Transcript Health Administration Center Denver, Colorado

Health Administration Center
Programs for Veterans and Their
Family Members
Veteran Service Officer Training
Glenn Johnson
Chief 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
340
330
320
310
300
290
280
270
Start Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
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
Cumulative
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 DAYSNO 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
• Other Programs
• All CHAMPVA items
– On request
– Spanish in stock
– 3-5 weeks to
• CHAMPVA Handbook
translate
Only
– Other languages
• Phone Center
and Braille upon
– Any language
request
– Hearing impaired
– 3-5 weeks to
translate
Summary
• HAC overview
• The Programs
– Resources
– Eligibility
– Application Process
– Benefits
Foreign Medical Program
• Application must include:
– FMP Registration Form - VA Form 10-7959f1
– 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