leftyf
SSG Stumpy-VA Terrorist
If you are 100% or have been permanently and totally disabled for a service-connected disability your wife and kids are eligible for free medical treatment. Kind of like the old CHAMPUS but for veterans. Ans, if you are disabled, no matter the percentage, you cannot afford insurance for your family. And, if you aren't employed how do you afford to pay civilian rates for your family? I know been there too.
You can be rated at 40% and still be permanently and totally disabled for a service-connected disability. All you need for this is obtain a Individual Unemployability Certificate. You can get this at your Vocational Rehab Department. It's not an overnight thing. Basically, if you cannot work and probably never will be able to return to the workforce, you apply for Individual Unemployability based on your disability. If this office says you cannot be gainfully employed, they get you an IU rating. While your disability rating does not change (0-90%)...you get paid at the 100% rate. Which is around $2500+ bucks, as I type this. Theoretically, you could be rated at 0% (they don't pay you any money for this, but they admit this problem is service connected). 0% entitles you to a 10 point Veterans Preference for Government Employment and that's about it. Anyhow, theoretically, you could be rated at 0%, and get paid at the 100% rate. I know it's crazy, but that's how it works.
Usually you would need a combination of multiple low rated disabilites that taken as a whole, keep you from being gainfully employed. Ask me how I know...go on, ask me.
Overview
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. The program is administered by Health Administration Center and our offices are located in Denver, Colorado.
Due to the similarity between CHAMPVA and the Department of Defense (DoD) TRICARE program (sometimes referred to by its old name, CHAMPUS) 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. In some cases a veterans may look to be eligible for both/either program on paper. However, if you are a military retiree, or the spouse of a veteran who was killed in action, you are and will always be a TRICARE beneficiary, you can´t choose between the two.
Eligibility
To be eligible for CHAMPVA, you cannot be eligible for TRICARE/CHAMPUS and you must be in one of these categories:
Benefits
In general our CHAMPVA program covers most health care services and supplies that are medically and psychologically necessary. Upon confirmation of eligibility, you will receive program material that specifically addresses covered and noncovered services and supplies in the form of a CHAMPVA handbook.
General Exclusions
Like all health programs there are certain services and supplies that are not covered by our program, some of these are:
CHAMPVA is always the secondary payer to Medicare. If you are eligible for CHAMPVA, under age 65 and enrolled in both Medicare Parts A&B, SSA documentation of enrollment in both Parts A&B is required.
For your benefits to be extended past age 65, you must meet the following conditions:
Notice to new & expectant parents
If you are expecting and you need to establish CHAMPVA eligibility for your new child, the following must be accomplished before you can submit an application.
Eligibility Definitions
Term Definition 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 the CHAMVPA 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.
Remarried Widows/Widowers
Remarriage: Eligibility for CHAMPVA ends at midnight on the date of your remarriage if you remarry prior to age 55. If you remarry on or after your 55 th birthday, The Veterans Benefit Act of 2002, Public Law 107-330, allows you to keep your CHAMPVA benefits.
Termination of Remarriage: If you are a widow(er) of a qualifying sponsor and you remarry and the remarriage is later terminated by death, divorce, or annulment you may reestablish CHAMPVA eligibility. The beginning date of your re-eligibility is the first day of the month after termination of the remarriage or December 1, 1999, whichever date is later. To reestablish CHAMPVA eligibility, copies of the marriage certificate and death, divorce, or annulment documents (as appropriate) must be provided.
How to Learn More About CHAMPVA Before Your Card Arrives
You can read more about CHAMPVA by visiting the Fact Sheets posted on our web site or by visiting the CHAMPVA handbook also posted on our web site.
CHAMPVA Policy Manual
http://www.va.gov/hac/forbeneficiaries/champva/policymanual/index.asp
You can be rated at 40% and still be permanently and totally disabled for a service-connected disability. All you need for this is obtain a Individual Unemployability Certificate. You can get this at your Vocational Rehab Department. It's not an overnight thing. Basically, if you cannot work and probably never will be able to return to the workforce, you apply for Individual Unemployability based on your disability. If this office says you cannot be gainfully employed, they get you an IU rating. While your disability rating does not change (0-90%)...you get paid at the 100% rate. Which is around $2500+ bucks, as I type this. Theoretically, you could be rated at 0% (they don't pay you any money for this, but they admit this problem is service connected). 0% entitles you to a 10 point Veterans Preference for Government Employment and that's about it. Anyhow, theoretically, you could be rated at 0%, and get paid at the 100% rate. I know it's crazy, but that's how it works.
Usually you would need a combination of multiple low rated disabilites that taken as a whole, keep you from being gainfully employed. Ask me how I know...go on, ask me.
Overview
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. The program is administered by Health Administration Center and our offices are located in Denver, Colorado.
Due to the similarity between CHAMPVA and the Department of Defense (DoD) TRICARE program (sometimes referred to by its old name, CHAMPUS) 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. In some cases a veterans may look to be eligible for both/either program on paper. However, if you are a military retiree, or the spouse of a veteran who was killed in action, you are and will always be a TRICARE beneficiary, you can´t choose between the two.
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 from a service connected disability, 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).
Benefits
In general our CHAMPVA program covers most health care services and supplies that are medically and psychologically necessary. Upon confirmation of eligibility, you will receive program material that specifically addresses covered and noncovered services and supplies in the form of a CHAMPVA handbook.
General Exclusions
Like all health programs there are certain services and supplies that are not covered by our program, some of these are:
- 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 (01-01)
For a complete listing of noncovered services and supplies please consult the CHAMVPA handbook.
CHAMPVA is always the secondary payer to Medicare. If you are eligible for CHAMPVA, under age 65 and enrolled in both Medicare Parts A&B, SSA documentation of enrollment in both Parts A&B is required.
For your benefits to be extended past age 65, you must meet the following conditions:
- if the beneficiary was 65 or older prior to June 5, 2001, and was otherwise eligible for CHAMPVA, and was entitled to Medicare Part A coverage, then the beneficiary 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.
- you are not required to enroll in Medicare Part D in order to become or remain CHAMPVA eligible.
Notice to new & expectant parents
If you are expecting and you need to establish CHAMPVA eligibility for your new child, the following must be accomplished before you can submit 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.
Eligibility Definitions
Term Definition 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 the CHAMVPA 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.
Remarried Widows/Widowers
Remarriage: Eligibility for CHAMPVA ends at midnight on the date of your remarriage if you remarry prior to age 55. If you remarry on or after your 55 th birthday, The Veterans Benefit Act of 2002, Public Law 107-330, allows you to keep your CHAMPVA benefits.
Termination of Remarriage: If you are a widow(er) of a qualifying sponsor and you remarry and the remarriage is later terminated by death, divorce, or annulment you may reestablish CHAMPVA eligibility. The beginning date of your re-eligibility is the first day of the month after termination of the remarriage or December 1, 1999, whichever date is later. To reestablish CHAMPVA eligibility, copies of the marriage certificate and death, divorce, or annulment documents (as appropriate) must be provided.
How to Learn More About CHAMPVA Before Your Card Arrives
You can read more about CHAMPVA by visiting the Fact Sheets posted on our web site or by visiting the CHAMPVA handbook also posted on our web site.
CHAMPVA Policy Manual
http://www.va.gov/hac/forbeneficiaries/champva/policymanual/index.asp
