CHAMPVA Coverage for Vision and Dental Care

Routine eye examinations and dental care are often not covered by regular commercial health insurance.  CHAMPVA, a federal benefit program, is no different.  Benefits for vision and dental care are quite restricted and only what is absolutely medically necessary will be paid for.  If you need to have your eyes or teeth checked or treated and you are not sure if it will be covered, it would be prudent to contact CHAMPVA first.

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Dental Care

Dental coverage is highly limited.  Routine checkups, preventive care, cleaning, etc. are not covered.  Neither are less-than-severe congenital anomalies, bridge work, dentures, etc.

Dental care is covered if it is adjunctive; that is, integral to the treatment of a covered illness or injury.  For example, if it is in connection with facial cancer, or if it is to remove a severe congenital problem like a cleft palate.  Adjunctive dental care still requires pre-authorization.

UPDATE:  The new VA Dental Health Insurance Program gives an opportunity to enrolled veterans and CHAMPVA beneficiaries a chance to buy dental insurance at reduced costs.  the program opens for enrollment on November 15, 2013 with coverage beginning no sooner than January 1, 2014.  Only veterans enrolled in the VA health care system and veterans’ dependents who are covered by CHAMPVA may participate.  The VA has contracted with Delta Dental and MetLife for the 3-year pilot program.

See CHAMPVA dental insurance benefits for more detailed explanations and specifications.

Vision

Routine eye examinations for measuring and prescribing eyeglasses are specifically excluded from coverage.  That means going to an opthalmologist or optometrist just to have new glasses fitted won’t get you covered.

However, CHAMPVA will cover opthalmological services that are connected to a surgical or medical condition, or are used to treat a covered condition.  This can include refractive services, but must come with proper documentation from the doctor. VA notes that is decided based on the purpose of the service, rather than the final diagnosis of the patient.

The CHAMPVA Handbook states that eyeglasses have limited coverage; namely in case of a congenital absence of the lens, due to eye injury or after intraocular surgery.

See CHAMPVA Policy Manual on eye services and also Chapter 2: Section 10.

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