Benefits

CHAMPVA beneficiaries receive a comprehensive health care coverage.  Through the program, the VA shares in the cost of medically necessary services and supplies.  Benefits may have limitations and exclusions.  Contact the VA, refer to your CHAMPVA Guide (sent by the VA to beneficiaries when they are approved) or see the CHAMPVA Policy Manual for more more information.  See the notice at the end of this article for useful links.

Advertisement

End of Advertisement


Benefit Highlights

  • Coverage for medically necessary care services and supplies
  • Coverage for hospice care services
  • Coverage for mental health care services (including substance abuse treatment).
  • Coverage for medically necessary equipment or DME’s
  • Refills of covered maintenance medicine through Meds by Mail program
  • Access to CITI program (where available, restrictions apply)
  • Open access to health care, that is, no referral required from a primary physician for most types of services (but note prior authorization below)
  • Immediate coverage– no waiting period for preexisting conditions

Limitations and Requirements

  • Prior authorization is required in some cases, such as DME, covered dental services (which is very limited already), organ transplants, and mental care  services.  Check with the VA and your provider to find out if the service/supply you need requires authorization.
  • Beneficiary has a cost share in most cases, until the annual catastrophic cap is met
  • There is an annual deductible for individuals and families
  • Dental and vision care coverage are very limited, though you can now purchase dental insurance from private insurance carriers through VADIP
  • Having Medicare or other health insurance may affect eligibility for CHAMPVA benefits, or a specific benefit (such as pharmacy benefit or access to CITI)

Covered and Non-Covered Services/Supplies

The CHAMPVA Guide or CHAMPVA Handbook gives a comprehensive (but not all-inclusive) list of covered and non-covered services and supplies.  In general, CHAMPVA will cover what are deemed “medically necessary.”

You can find the CHAMPVA guide in the official VA website (link opens in new window and takes you away from this site).  The lists of covered and non-covered benefits appear in Section 4 of the guide.  Beneficiaries of the program receive a copy of this guide when they join.

The CHAMPVA Guide itself states that that publication is not updated every year. That means both the version online at the VA site and the physical copy you may receive as a CHAMPVA beneficiary may not reflect the latest changes in the laws, regulations and policies governing the program.   The CHAMPVA Guide refers beneficiaries to the CHAMPVA Policy Manual for more detailed explanations and information.  You can also contact the VA if you have questions about CHAMPVA.

ATTENTION:

ChampvaBenefits.com is an unofficial, privately owned website that is NOT connected with the VA or the government. Please do not use this site as an alternative to official sources such as the official CHAMPVA site. To find a specific page or resource, see a list of CHAMPVA resource links.

We do not guarantee that the information at our website is 100% correct or accurate, nor that changes in government laws, policies and benefits will be reflected immediately on this websitePlease always check with official sources before doing anything with your CHAMPVA coverage!

We will NEVER ask for your personal/sensitive information relating to your VA benefits, medical information, etc. We will NEVER attempt to contact you either promising or soliciting information about your CHAMPVA benefits! Please DO NOT attempt to send messages to this website about CHAMPVA benefits, claims, applications, etc. We are not the VA, and our website has no encryption to protect data!

If you need to contact CHAMPVA, check the official VA contact info here! Read about their warnings and communication safety here.



Advertisement

End of Advertisement


email