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Military families often find it difficult to differentiate between the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) and Tricare, a Department of Defense health-care program formerly called CHAMPUS.

Essentially, both programs have similar benefits, but the CHAMPVA program is administered separately with significant differences in claim filing and preauthorization requirements. Military families planning on taking advantage of CHAMPVA eligibility should be familiar with the rules and regulations involved.

To avoid confusion with the Tricare program, and to help ensure potential beneficiaries are well informed, here is an overview of the CHAMPVA program to help get you started.

Eligibility Guidelines

There is one main aspect of CHAMPVA that separates it from Tricare: only those who are not entitled for Tricare are eligible for CHAMPVA.

The Department of Defense extends benefits to those who fall within one of four possible scenarios:

•  You must be the spouse or child of a military member deemed permanently physically or mentally disabled for a service-related disability by a VA regional office
• You are a widow or widower of a veteran who at the time of death was considered permanently and completely disabled
• You must be the surviving spouse or child of a veteran who died due to a service-related disability
• You are the surviving spouse or child of a veteran who died while serving our country, although these cases are usually eligible for Tricare

CHAMPVA Benefits

The CHAMPVA program covers most services and supplies that are medically and psychologically necessary.

Typically, under most circumstances, CHAMPVA is meant to act as supplemental health coverage. But for those who must rely solely on CHAMPVA to cover their health expenses, there are some minor out-of-pocket expenses.

Besides the annual deductible of $50 per person and up to $100 per family, beneficiaries must contribute 25 percent as co-payment. But once this is squared away, the program will cover most expenses.

Additionally, if you happen to have alternate insurance, such as Medicare, your co-payment is waived, and CHAMPVA will pay the remaining amount due, after your other insurance is applied.

Applying for The CHAMPVA program

To apply for the program you must submit certain required documentation:

• VA Form 10-10d, which is the application for CHAMPVA benefits form
• Other health insurance certification form, VA Form 10-7959c
• Marriage/Divorce information letter

Once your forms are mailed, and depending on whether you submitted any optional documentation, then it’ll takes six weeks to receive your CHAMPVA card and other materials.

Photo thanks to Perfectoinsecto via Flickr Creative Commons

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