Transcript Health Administration Center Denver, Colorado
Health Administration Center Programs for Veterans and Their Family Members Veteran Service Officer Training
Overview
• The CHAMPVA Program – Resources – Eligibility – Application process – Benefits
CHAMPVA
Enrolled Beneficiaries 340 330 320 310 300 290 280 270 260 250 Start Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep FY08 FY07 291.4 294.5 296.8 298.9 301.3 303.9 306.7 308.7 310.4 310.8
275.1 277.7 280.5 282.0 283.4 285.9 288.3 290.4 292.4 295.4 299.2 302.3 305.0
FY06 259.9 261.2 267.5 268.1 268.7 271.7 273.7 276.4 277.1 277.7 279.9 282.3 285.0
FY08 Proj 291.4 293.8 296.1 298.5 300.8 303.2 305.5 307.8 310.2 312.5 314.9 317.2 319.6
Cumulative Fiscal Year Enrollment by EOM
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
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
CHAMPVA Application Process
• Application must include: – Application (VA Form 10-10d) – OHI Certification Form (10-7959c) – Copy of Medicare card (if on Medicare)
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
CHAMPVA 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 “
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
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
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
• HAC overview • The Programs – Resources – Eligibility – Application Process – Benefits