CHAMPVA is a valuable benefit for eligible veterans and veteran family members (survivors and caregivers). Every veteran with disabilities, every surviving spouse of or child of a veteran with disabilities and every surviving spouse or child of a veteran who has died needs to know about CHAMPVA benefits and how to apply for those benefits.
If a veteran or survivor does not qualify for TRICARE (the Department of Defense’s health care program for active-duty and retired service members and their families), they may be able to get health insurance through CHAMPVA.
The CHAMPVA benefits
With CHAMPVA, veterans and their beneficiaries will be covered for services and supplies when the VA determines they are medically necessary and were received from an authorized provider. When providers are performing services within the scope of their license or certification, the VA considers them to be authorized.
The following covered services include ambulance service, ambulatory surgery, durable medical equipment (DME), family planning and maternity, inpatient services, mental health services, outpatient services, pharmacy (prescription medicines), skilled nursing care, transplants, and hospice.
When you’re signed up for CHAMPVA, you’ll get a copy of the 89-page VA CHAMPVA Program Guide. This guide will tell you more about covered and non-covered services and supplies. Veterans and their beneficiaries should carefully read the information in the guide. Veterans and their beneficiaries should download and carefully read the guide at https://bit.ly/3UG910Q. They should also read the VA CHAMPVA Fact Sheets at http://bit.ly/3UG9q3m.
How to apply for CHAMPVA benefits
Veterans and eligible family members can apply for CHAMPVA benefits by submitting:
- Application For CHAMPVA benefits, VA Form 10-0d, found at http://bit.ly/3Eh8VaS. Be sure to sign and date your application. If your Veteran is applying for you as a spouse, be sure to also include the date of the marriage on the application.
- Other Health Insurance (OHI) Certification, VA Form 10- 7959C, found at http:// bit.ly/3hqTmnI.
- Documents related to your Medicare status. If you qualify for Medicare for any reason, you’ll need to submit a copy of your Medicare card. If you are 65 years old or older and don’t qualify for Medicare, you will need to send the VA documentation from the Social Security Administration that confirms you do NOT qualify for Medicare benefits under anyone’s Social Security number. To speed up the processing of your application, you should also send copies (not originals) of these optional documents:
- VBA Disability Rating Decision. The page from the VBA rating decision showing your veteran is permanently and totally disabled (or the death rating if you’re a survivor)
- DD214. Your Veteran’s DD214 (Certificate of Release or Discharge from Active Duty)—or, if the Veteran was a World War II or Korean War Veteran, the Report of Separation. If you do not have a copy of the necessary form, you can request it by submitting a Standard Form 180, Request Pertaining to Military Records, from the National Archives. The URL for the National Archives is http://bit. ly/3UFgLQN. Recent military service and medical records are not online. However, most veterans and their next of kin can obtain free copies of their DD Form 214 (Report of Separation) and the following military service records either online, by mail, or by FAX.
- Dependent Children Documentation. Documents related to any dependent children you are including in your application. Those documents should include: (a.) A copy of each child’s birth certificate or adoption papers and (b.) School certification of full-time enrollment for children ages 18-23. Applicants should download and read the VA’s Fact Sheet titled School Enrollment Certification Requirements for CHAMPVA Benefits, which is found at https://bit.ly/3SS4U0C.
- Remarried Surviving Spouse Documentation. If you are a surviving spouse who remarried but is once again single, also send to the VA a copy of the legal document that ended your marriage. This may be a divorce decree, death certificate, or annulment decree.
Mail your application to: VHA Office of Community Care, CHAMPVA Eligibility, P.O. Box 469028, Denver, CO 80246-9028, or FAX it to 303- 331-7809
How long will it take to hear back about my application?
If you send the VBA all required and optional documents and if your application is complete, it should take about six weeks after the VBA receives your application package until you get your CHAMPVA ID card and related materials. If you send the VBA only the required documents, it may take two to eight months since we’ll need to confirm your information with other federal agencies.
Answers to frequently asked questions about CHAMPVA
Veterans and their family members should read the 10 Frequently Asked Questions About CHAMPVA, which are found at http://bit.ly/3fHYlAg.
How to file a CHAMPVA claim
Veterans and eligible beneficiaries can find out how to file a CHAMPVA Claim at http://bit.ly/3UFhIbP. The VA encourages beneficiaries to have their provider(s) file claims directly with CHAMPVA. Providers are more likely to submit all the information necessary for CHAMPVA to process claims.
CHAMPVA In-House (Within the VA) Treatment Initiative (CITI)
The CHAMPVA In-house Treatment Initiative (CITI) is a voluntary program that allows treatment of beneficiaries of the Civilian Health and Medical Program of the Department of Veteran Affairs (CHAMPVA) at Veterans Affairs medical centers (VAMCs) that have elected to participate in CITI. To find out if your local VA Medical Center or clinic participates in CITI, you should contact the VA Medical Center or Community Based Outpatient Clinic directly. CITI is designed to provide CHAMPVA beneficiaries with access to care in a VA facility after the facility meets the needs of their Veteran population. In some areas, veterans’ needs already utilize the full capacity of the VA medical facility.
The VA [publishes a list of participating medical centers is published by the VA at https://bit.ly/3DRPyU6. The Ralph H. Johnson VA Medical Center is not on that published list. Read about CHAMPVA In-House Treatment Initiative (CITI) at the VA’s Fact Sheet found at https://bit.ly/3DTKgaC. The CHAMPVA Customer Call Center phone number is 800-733-8387.
The bottom line
CHAMPVA provides eligible beneficiaries with high-quality healthcare coverage, including services and supplies, at very competitive rates. Eligible veterans and their family members should not miss out on their hard-earned VA benefits.
Larry Dandridge is a Vietnam War wounded warrior, disabled veteran, ex-Enlisted Infantryman, ex-Warrant Officer Pilot, and retired Lt. Colonel. He is a past Veterans Service Officer, a Patient Adviser at the RHJ VA Hospital, the Fisher House Charleston Good Will Ambassador, and the VP for Veteran Affairs for the local Army Association Chapter. Larry is the author of the award-winning book Blades of Thunder and a contributing freelance writer with the Island News. Contact him at LDandridge@earthlink.net or 843-276-7164.
