health administration center programs for veterans and their family members veteran service officer...

Health Administration Center

Programs for Veterans and Their Family Members

Veteran Service Officer Training

Glenn JohnsonChief of Communications

303-331-7864

Overview

• HAC 101

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

HAC

• Part of VHA’s CBO• Administer health benefits for veterans’

families and for veterans with service connected conditions traveling or living overseas

• We establish benefits policy, determine eligibility, process claims and check for fraud, waste and abuse

HAC

• Employees: – 720 staff members and growing

– 36% are veterans

– Many others are family members of veterans

– One is a CHAMPVA beneficiary

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

CHAMPVA Beneficiaries

270

280

290

300

310

320

330

340

Cumulative

FY09 302.5 304.8 306.6 309.4 311.6 313.8 316.5 318.5 320.0 321.1 322.1 323.1

FY08 291.4 294.5 296.8 298.9 301.3 303.9 306.7 308.7 310.4 310.8 312.1 314.2 317.0

FY07 275.1 277.8 280.5 282.1 283.5 286.0 288.3 290.4 292.5 295.4 299.2 302.3 305.0

FY09 Proj 302.5 304.8 306.7 309.1 311.2 313.2 315.5 317.9 320.0 322.3 324.5 326.8 329.0

Start Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep

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

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

Application Process

• Application must include:– Application (VA Form 10-10d)

– OHI Certification Form (10-7959c)

– Copy of Medicare card (if on Medicare)

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

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 “

Resources

• Email, 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

Summary

• HAC overview

• The Programs– Resources– Eligibility– Application Process– Benefits

Foreign Medical Program

• Application must include:– FMP Registration Form - VA Form 10-

7959f-1 – Rating decision

• Mail the application to:

FMP Office

PO Box 469061 Denver,

CO 80246-9061 USA

Application Process

• Will receive a letter from us listing conditions we will pay for

• Veteran can have any % of disability including 0%

• 100% disability overseas does not entitle Veteran to full coverage, only listed conditions

Application Process

• Claims must be made within one year of service

• Payments are made at the exchange rate on day of service

• Different rules in Philippines and Canada– Philippines has a VA

– Veterans can us Canadian VA

Questions