- Affordable coverage - $50 deductible per dependent ($100 max per family), $3,000 max out-of-pocket
- For dependents of Veterans who are P&T, died service-connected, or died on Active Duty
- Cannot be eligible for TRICARE - CHAMPVA is for those who do not qualify for TRICARE
- Primary caregivers under PCAFC may also be eligible if they have no other health insurance
CHAMPVA is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries.
Compared to most health insurances CHAMPVA is exceptionally affordable per calendar year:
There is a $50 deductible per dependent, up to $100 MAX per family!
MAX out of pocket amount per family is $3,000!
Eligibility
CHAMPVA provides coverage to the spouse or widow(er) and to the children (aged 0-17, 18-23 enrolled in school, 18+ Helpless child) of a Veteran who:
Is rated Permanently and Totally disabled due to service-connected condition(s);
Was rated Permanently and Totally disabled due to service-connected condition(s) at the time of death;
Died due to a service-connected condition; or
Died on Active Duty and the dependents are NOT otherwise eligible for Department of Defense TRICARE benefits.
IMPORTANT NOTES:
- To be eligible for CHAMPVA, the beneficiary CANNOT be eligible for TRICARE.
- For Gray Area Retirees see the Frequently Asked Questions section.
- Children who marry will lose eligibility.
- In the event of divorce, entitlement for the former spouse is ended effective the date of the divorce!
- If entitlement is established due to death of Veteran/Servicememember then remarriage will end entitlement UNLESS:
- Remarriage takes place on or after your 55th birthday; or
- If you remarry before age 55, and your remarriage ENDS (you will need to reapply to reestablish this benefit).
Additional Eligibility
A Veteran's primary caregiver under Program of Comprehensive Assistance for Family Caregivers (PCAFC) can be eligible for CHAMPVA, assuming the caregiver does NOT have any other health insurance coverage.
IMPORTANT NOTE: To be eligible for CHAMPVA, the beneficiary CANNOT be eligible for TRICARE.
Applying
You have several ways to submit an application and supporting documents:
Online;
Fax; and
Snail mail.
Copies of Documents to include:
Related to Medicare status (if applicable):
If the dependent qualifies for Medicare for ANY reason, they'll need to submit a copy of their Medicare card.
If the dependent is 65 years old or older and does not qualify for Medicare, they'll need to send documentation from the Social Security Administration that confirms they don't qualify for Medicare benefits under anyone's Social Security Number.
If you are including dependent children ages 18-23:
If you're a spouse or surviving spouse:
Certificate of civil union;
Common-law marriage affidavit; or
Marriage certificate.
If you're a surviving spouse who remarried before age 55 and your remarriage has ended:
Annulment decree;
Divorce decree; or
Death certificate.
IMPORTANT NOTE: To expedite processing (for any dependent) include COPIES of:
- Dependents' birth certificate;
- Benefits Letter - showing the Veteran is permanently and totally disabled (or the death rating if you're a survivor); and
- Veteran's DD214.
1. Online
Click HERE to apply online.
2. Fax/3. Snail Mail
Complete the following forms:
And include copies of any of the previously mentioned supporting/expediting documents.
Fax
303-331-7809
VHA Office of Community Care
CHAMPVA Eligibility
PO Box 137
Spring City, PA 19475
Finding a Provider
CHAMPVA does not have a network of providers. As such it is recommended you visit the Medicare website or TRICARE website to find a doctor.
Generally, providers who accept Medicare, Medicaid, or TRICARE also accept CHAMPVA - but they may not be familiar with the program and incorrectly assume that it is a group health insurance plan rather than a government health care program.
If the receptionist tells you they don't accept CHAMPVA, ask the billing department - sometimes they are the only ones that really know!
Providers that Accept "Assignment" for VA Family Member Programs
When you locate a medical provider, confirm that they will participate in the VA family member health care program you belong to. Providers most often refer to participation as "accepting assignment." Providers that accept assignment will bill the VA directly for covered services, items and supplies. Doctors or other providers who accept assignment must accept the VHA Office of Community Care (VHA OCC) allowable amount as payment-in-full and cannot collect additional amounts from you beyond your cost share and deductible.
IMPORTANT NOTE: All hospitals that participate in Medicare, and hospital-based health care professionals who are employed by, or contracted to, such hospitals are required by law to accept the VHA OCC allowable amount for inpatient hospital services.
Providers that do NOT Accept "Assignment" for VA Family Member Programs
If your provider does not accept assignment, you can still see that provider, but be aware that you will likely have to pay the entire charge at the time of service. Additionally, you may be charged more than the VHA OCC allowable amount.
Providers that do not accept assignment are not permitted to file for reimbursement. If you choose to use them, you will have to submit for reimbursement yourself.
To obtain reimbursement in cases where a VA family member health care program is your only insurance, you will have to submit the itemized bill from the provider along with the appropriate VA form. When the claim is processed, the VA will send you the VHA OCC share of the allowable amount.
What this means to you is that when the medical provider does NOT accept assignment, your cost will include not only your share of our determined allowable amount, but also any charges over the VA's allowable amount.
Benefits
In general, CHAMPVA covers most health care services and supplies that are medically and psychologically necessary. Upon confirmation of eligibility, you will receive a CHAMPVA Program Guide that specifically addresses covered and non-covered services and supplies.
Dental care is NOT covered UNLESS you also enroll in VA Dental Insurance Program (VADIP).
For a complete listing of non-covered services and supplies consult the CHAMPVA Policy Manual.
Pharmacy Benefits
Click HERE for information on pharmacy benefits.
Filing a Claim
Generally, the providers should handle billing to CHAMPVA automatically.
However if you need to; click HERE to file a claim online.