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CHAMPVA Beneficiary Newsletter
How to Apply to CHAMPVA Brochure
Cómo Aplicar a los Beneficios CHAMPVA
Cómo Solicitar un Reclamo al CHAMPVA
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Change of Address
The HAC needs your help - if you change your address, it is vital that you let us know your new address. You can do this by email (Contact the VA). You can mail the information to PO BOX 65023, Denver, CO, 80206. You can call us at 800-733-8387. Please help us keep our records up to date!
Overview
Under CHAMPVA, VA shares the cost of covered health care services and supplies
with eligible beneficiaries. CHAMPVA is a health care benefits program for the
spouse or
- is rated permanently and totally disabled due to a service-connected disability by a VA regional office, or
- was rated permanently and totally disabled due to a service-connected condition at the time of death, or
- died of a service-connected disability, or
- died on active duty and
The dependents are not otherwise eligible for DoD TRICARE benefits.
The administration of CHAMPVA is centralized to the Health Administration Center in Denver, Colorado.
Due to the similarity between CHAMPVA and the Department of
Defense (DoD) TRICARE program, the two are often mistaken for
each other. CHAMPVA is a Department of Veterans Affairs program
whereas TRICARE is a regionally managed health care program for
active duty and retired members of the uniformed services, their
families, and survivors.
CHAMPVA Program (01-4)
Benefits
In general, CHAMPVA covers most health care services and supplies that are medically and psychologically necessary. Upon confirmation of eligibility, applicants will receive program material that specifically addresses covered and noncovered services and supplies.
General Exclusions
- Services and supplies obtained as part of a grant, study, or research program.
- Services and supplies not provided in accordance with accepted professional medical standards or related to experimental/investigational or unproven procedures or treatment regimens.
- Care for which you are not obligated to pay, such as services obtained at a health fair.
- Care provided outside the scope of the provider's license or certification.
- Services or supplies above the appropriate level required to provide the necessary medical care.
- Services by providers suspended or sanctioned by any federal agency.
- Services provided by a member of your immediate family or person living in your household.
CHAMPVA Mental Health and Substance Use Disorder Benefits (01-1)
Eligibility
To be eligible for CHAMPVA, you cannot be eligible for TRICARE/CHAMPUS and you must be in one of these categories:
- the spouse or child of a veteran who has been rated permanently and totally disabled for a service-connected disability by a VA regional office, or
- the surviving spouse or child of a veteran who died from a VA-rated service connected disability, or
- the surviving spouse or child of a veteran who was at the time death rated permanently and totally disabled, or
- the surviving spouse or child of a military member who died in the line of duty, not due to misconduct (in most of these cases, these family members are eligible for TRICARE, not CHAMPVA).
- An eligible CHAMPVA sponsor may be entitled to receive medical care through the VA health care system based on his or her own veteran status. Additionally, as the result of a recent policy change, if the eligible CHAMPVA sponsor is the spouse of another eligible CHAMPVA sponsor, both may now be eligible for CHAMPVA benefits. In each instance where the eligible spouse requires medical attention, he or she may choose the VA health care system or coverage under CHAMPVA for his/her health care needs. If you have been previously denied CHAMPVA benefits and you believe you would now be qualified, please submit an application following the guidelines as listed on the “How to apply” section.
Medicare Impact: Eligible individuals under age 65 who are enrolled in both Medicare Parts A&B; who are eligible for CHAMPVA, CHAMPVA is secondary payer to Medicare. SSA documentation of enrollment in both Parts A&B; is required.
You must meet the following conditions for benefits to be extended past age 65:
- if you turned 65 before June 5, 2001, and only have Medicare Part A, you will be eligible for CHAMPVA without having to have Medicare Part B coverage.
- if you turned 65 on/or before June 5, 2001, and have Medicare Parts A and B, you must keep both Parts to be eligible.
- if you turned 65 on or after June 5, 2001, you must be enrolled in Medicare Parts A and B to be eligible.
Notice to new & expectant parents: In order to establish CHAMPVA eligibility for a newborn child, the following must be accomplished prior to the submission of an application.
- Obtain a Social Security Number for the newborn by applying to the nearest Social Security Administration office.
- Establish dependency of the newborn to the veteran sponsor by contacting the local VA regional office.
Since the payment of claims is contingent upon the claimant's eligibility status, new parents are encouraged to take the above action as early as possible.
Eligibility Definitions
- Beneficiary
- - a CHAMPVA-eligible spouse,
widow(er) , or child. - Child
- - includes birth, adopted, stepchild, or helpless child as determined by a VA Regional Office (see the Rules that Impact CHAMPVA Eligibilty section of this handbook).
- Dependents
- - a child, spouse, or
widow(er) of a qualifying sponsor. - Qualifying Sponsor
- - a veteran who is permanently and totally disabled from a service-connected condition, died as a result of a service-connected condition, was rated permanently and totally disabled from a service-connected condition at the time of death, or died on active duty and whose dependents are not otherwise entitled to DoD TRICARE benefits.
- Service-connected
- - a VA Regional Office determination that a veteran's illness or injury is related to military service.
- Spouse
- - the wife or husband of a qualifying sponsor.
- Widow(er)
- - the surviving spouse of a qualifying sponsor.
NOTE: The eligibility of a child is not affected by the
divorce or remarriage of the spouse except in the case of
a stepchild. When a stepchild leaves the sponsor's
household, the child is no longer eligible for CHAMPVA.
CHAMPVA Eligibility (01-3)
CHAMPVA School Certifications (01-2)
Remarried Widows/Widowers
Remarriage: Eligibility for CHAMPVA ends at midnight on the date of
remarriage if the
Termination of Remarriage: A
How To Apply
Required Documents
To apply for CHAMPVA benefits, you must submit the following documents:
- Application for CHAMPVA Benefits form (VA Form 10-10d) or Forma 10-10d Aplicación a los Beneficios CHAMPVA
- Other Health Insurance (OHI) Certification form (VA Form 10-7959c) or Forma 10-7959c Certificacion CHAMPVA de Otros Seguros de Salud (OSS)
- Marriage / Divorce Information Letter CHAMPVA Marriage Status Application Attachment
- For individuals who are eligible for Medicare (normally those age 65 and older), we also need a copy of your Medicare card.
- If you are age 65 or older and are not entitled to Medicare, you must send documentation from the Social Security Administration, which confirms that you are not entitled to Medicare benefits under anyone's Social Security number.
Optional Documents
You can speed the processing of your application if you also send copies (do not send originals)
- Veteran and spouse marriage license
- Birth certificate/adoption papers for children
- The page from the VBA rating decision that shows the veteran is permanently and totally disabled (or death rating for a survivor)
- If you are a remarried widow/widower and are once again single, provide a copy of the legal documentation that terminated the remarriage. The legal documentation of termination of a remarriage may be a divorce decree, death certificate or annulment decree.
- Veteran's DD214 (Certificate of Release or Discharge from Active Duty) or if the veteran was a WWII or Korea veteran, the Report of Separation. The VA does not have copies of this form, you must obtain it from your veterans military service. If you do not have this form readily available, we recommend that you not spend time requesting one from the military, send your application package in without it and we will obtain it for you.
- School certification of full-time enrollment for children ages 18-23 (see Fact Sheet 01-2)
Send your complete package to:
CHAMPVA-Eligibility
PO Box 469028
Denver, CO 80246-9028
Application Process
If you provide all the required and optional documents, and if your application is complete, then it normally takes 6 weeks after we get your package until you get your CHAMPVA card and related materials.
If you provide only the required documents and not the optional documents, processing can take 2-8 months since we have to confirm information with other federal agencies.
Once we get your application, we will review it to be sure its complete and that all the required forms are included. If your application is not complete, we will return it to you with further instructions.
Fact Sheet 02-01 Instructions for Applicants
How to Learn More About CHAMPVA Before Your Card Arrives
If you have access to the internet, you can read more about CHAMPVA by checking out our web site at the Fact Sheets on our web site.
Communicating with CHAMPVA
When sending correspondence, applications or claims to the Health Administration Center, please do not staple, tape or bind the materials together in any manner as this will cause a delay in your correspondence or request being processed.
CHAMPVA is managed by the VA's Health Administration Center. You can call us at 800-733-8387, Monday through Friday from 8:15 AM to 7:00 PM Eastern Time. You can e-mail us at hac.inq@med.va.gov. E-mail is the best way to communicate with us if you have this capability. You can also fax us at 1-303-331-7804. PLEASE do NOT fax applications to this number.
NEED A SPEAKER OR MATERIALS ON OUR PROGRAMS FOR YOUR GROUP?.
Assistance and Claims Address
If you have a general question (other than one regarding an application), an appeal, or if you need to file a claim for reimbursement for health care and the claim is older than one year, please send your request to:
VA Health Administration Center CHAMPVA PO Box 65023 Denver CO 80206-9023
For submitting new (less than one year old) health care claims only, please use:
VA Health Administration Center CHAMPVA Claims PO Box 65024 Denver CO 80206-9024
Frequently Asked Questions
Before you ask us your question, chances are someone else has already asked it. Please check the Frequently Asked Questions (FAQ) first. Thank you.
CHAMPVA Handbook
The CHAMPVA Handbook
contains important benefit information. Beneficiaries are encouraged
to carefully read the handbook prior to using CHAMPVA benefits.
You can view the online version
here.
CHAMPVA Handbook Change
CHAMPVA Policy Manual
The CHAMPVA Policy Manual is available online.
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Reviewed/Updated: January 13, 2004
This page has been accessed times since January 13, 2004.