ChampVA benefits are also known as the Civilian Health and Medical Program of the Department of Veterans Affairs, is an essential healthcare program for eligible dependents and survivors of veterans.
It helps cover the cost of medically necessary healthcare services and supplies. In this guide, we’ll explore everything you need to know about ChampVA benefits, including its benefits, eligibility, coverage details, how it works with other insurance plans, and key contact information.
What Are ChampVA Benefits?
ChampVA is a VA-administered healthcare program designed for certain family members of veterans. It shares the costs of various medical services and supplies with eligible beneficiaries. ChampVA is distinct from TRICARE, which serves active-duty service members, retirees, and their families. Instead, ChampVA primarily supports dependents and survivors of veterans who meet specific criteria.
Key benefits include coverage for:
- Doctor visits
- Hospital stays
- Prescription drugs
- Durable medical equipment (DME)
- Mental health services
ChampVA Eligibility
To qualify for ChampVA, you must fall into one of these categories:
- Be the spouse or child of a veteran who:
- Is permanently and totally disabled due to a service-connected condition – IE 100% P&T
- Died as a result of a service-connected condition.
- Was permanently and totally disabled at the time of their death, even if unrelated to their service.
Eligibility is also impacted by factors like Medicare enrollment, divorce, or remarriage. For instance:
- Spouses lose eligibility upon divorce from the veteran.
- Children lose eligibility at 18 unless enrolled full-time in school (eligibility can continue until age 23 with verification of student status).
Changes in eligibility status must be reported promptly to avoid coverage interruptions. For questions about eligibility, contact the ChampVA phone number: 1-800-733-8387.
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What Does ChampVA Cover?
ChampVA insurance provides a wide range of benefits. Some of the key covered services include:
- Preventive Care: Immunizations, wellness checks, and screenings.
- Mental Health Services: Inpatient and outpatient care, subject to certain limitations.
- Hospital Services: Emergency and inpatient care.
- Outpatient Care: Doctor visits, diagnostic tests, and specialist care.
- Prescription Drugs: Includes access to the Meds by Mail (MbM) program.
Services Not Covered by ChampVA
Certain services are excluded from ChampVA coverage, such as:
- Routine dental care.
- Custodial long-term care.
- Experimental treatments.
- Cosmetic procedures.
It’s important to verify coverage for specific treatments or medications by contacting ChampVA directly or consulting the policy guide.
Using ChampVA With Other Health Insurance (OHI)
For beneficiaries with other health insurance (OHI), including employer-sponsored plans or Medicare, ChampVA acts as a secondary payer. Here’s how it works:
ChampVA: Primary vs. Secondary Coverage
When you have another health plan:
- Your primary insurance processes claims first.
- ChampVA covers the remaining eligible costs.
- The explanation of benefits (EOB) from your primary insurer must be submitted to ChampVA for reimbursement.
For example:
- If your primary insurance pays 80% of a covered service, ChampVA may cover the remaining 20%, subject to its allowable rates and guidelines.
Filing Claims
If your healthcare provider doesn’t file claims with ChampVA, you must:
- Obtain an itemized bill and the EOB from your primary insurer.
- Complete the ChampVA Claim Form (VA Form 10-7959a).
- Mail the documents to the ChampVA Claims Office.
Medicare and ChampVA
If you are eligible for Medicare Parts A and B, Medicare serves as your primary insurance, and ChampVA is secondary. Claims are automatically forwarded to ChampVA after Medicare processes them. Beneficiaries are not required to enroll in Medicare Part D (prescription drug plan) to maintain ChampVA eligibility.
For more information about coordinating benefits, call the ChampVA contact number.
Special Features of ChampVA
ChampVA offers several unique benefits that make managing healthcare costs easier for eligible beneficiaries:
Meds by Mail (MbM)
This program provides maintenance medications at no cost to beneficiaries without other pharmacy coverage. Benefits of MbM include:
- No co-pays or deductibles.
- Convenient home delivery.
- Availability of generic medications.
To use this service, complete the Meds by Mail Order Form and submit it to your servicing center. For assistance, call 1-800-733-8387.
Catastrophic Cap Protection
ChampVA caps annual out-of-pocket expenses at $3,000 per family, ensuring financial protection for high medical costs. Once this limit is reached, ChampVA covers 100% of allowable expenses for the remainder of the year.
OptumRx Pharmacy Network
ChampVA also offers access to an extensive pharmacy network for those without other prescription coverage. Participating pharmacies process claims electronically, reducing the need for manual submissions.
How to Apply for ChampVA
Applying for ChampVA insurance is a straightforward process. Here are the steps:
- Complete the Application:
- Use VA Form 10-10d, “Application for ChampVA Benefits,” available online at VA Community Care.
- Gather Supporting Documents:
- Proof of relationship to the veteran (e.g., marriage or birth certificates).
- Medicare information, if applicable.
- Submit the Application:
- Mail the completed form and documentation to:
- ChampVA Eligibility Office
PO Box 469028
Denver, CO 80246-9028
- ChampVA Eligibility Office
- Mail the completed form and documentation to:
You can check your application status by calling the ChampVA number: 1-800-733-8387.
Contact Information for ChampVA
For assistance with eligibility, claims, or program details, use these contact options:
- Phone: 1-800-733-8387
- Mailing Address:
- ChampVA
PO Box 469063
Denver, CO 80246-9063
- ChampVA
- Online Resources: Visit VA Community Care for forms, policy guides, and FAQs.
For pharmacy services or questions, reach out to the Meds by Mail team at 1-888-370-1699.
Frequently Asked Questions About ChampVA
Can I Use ChampVA Outside the United States?
Yes, ChampVA covers certain medical services abroad. However, claims for care received outside the U.S. must be submitted manually with appropriate documentation.
What If My Primary Insurance Denies a Claim?
If your primary insurer denies a claim, ChampVA will review the denial and may cover eligible costs, provided they meet ChampVA’s guidelines.
How Does ChampVA Work With Medicare Advantage Plans?
If you have a Medicare Advantage Plan (Part C), it serves as your primary insurance, and ChampVA processes claims for remaining balances.
What to Do If ChampVA Coverage Is Denied
If ChampVA denies a claim, beneficiaries can file an appeal. The reconsideration process involves submitting additional evidence to support your case. Contact ChampVA at 1-800-733-8387 for details on appeals and claim reconsideration.
