Medical

How to Apply and Application Assistance

Provided below is information and links regarding benefits and services potenitally available to you. We strongly recommend, if you are considering requesting services or submitting an application to the VA, that you contact your County Veterans Service Office. Their Service Officers specialize in assisting veterans and their family members with claims, applications, and appeals to the VA.

Please visit our County Veterans Service Offices web page to obtain your County Veterans Service Office\'s contact information.

Mental Health Veterans Crisis Line Logo and hyperlink

Veterans Crisis Line

If you are experiencing a mental health emergency call 911 or the Veterans Crisis Line 1-800-273-8255 and Press 1.

The Veterans Crisis Line is a toll-free, confidential resource connecting Veterans in crisis and their families and friends with qualified caring responders.

Veterans and their loved ones can:

To receive free, confidential support 24 hours a day, 7 days a week, 365 day per year even if they are not registered with VA or enrolled in VA health care.

The professionals at the Veterans Crisis Line are specially trained and experienced in helping Veterans of all ages and circumstances - from Veterans coping with mental health issues to Veterans struggling with relationships, transitions, etc.

Additional Emergency and Mental Health Services

VA Mental Health Overview

Listed below are brief overviews of the programs, services, and resources provided by the U.S. Department of Veterans Affairs. To find the most current or additional information on any of the listed topics please visit the VA\'s official Mental Health web page.

The VA Medical Center provides counseling and resources for all veterans of all eras.

VAMC
1055 Clermont Street
Denver, CO 80220-3808

We are a 24/7/365 VA organization, staffed by combat veterans to refer veterans and their families to Vet Centers around the country for readjustment counseling. We also provide peer to peer counseling for when vets are in crisis without suicidal ideation being present such as anniversaries of personal events or when fireworks are going off. We are requesting that you list our phone number 877-WAR-VETS or 877-927-8387 on your home page along with the number to the Veterans Crisis Line 800-273-8255 to provide information for veterans and their families for both critical/suicidal calls and those that do not require immediate intervention. Your consideration making this information available to our fellow vets is greatly appreciated.

Tom McCabe, LPC, MS, MHR
Supervisory Readjustment Counseling Therapist
PNCM(SW) USN (ret)
1-877-WAR-VETS

RCS Vet Center Call Center Manager
Office: 720-874-1024
Fax: 303-216-9074

To find your closet VA medical center please visit the VA Locations Finder.

For mental health please visit the VA Mental Health Services web page.

Counseling

Art of Redirection Counseling

Give an Hour

Military Mental Health

People House

Soldiers Project

Vet Centers (Readjustment Counseling)

Veterans Helping Veterans Now

Expanded Mental Health Care

Washington, DC - The Department of Veterans Affairs (VA), under authority from the Veterans Access, Choice, and Accountability Act of 2014 (VACAA), announced expanded eligibility for Veterans in need of mental health care due to sexual assault or sexual harassment that occurred during their military service. This trauma is commonly known as military sexual trauma (MST).

To learn more, please visit the VA\'s Office of Public and Intergovernmental Affairs.

Treatment Settings &, Services

VA offers a range of treatments and services to improve the mental health of Veterans.

  • Short-term, inpatient care
  • Outpatient care in a psychosocial rehabilitation and recovery centers (PRRC)
  • Regular outpatient care, which may include telemedicine services
  • Residential Rehabilitation Treatment Programs (RRTP)
  • Primary care
  • Residential care
  • Supported work settings

The VA's focus is the following:

  • Focus on Recovery - Recovery empowers the Veteran to take charge of his/her treatment and live a full and meaningful life. This approach focuses on the individual's strengths and gives respect, honor, and hope to our nation's heroes and their families.
  • Coordinated Care for the Whole Person - VA health care providers coordinate with each other to provide safe and effective treatment for the whole person‚Äîhead to toe. Having a healthy body, satisfying work, and supportive family and friends, along with getting appropriate nutrition and exercising regularly, are just as important to mental health as to physical health.
  • Mental Health Treatment in Primary Care - Primary Care clinics use Patient Aligned Care Teams (PACTs) to provide the Veteran's healthcare. A PACT is a medical team that includes mental health experts.
  • Mental Health Treatment Coordinator - Veterans who receive specialty mental health care have a Mental Health Treatment Coordinator (MHTC). The MHTC's job is to understand the overall mental health goals of the Veteran.
  • Around-the-Clock Service - Emergency mental health care is available 24 hours per day, 7 days per week at VA medical centers. If your VA does not have a 24-hour emergency room, it must provide these services through a local, non-VA hospital. Telephone evaluations at VA medical centers and the national crisis hotline are also available 24/7.
  • Care that is Sensitive to Gender &, Cultural Issues - VA health care providers receive training about military culture, gender differences, and ethnic issues in order to better understand each Veteran.
  • Care Close to Home - VA is moving closer to where Veterans live by adding more rural and mobile clinics and working with other health care providers in the community.
  • Evidence-Based Treatment - Evidence-based treatments are treatments that research has proven are effective for particular problems. Mental health providers receive training on a wide variety of proven treatments. Mental health providers must offer evidence-based treatments to Veterans.
  • Family &, Couple Services - Sometimes, as part of a Veteran's treatment, some members of the Veteran's immediate family or the Veteran's legal guardian may be included and receive services, such as family therapy, marriage counseling, grief counseling, etc.

Services Available

VA offers a range of treatments and services to improve the mental health of Veterans including:

  • Short-term inpatient care
  • Outpatient care in a psychosocial rehabilitation and recovery center
  • Residential Rehabilitation Treatment Programs
  • Primary Care
  • Residential Care
  • Supported work settings

Special Programs

VA recognizes that some groups of Veterans have special mental health needs. In response to these needs, VA has developed special programs tailored for these groups. VA special programs include:

  • Service for Women Veterans
  • Family Services
  • Readjustment Counseling Services
  • Military Sexual Trauma Services
  • Services for Veterans whoa re homeless
  • Services for Veterans involved with the Criminal Justice System
  • Services for Older Veterans

DOD agrees to change bad discharges for Vietnam and other Veterans with PTSD

The Department of Defense will reconsider the discharges of Vietnam Veterans who may have suffered PTSD and were discharged before PTSD was diagnosed. PTSD was not recognized by the medical profession until the 1980s. Veterans form Vietnam and other past wars who received Other-than-Honorable discharges may seek correction of their military records if they can provide a PTSD diagnosis that existed at the time of service. Upgraded discharges may result int he restoration and opportunity for Veterans to obtain benefits. Note, the guidance from the Pentagon is focused on Veterans with low-level misconduct and is unlikely to affect Veterans who were court martialed for serious misconduct. The Pentagon's goal is to address those who suffered from a legitimate disorder without eroding the respect derived from honorable service.

To learn more, please view DoD Releases Clarifying Guidance to Veterans Regarding Discharges and Military Records.

Additional Resources

  • PTSD coach online - a free app for Apple and Andriod phones offering 17 tools to manage stress and issues like sleeplessness, anger, and anxiety.
  • Mindfulness Coach - free on iTunes reminds users to stay in the moment with exercises they can do independently.
  • Parenting2Go - free on iTunes helps returning service members sharpen rusty parenting skills.
  • CPT Coach and PE Coach - free on ITunes helps Veterans track symptoms and keep appointments organized.
  • About Face - a gallery of videos featuring Veterans and family members sharing stories about PTSD and how they found help.

 

PTSDVeterans Crisis Line Logo and hyperlink

If you are experiencing a mental health emergency call 911 or the Veterans Crisis Line 1-800-273-8255 and Press 1.

Please visit the VA\'s National Center for PTSD web page to learn more.

Post-traumatic stress disorder (PTSD) can occur after someone goes through a traumatic event like combat, assault, or disaster. Most people have some stress reactions after a trauma. If the reactions don't go away over time or disrupt your life, you may have PTSD.

Do I have PTSD?

The only way to know for sure if you have PTSD is to talk to a mental health care provider. The provider will ask you about your trauma, your symptoms and any other problems you have.

After a traumatic event, it\'s normal to think, act, and feel differently than usual. Most people will start to feel better after a few weeks. If your symptoms last longer than a few months, are very upsetting, and disrupt your daily life, you should get help. Whether or not you have PTSD, treatment can help if thoughts and feelings from the trauma are bothering you. Talk to:

  • Talk to your family doctor
  • A mental health professional, such as a therapist
  • Your local VA facility or Vet Center, if you are a Veteran
  • A close friend or family member who can support you while finding help
  • A clergy member

 

If I have other problems, can I also have PTSD?

Veterans with PTSD often have other types of problems. They might have other stress, medical or mental health problems. Sometimes PTSD is overlooked when other problems seem very pressing. If you have questions, ask your doctor if PTSD also needs to be treated.

DOD agrees to change bad discharges for Vietnam and other Veterans with PTSD

The Department of Defense will reconsider the discharges of Vietnam Veterans who may have suffered PTSD and were discharged before PTSD was diagnosed. PTSD was not recognized by the medical profession until the 1980s. Veterans form Vietnam and other past wars who received Other-than-Honorable discharges may seek correction of their military records if they can provide a PTSD diagnosis that existed at the time of service. Upgraded discharges may result int he restoration and opportunity for Veterans to obtain benefits. Note, the guidance from the Pentagon is focused on Veterans with low-level misconduct and is unlikely to affect Veterans who were court martialed for serious misconduct. The Pentagon's goal is to address those who suffered from a legitimate disorder without eroding the respect derived from honorable service.

To learn more, please view DoD Releases Clarifying Guidance to Veterans Regarding Discharges and Military Records.

Health and Insurance Benefits

VA Health Care and the Affordable Care Act

Please open the document below to see how the Affordable Health Care Act impacts you and VA health care.

VA Health Care and the Affordable Healthcare Act

Dental Care

The VA is partnering with Delta Dental and MetLife to allow eligible Veterans, plus family members receiving care under the Civilian Health and Medical Program (CHAMPVA), to purchase affordable dental insurance.

Veterans who are enrolled in VA health care can choose to purchase one of the offered dental plans. This three-year pilot has been designed for Veterans with no dental coverage, or those eligible for VA dental care who would like to purchase additional coverage. Participation will not affect entitlement to VA dental services and treatment.

There are no eligibility limitations based on service-connected disability rating or enrollment priority assignment. People interested in participating may complete an application online through either Delta Dental, www.deltadentalvadip.org, or MetLife, www.metlife.com/vadip . Coverage begins Jan. 1, 2014, and will be available throughout the United States and its territories.

Also eligible for the new benefits are spouses and dependent children who are reimbursed for most medical expenses under VA's CHAMPVA program. Generally, CHAMPVA participants are spouses, survivors or dependent children of Veterans officially rated as permanently and totally disabled by a service-connected condition.

Dental services under the new program vary by plan and include:

  • Diagnostic
  • Preventive
  • Surgical
  • Emergency
  • Endodontic/restorative treatment

Enrollment in the VA Dental Insurance Plan (VADIP) is voluntary. Participants are responsible for all premiums, ranging from $8.65 to $52.90 per month for individual plans. Co-payments and other charges may apply.

What if I am Service Connected for dental issues?

Historically VA's free dental services have gone to Veterans with dental problems connected to a medical condition that's officially certified as service connected. Free dental services will continue for those Veterans.

For more information on VADIP, visit www.va.gov/healthbenefits/vadip, or contact Delta Dental at 1-855-370-3303 or MetLife at 1-888-310-1681.

Veterans who are not enrolled in the VA health care system can apply at any time by visiting www.va.gov/healthbenefits/enroll, calling 1-877-222-VETS (8387) or visiting their local VA health care facility.

Denver VA Dental Clinic 303-393-2823.

Life Insurance

To serve Servicemembers, Veterans, and their families, the VA provides valuable life insurance benefits to give you the peace of mind that comes with knowing your family is protected. The VA's life insurance programs were developed to provide financial security for your family given the extraordinary risks involved in military service.

To learn more please visit the VA Life Insurance web page or call 800-462-7441.

Current active members of the Colorado National Guard are automatically protected with $1,000 of State-Sponsored Life Insurance (SSLI) at no charge. Additional coverage is available.

Please visit the National Guard State Sponsored Life Insurance web site or call 1-800-462-7441.

Veterans Choice Card

Have you heard about the new choice card from the VA which rolled out November 17, 2014? Depending on your circumstances you may qualify. The VA desired to provide a temporary benefit so veterans receive the timely quality care he need by allowing some veterans to receive health care in their communities rather than waiting for a VA appointment.

Please see this flyer for more information. Choice Card Flyeror call 1-86-606-8198 or visit www.va.gov/opa/choiceact

Mental Health For an emergency call 911 or 1-800-273-8255 (press 1)

Counseling and resources for all veterans of all eras:

VA Medical Center
1055 Clermont Street
Denver, CO 80220-3808

For additional resources:
https://www.mentalhealth.va.gov

CapTel for Veterans

CapTel is free for Veterans who have at least some hearing loss. The phone works like any normal phone AND it displays captions of what your caller is saying. Please see the application below.

CAPTEL for Veterans

Aid and Attendance

VA Aid and Attendance or Housebound benefits provide monthly payments added to the amount of a monthly VA pension for qualified Veterans and survivors. If you need help with daily activities, or you're housebound, you may qualify. To find out more please click here.

 

Colorado State Veterans Community Living Centers

Colorado\'s Veterans Community Living Centers serve honorably discharged veterans, veterans' spouses/widows and Gold Star parents of children who died while serving in the armed forces.

To learn more please visit the Colorado Department of Human Services.

Traumatic Brain Injury

The Veterans Affairs Department is proposing to add five medical conditions to a list of diseases that, if diagnosed in a patient with a brain injury received during military service, automatically would be presumed service-connected.

Illnesses under consideration include:

  • Unprovoked seizures
  • Symptoms of Parkinson's disease
  • Certain types of dementia including Alzheimer's disease
  • Depression
  • Hormone deficiencies caused by changes of the hypothalamus and pituitary glands.

Service connection will depend in part on the severity of the traumatic brain injury and onset of the illness, which will be considered secondary to the TBI, according to VA.

Exposure to hazardous materials

Select from the links below to find out if you can get disability compensation (monthly payments) and other benefits for illnesses or other conditions. These are illnesses and conditions that may have been caused by contact with harmful chemicals or other hazardous materials while serving in the military.

  • Agent Orange
    If you served in the Republic of Vietnam or in or near the Korean Demilitarized Zone (DMZ) during the Vietnam Era—or in certain related jobs—you may have had contact with Agent Orange, an herbicide used to clear plants and trees during the war.
  • Asbestos
    If you worked in certain military jobs, you may have had contact with asbestos (toxic fibers once used in many buildings and products).
  • Birth Defects like spina bifida
    If you served in the Republic of Vietnam, in Thailand, or in or near the DMZ during the Vietnam Era—and your child has spina bifida or certain other birth defects—your child may be eligible for disability benefits.
  • Contact with mustard gas or lewisite
    If you served at the German bombing of Bari, Italy, in World War II or worked in certain other jobs, you may have had contact with mustard gas.
  • Contaminated drinking water at Camp Lejune
    If you served at Camp Lejeune or MCAS New River between August 1953 and December 1987, you may be at risk for certain illnesses believed to be caused by contaminants found in the drinking water during that time.
  • Gulf War Illness
    If you served in the Southwest Asia theater of operations, you may be at risk of certain illnesses or other conditions linked to this region.
  • Gulf War Illness in Afghanistan
    If you served in Afghanistan, you may be at risk of certain illnesses or other conditions linked to this region.
  • Project 112/SHAD
    If you were part warfare testing for Projects 112 or Shipboard Hazard and Defense (SHAD) from 1962 to 1974, you may be at risk of illnesses believed to be caused by chemical testing.
  • Radiation exposure
    If you served in the post-WWII occupation of Hiroshima or Nagasaki, were imprisoned in Japan, worked with or near nuclear weapons testing, or served at a gaseous diffusion plant or in certain other jobs, you may be at risk for illnesses believed to be caused by radiation.
  • Specific environmental hazards
    If you served in Iraq, Afghanistan, Djibouti, or near Atsugi, Japan, you may have had contact with toxic chemicals in the air, water, or soil.

 

Sexual Assault Veterans Crisis Line Logo and hyperlink

If you need to talk to someone right away and/or are having a crisis of any kind call the Veterans Crisis Line 1-800-273-8255 and Press 1.

Where can I get treatment for conditions related to sexual assault or sexual harassment while in the military?

You may be eligible for Military Sexual Trauma (MST) related care. Every VA facility provides free care for mental and physical health conditions related to MST. To receive care, ask your VA provider for a referral to MST services.

Contact the VA Medical Center at 303-399-8020 or 888-336-8262.

Caregiver Stipend Benefit for Family Members

A primary family caregiver stipend is a monetary compensation paid to a primary family caregiver for providing personal care services to an eligible Veteran enrolled in the caregiver program. The stipend is not intended to replace career earnings and receipt of the stipend payments does not create an employment relationship between VA and the primary family caregiver.

Veteran Eligibility?

  • Veterans who sustained a serious injury including Traumatic Brain Injury (TBI), psychological trauma or other mental disorder incurred or aggravated int he lien of duty on or after September 11, 2001.
  • Veterans must need personal care because of an inability to perform one or more activities of daily living and/or need supervision or protection based on symptoms or residuals of neurological impairment injury.
  • Veterans must be enrolled for VA health benenfits
  • It is in the best interest if the Veteran to participate int he program
  • The Veteran agrees ti receive on-going care at home after VA designates a Family Caregiver
  • Personal care services which are provided by the Caregiver will not simultaneously be provided through another individual or entity

Caregiver Eligibility

  • At least 18 years of age
  • Must be either the Veteran's souse, son, daughter, parent, step-family member or extended family member or someone who lives with the Veteran full-time.
  • Prior to approval, the Caregiver will be provided training and must be able to demonstrate the ability to assist the Veteran with personal care functions required in everyday living

Additional Information

  • Veterans may begin the application process by filling out and turning in the application - VA Form 10-10CG. Send to: Family Caregivers Program, Health Eligibility Center, 2957 Clairmont Road NE, Suite 200, Atlanta, GA 30329-1647
  • If the Veteran is not already enrolled in VA health care a VA Form 1010EZ will need to be completed.
  • Can all caregivers receive the stipend? Only the designated primary family caregiver of an eligible veteran is entitles to receive a stipend and there can only be one primary family caregiver designated at a time.
  • Will my primary family caregiver stipend be taxable income? No. The stipend is a VA enhanced service and is not considered taxable income.
  • How does the VA determine the stipend amount? It is based on the weekly number of hours of personal care services a veteran requires during the month. It is also based on the Bureau of Labor Statistics' hourly wage for a home health aid in the geographic region in which the veteran resides (using the 75th percentile of the wage index times the annual Consumer Price Index Cost of Living adjustment, multiplied by 4.35 which is equal to the number of weeks in the month the Primary Family Caregiver provided care to the eligible Veteran.
  • Who determines the number of hours of personal care services a veteran requires? The veterans patient aligned primary care team makes this determination after evaluating the veteran based on the degree to which the eligible veteran is unable to perform one or more activities of daily living, needs supervision or protection i.e. due to a TBI. There are three tiers: high tier equals a maximum of 40 hours of care per week, medium tier equals a maximum of 25 hours per week, low tier equals a maximum of 10 hours of care per week.
  • What is the role of the Health Administration Center in the stipend process? The health administration center processes the administrative portion and makes the recurring monthly payments. The payment is retroactive tot he date the application was received at the VA Medical Center.

To find out more please visit the VA Caregiver Support web page or call their support line: 1-855-260-3274.

For additional caregiver resources, please visit the VA Caregiver Support - Additional Resources web page or call 1-877-733-7927.

Non-VA Emergency Care

What do I need to do if admitted to a non-VA Medical Center in the case of an emergency?

Contact the Network Authorization Center within 72 hours of admission at 1-888-795-0773.

  • Must be 100% SC or emergency must be for a SC disability
  • Must be enrolled in VA health care system
  • VA will also pay if veteran is referred by the VA for care to that facility but still call the Network Authorization Center

NON-VA Emergency Care Fact Sheet

Champ VA

Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a health benefits program in which the Department of Veterans Affairs (VA) shares the cost of certain health care services and supplies with eligible beneficiaries.

CHAMPVA is managed by the VA's Chief Business Office Purchased Care (CBOPC) in Denver, Colorado. CBOPC processes CHAMPVA applications, determines eligibility, authorizes benefits, and processes medical claims.

Q&,A

  • To be eligible for CHAMPVA, the beneficiary cannot be eligible for TRICARE. CHAMPVA provides coverage to the spouse or widow(er) and to the children of a veteran who:

    • Is rated permanently and totally disabled due to a service-connected disability, or
    • Was rated permanently and totally disabled due to a service-connected condition at the time of death, or
    • Died of a service-connected disability, or
    • Died on active duty and the dependents are not otherwise eligible for DoD TRICARE benefits.

    Effective October 1, 2001, CHAMPVA benefits were extended to age 65 and older. To be eligible, you must also 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 the beneficiary turned 65 before June 5, 2001, and has Medicare Parts A and B, the beneficiary must keep both Parts to be eligible.
    • If the beneficiary turn age 65 on or after June 5, 2001, the beneficiary must be enrolled in Medicare Parts A and B to be eligible.
  • In most cases, CHAMPVA pays equivalent to Medicare/TRICARE rates. CHAMPVA has an outpatient deductible ($50 per person up to $100 per family per calendar year) and a cost share of 25% up to the catastrophic cap (up to $3,000 per calendar year). You should collect the 25% allowable cost share from the patient except when the patient has other health insurance.

  • If the patient has other health insurance, then CHAMPVA pays the lesser of either 75% of the allowable amount after $50 calendar year deductible is satisfied, or the remainder of the charges and the beneficiary will normally have no cost share.
  • Yes. If the beneficiary has other health insurance (OHI), they should be billed first. The explanation of benefits (EOB) from the OHI should then be submitted with the claim for reimbursement to CHAMPVA.

    By law, CHAMPVA is always secondary payer except to Medicaid, State Victims of Crime Compensation Programs and supplemental CHAMPVA policies.

  • CHAMPVA does not maintain a provider listing. Most Medicare and TRICARE providers will also accept CHAMPVA (but be sure you ask the provider).

    If you are having difficulty finding a provider, we recommend you visit the Medicare website HTTP://WWW.MEDICARE.GOV and use the Search Tools at the bottom of that page to locate a Medicare provider.

    You may also visit the TRICARE website at (https://www.tricare.mil/STANDARDPROVIDER/) to locate a provider in your area.

    If you choose to see a provider who does not accept CHAMPVA, you will likely have to pay the entire bill and then submit a claim for reimbursement of our cost share. Remember that CHAMPVA cost shares are based on the CHAMPVA allowable amount.

  • As a result of a Federal law passed June 5, 2001, CHAMPVA expanded benefit coverage to eligible family members and survivors of qualifying Veteran sponsors effective October 1, 2001.

    If the beneficiary is eligible for CHAMPVA and also has Medicare Part A entitlement (premium-free hospitalization coverage) and Medicare Part B (outpatient coverage) we will cover many of the costs not covered by Medicare. CHAMPVA will pay after Medicare and any other insurance, such as Medicare HMOs and Medicare supplemental plans, for health care services and supplies.

    CHAMPVA does not pay Medicare Part B premiums.

  • Although similar, CHAMPVA is completely separate with a totally different beneficiary population than TRICARE - a Department of Defense healthcare program formerly called CHAMPUS.

    While the benefits are similar, the programs are administered separately with significant differences in claim filing procedures and preauthorization requirements.

  • There are a couple ways to obtain an Application for CHAMPVA Benefits (VA Form 10-10D):

    1. Fillable Application
    2. Call the Chief Business Office Purchased Care at 1-800-733-8387. When calling, select the Application Form option from the voice-mail menu. To help reduce the volume of telephone calls during business hours, please consider placing these calls during evening or weekend hours.
  • Generally, applicants can expect to receive written notification from the Chief Business Office Purchased Care within 45 days from mailing their application. To streamline the process, applicants are encouraged to complete the Application for CHAMPVA Benefits (VA Form 10-10D) in its entirety and to attach all required documents. As further explained on the application, required documents include a copy of each applicant's Medicare card (if Medicare eligible) and a school certification for all applicant children between the ages of 18 and 23.
    CHAMPVA School Certifications (01-02)
  • Fact Sheet - CHAMPVA-OHI (01-23)

    To answer this question, a look at CHAMPVA's origin and the congressional intent behind its legislation may help. From the start, CHAMPVA was intended to serve as a safety net in the event other coverage was not available - rather than being the primary carrier. While families with OHI are not disqualified from CHAMPVA benefits, CHAMPVA's safety net protection becomes available after the OHI has paid.
    This includes enrollment benefits available from:

    • Health Maintenance Organization (HMO)
    • Preferred Provider Organization (PPO)
    • Medicare
    • Other health insurance

    Exceptions to CHAMPVA's secondary payer status:

    • Supplemental CHAMPVA policies
    • Medicaid
    • State Victims Compensation Programs

    CHAMPVA becomes the primary payer in these cases.

  • Just as beneficiaries with OHI cannot opt to waive those benefits to have CHAMPVA become the primary payer, beneficiaries enrolled in an HMO cannot elect to waive the HMO benefits without forfeiting their CHAMPVA benefits. CHAMPVA benefits, however, do apply to covered services that are not covered by the HMO.
  • Under the CHAMPVA Inhouse Treatment Initiative (CITI for short), CHAMPVA beneficiaries may receive cost-free healthcare services at participating VA facilities.
  • Although some VA facilities are not CITI participants due to the volume of Veterans they are responsible for serving, most are. To find out if your local facility is participating, click here. However, CHAMPVA beneficiaries who are also covered by MEDICARE cannot use a VA medical center because MEDICARE does not pay for services provided by a VA Medical Center.
  • None - CHAMPVA beneficiaries don't pay a thing when receiving services under the CITI program.
  • VA's authority to offer inhouse services to CHAMPVA beneficiaries is conditional providing Veteran access to care is not compromised. Unfortunately, some facilities are experiencing such a high Veteran demand for services that participation in the CITI program is not possible.
  • The annual outpatient deductible begins over again each Jan 1st and is $50.00 per person, no more than $100.00 per family. This deductible must be paid before CHAMPVA will pay 75% of the allowable amount. As claims are processed for covered services, charges are automatically credited to individual and cumulative family deductible requirements for each calendar year.

    The catastrophic cap (cat cap) begins over again each Jan 1st and is $3000.00 per family per year. Each time we pay a bill, the deductible and cost share (out of pocket expenses) are calculated and credited to the cat cap. When the cat cap reaches $3000.00 for the family, CHAMPVA will then pay at 100% of our allowable amount for the rest of the calendar year.