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

1. Health Administration CenterPrograms for Veterans and Their Family MembersVeteran Service Officer Training

2. Overview • The CHAMPVA Program • Resources • Eligibility • Application process • Benefits

4. CHAMPVAEnrolled Beneficiaries

5. 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

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

7. 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

8. 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

9. 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

10. CHAMPVA-Application Process • Application must include: • Application (VA Form 10-10d) • OHI Certification Form (10-7959c) • Copy of Medicare card (if on Medicare)

11. 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

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

13. 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

14. CHAMPVABenefits • 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

15. CHAMPVABenefits • Not Covered • Routine dental • Routine vision, unless disease • Chiropractic • Routine exams except school physicals • Custodial/Domiciliary Care (nursing home, long term care)

16. 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 “

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

18. Resources • Email, Web site (Forms, Information), Phone center • All information is in the trifold/handbook

19. 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 Language Availability

20. 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

21. Summary • HAC overview • The Programs • Resources • Eligibility • Application Process • Benefits

22. Questions ?