will only be approved if it is tied to a separate condition. For example, broken teeth can be removed if necessary to repair a broken jaw.
Medical treatment can be received at no cost through the CITI outreach program, which requires patients to receive their treatment from the nearest participating VA Medical Center. Care received from non-VA providers is not a free. Copayments are determined on a percentage of the CHAMPVA allowable amount and are not a predetermined dollar figure. Annual deductibles and a $3,000 annual catastrophic cap prevent eligible patients from paying excessive out-of-pocket expenses.
Apply
To apply for CHAMPVA benefits online, print and fill out the application found at 4.va.gov/vaforms/medical/pdf/vha-10-10d-fill.pdf. This documentation should be mailed to the VA Health Administration Center, CHAMPVA Eligibility, at PO Box 469028 in Denver, Colorado (80246).
Applicants can also call 1 (800) 733-8387 during business hours Monday through Friday for more information. A live chat service is also available online at www.va.gov/hac/contact/contact.asp to answer any questions between 10 am and 6 pm (EST) Monday through Friday.
Tags: health care, Department Veterans, Department Veterans Affairs, eligible CHAMPVA, Veterans Affairs
