What Are The VA Health Care Benefits?

Each VA health care benefits package is different. Yours will include care and services to help:

• Treat illnesses and injuries

• Prevent future health problems

• Improve your ability to function

• Enhance your quality of life

Downloadable PDF | VA Health Care Benefits: A Veteran’s Guide

Downloadable PDF | VA Health Care Benefits: A Veteran’s Guide

1  |  Basic Eligibility

• A person who served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable.

• Qualifying Reserve and National Guard members.

2  |  Minimum Duty Requirements

• Veterans who enlisted after September 7, 1980, or who entered active duty after October 16, 1981, must have served 24-continuous months or the full period for which they were called to active duty in order to be eligible.

• May not apply to Veterans discharged for hardship, early out, or a disability incurred or aggravated in the line of duty.

3  |  Enrollment

• Apply by phone, call 1-877-222-8387

• • Monday through Friday between 8 a.m. and 8 p.m. EST

• • VA staff members will collect the needed information and process the enrollment application for an enrollment determination

• Apply online at va.gov.

• • Veterans fill out the application and electronically submit it to VA for processing

• • VA will search for your supporting documentation through its electronic information systems and will contact you if it is unable to verify your military service

• Apply by mailing application form.

• • Application form can also be downloaded from www.va.gov/health-care/apply/application/introduction

• • Mail the completed form to:

• • • Health Eligibility Center ATTN: Enrollment
      Eligibility Division 2957 Clairmont Road Suite 200
      Atlanta, GA 30329-1647

4  |  Veteran Who Are Not Required To Enroll But Should Anyways

• Veterans with a service-connected disability rated at 50 percent or more.

• Veterans seeking care for a disability the military determined was incurred or aggravated in the line of duty.

• • Which VA has not yet rated, within 12 months of discharge

• Veterans seeking care for a service-connected disability only.

• Veterans seeking registry examinations.

• • Ionizing radiation

• • Agent Orange

• • Gulf War / Operation Enduring Freedom / Operation Iraqi Freedom / Operation New Dawn (OEF/OIF/OND)

• • Depleted uranium

• • Airborne Hazards and Open Burn Pit Registry

5  |  Priority Groups

• During enrollment, each Veteran is assigned to a priority group.

• VA uses priority groups to balance the demand for VA health care enrollment with resources.

Downloadable PDF | A Veteran’s Guide

Group 1

• During enrollment, each Veteran is assigned to a priority group.

• Veterans determined by VA to be unemployable due to service-connected conditions

• Veterans who have been awarded the Medal of Honor

Group 2

• Veterans with service-connected disabilities rated 30 or 40 percent

Group 3

• Veterans who are former Prisoners of War

• Veterans awarded the Purple Heart medal

• Veterans whose discharge was for a disability incurred or aggravated in the line of duty

• Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation.”

Group 4

• Veterans who receive increased compensation or pension based on their need for regular aid and attendance or by reason of being permanently housebound

• Veterans determined by VA to be catastrophically disabled

Group 5

• Nonservice-connected Veterans and non-compensable service-connected Veterans rated by VA as 0-percent disabled and who have an annual income below the VA’s geographically-adjusted income limit (based on your resident ZIP code)

• Veterans receiving VA Pension benefits

• Veterans eligible for Medicaid benefits

Group 6

• Compensable 0 percent service-connected Veterans

• Veterans exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki

• Project 112/SHAD 2 participants

• Veterans who served in the Republic of Vietnam between Jan. 9, 1962, and May 7, 1975

• Veterans who served in the Southwest Asia theater of operations from Aug. 2, 1990, through Nov. 11, 1998

• Veterans who served in a theater of combat operations after Nov. 11, 1998, as follows:

• • Veterans discharged from active duty on or after Jan. 28, 2003, for five years post-discharge

• Currently enrolled Veterans and new enrollees who served in a theater of combat operations after Nov.11, 1998, and those who were discharged from active duty on or after Jan. 28, 2003, are eligible for the enhanced benefits for five years post-discharge

Group 7

• Veterans with gross household income below the geographically-adjusted VA income limit for their resident location and, who agree to pay copayments

Group 8

• Veterans with gross household incomes above VA national income limit and the geographically-adjusted income limit for their resident location and, who agree to pay copayments

6  |  Veterans Community Care Program

• Veterans may be eligible for care through a provider in their local community depending on their health care needs or circumstances, and if they meet specific eligibility criteria.

• If a Veteran is eligible for community care, they still have the option to receive care from a VA medical facility.

• Veterans must receive approval from VA before receiving care from a community provider to avoid being billed for the care. VA staff members make all eligibility determinations for community care.

Eligibility

You may see a community provider if you meet one of these six eligibility criteria:

• Service Unavailable – You need a service that is not available at VA (e.g. maternity care, in vitro fertilization)

• Facility Unavailable – You reside in a U.S. state or territory without a full-service VA medical facility

• Grandfathered Choice – You were eligible for community care under the Veterans Choice Program distance criteria

• Medical Interest – Your VA provider determines it is in your best medical interest to be referred to a community provider

• Quality Standards – You need care from a VA medical service that VA determines is not providing care that complies with VA’s quality standards

• Access Standards – You meet the accessibility standards for average drive time or wait time for a VA appointment

• • Drive time access standards

You may be eligible to see a community provider if your average drive time from home to a VA medical facility that provides the service you need takes more than:

• • • 30 minutes travel time to receive primary care, mental health, and non-institutional extended care services (including adult home daycare)

• • • 60 minutes travel time to receive specialty care services

• • Wait time access standards

You may be eligible if the wait time for an appointment at a VA medical facility that provides the service you need exceeds:

• • • 20 days for primary care, mental health, and non-institutional extended care services

• • • 28 days for specialty care from the date of request with certain exceptions

Process Overview

• Eligibility: VA confirms a Veteran’s eligibility to receive community care.

• Appointments: A veteran or a VA staff member schedules appointments with a provider in VA’s network.

• Getting Care: Veteran receives care from a community provider in the VA’s network.

• Billing: The community provider sends the claim to a Third Party Administrator (TPA) or VA for payment.

7  |  Meeting the Unique Needs of Women Veterans

• VA staff delivers the highest quality health care in a setting that ensures privacy, dignity, and sensitivity.

• Local VA facilities offer a variety of services, including women’s gender-specific health, screening and disease prevention, maternity care, and routine gynecologic services.

• Women Veterans are eligible to receive care provided in the community when they meet the eligibility criteria and are authorized by VA.

• A Veteran’s eligibility for community care depends on individual health care needs or circumstances.

Downloadable PDF | A Veteran’s Guide

Eligibility

There are six criteria that can qualify a Veteran to receive community care. Veterans only need to meet one of these criteria to be eligible:

• Veteran needs a service not available at a VA medical facility

• Veteran lives in a U.S. state or territory without a full-service VA medical facility

• Veteran qualifies under the “Grandfather” provision related to distance eligibility for VCP

• VA cannot provide care within certain designated access standards

• It is in the Veteran’s best medical interest

• A VA service line does not meet certain quality standards

8  |  Lesbian Gay Bisexual and Transgender (LGBT) Veterans

• VA staff delivers the highest quality health care in a setting that ensures privacy, dignity, and sensitivity.

• Local VA facilities offer a variety of services, including women’s gender-specific health, screening and disease prevention, maternity care, and routine gynecologic services.

• Women Veterans are eligible to receive care provided in the community when they meet the eligibility criteria and are authorized by VA.

• A Veteran’s eligibility for community care depends on individual health care needs or circumstances.

9  |  Military Sexual Trauma (MST)

• MST is the term that VA uses to refer to sexual assault or repeated, threatening sexual harassment occurring during a Veteran’s military service.

• VA has expanded eligibility for Veterans in need of mental health care due to sexual assault or sexual harassment to Reservists and National Guard members participating in the weekend drills.

• To receive free treatment related to MST, Veterans do not need a VA service-connected disability.

• Veterans do not need to have reported the incident when it happened or have other documentation that it occurred.

• There are no length-of-service requirements to receive care, and some Veterans may be able to receive free MST-related care even if they are not eligible for other VA care.

• There are no length-of-service requirements to receive care, and some Veterans may be able to receive free MST-related care even if they are not eligible for other VA care.

10  |  Care Management for Post 9/11 Era Veterans

• Each VA medical center has a Transition and Care Management team in place to coordinate patient care activities and ensure that Veterans are receiving patient-centered, integrated care and benefits.

• Veterans who served in a theater of operations after November 11, 1998, are eligible for an extended period of eligibility for health care for five years after their discharge.

• In the case of multiple call-ups, the five-year enrollment period begins on the most recent discharge date.

• This special eligibility includes cost-free health care services and nursing home care for conditions possibly related to military service and enrollment in Priority Group 6 or higher for five years from their date of discharge or release from active duty unless they are eligible for enrollment in a higher priority group.

11  |  Tax Credit

• Veterans who are enrolled with VA for their health care meet the standard for minimum health care coverage; therefore, they are not eligible for assistance to lower their cost of health insurance premiums if they chose to purchase additional health insurance outside of their VA health care coverage.

• Veterans cannot receive a tax credit for themselves when enrolling within the marketplace if they are currently enrolled with VA for their health care.

12  |  Financial Assessment

• Most Veterans not receiving VA disability compensation or pension payments must provide a financial assessment upon initial application to determine their eligibility for free medical care, medications and/or travel benefits.

• This financial information also may be used to determine the Veteran’s enrollment priority group.

• VA no longer requires enrolled non-service-connected and 0-percent non-compensable service-connected Veterans to provide their financial information annually.

• An assessment will continue to be collected from Veterans at the time of application for enrollment.

• In lieu of the annual financial reporting, VA will confirm the Veteran’s financial information using information obtained from the Internal Revenue Service and Social Security Administration.

13  |  Medical Services and Medication Copayments

• While many Veterans qualify for free health care based on a VA compensable service-connected condition or other special eligibilities, most Veterans are required to complete a financial assessment at the time of enrollment to determine if they qualify for free health care services.

• Veterans whose income exceeds the VA income limits as well as those who choose not to complete the financial assessment at the time of enrollment must agree to pay required copayments for care to become eligible for VA healthcare services.

14  |  Private Health Insurance Billing

• Veterans with private health insurance may choose to use these sources of coverage as a supplement to their VA benefits.

• Veterans are not responsible for paying any remaining balance of VA’s insurance claim not paid or covered by their health insurance.

• By law, VA is obligated to bill health insurance carriers for services provided to treat a Veteran’s nonservice-connected conditions.

• Veterans are asked to disclose all relevant health insurance information to ensure current insurance information is on file, including coverage through a spouse.

• Any payment received by VA may be used to of set “dollar for dollar” a Veteran’s VA copay responsibility.

• Funds that VA receives from third-party health insurance carriers go directly back to VA medical center’s operational budget.

• That money can be used to hire more staff or buy medical equipment to improve Veterans’ healthcare.

• • Enrolled Veterans can provide or update their insurance information by:

• • • Using the online Health Benefits Renewal form (10-10-EZR)

• • • Calling 1-877-222-VETS (8387) Monday through Friday between 8 a.m. and 8 p.m. EST

• • • Presenting their health insurance card to the clinic clerk or using the self-service kiosks available at their local VA health care facility. VA health care is NOT considered a health insurance plan

15  |  Reimbursement of Travel Costs

• Eligible Veterans and non-Veterans may be provided mileage reimbursement or, when medically indicated, special mode transport (e.g., wheelchair van, ambulance), when travel is in relation to VA medical care.

• Mileage reimbursement is 41.5 cents per mile and is subject to a deductible of $3 for each one-way trip and $6 for a round trip; with a maximum deductible of $18 or the amount after six one-way trips (whichever occurs first) per calendar month.

• The deductible may be waived when travel is; in relation to a VA compensation or pension examination; by a special mode of transportation; by an eligible non-Veteran; or will cause severe financial hardship, as defined by current regulatory guidelines.

Eligibility

A Veteran may be eligible for beneficiary travel services if the following criteria are met:

• Have a service-connected (SC) rating of 30 percent or more, or

• are traveling for treatment of an SC condition, or

• receive a VA pension, or your income does not exceed the maximum annual VA pension rate, or

• are traveling for scheduled compensation or pension, or if not otherwise eligible as noted above and;

• have a vision impairment, spinal cord injury or disorder, or a double or multiple amputations who’s travel in connection with care provided through a VA special disabilities rehabilitation program (including programs provided by spinal cord injury centers, blind rehabilitation centers, and prosthetics rehabilitation centers) if such care is provided on an inpatient basis or during a period in which you are provided with temporary lodging at a facility of the Department to make such care more accessible.

Veterans may qualify for special mode transportation

• If they meet one of the eligibility criteria in the list above and have a medical condition requiring an ambulance or a specially equipped van as determined by a VA clinician, and the travel is preauthorized

• Authorization is not required for emergencies if a delay would be hazardous to life or health

16  |  Veteran Health Registries

• Certain Veterans can participate in a VA health registry and receive free evaluations.

• VA maintains health registries to provide special health evaluations and health-related information.

• To participate, contact the environmental health coordinator at the nearest VA health care facility or visit www.publichealth.va.gov/exposures to see a directory that lists environmental health coordinators by state and U.S. territory.

Downloadable PDF | A Veteran’s Guide

• Veterans should be aware that a health registry evaluation is not a disability compensation exam.

• A registry evaluation does not start a claim for compensation and is not required for any VA benefits.

• No in-person medical evaluation is required to become registered.

• Veterans not already enrolled in VA health care should contact an environmental health coordinator at a nearby VA facility by visiting the following link: (www.publichealth.va.gov/ exposures/coordinators.asp) or calling 1-877-222-8387.

17  |  Vet Center Readjustment Counseling Services

• Vet Centers provide confidential, community-based counseling, outreach, and referral services for a wide range of concerns eligible Active Duty Service Members, Veterans, including members of the National Guard and Reserve Components may face.

• You are eligible for Vet Center services if you:

• • Have served on active military duty in any combat theater or area of hostility

• • Experienced sexual trauma while serving on active duty

• • Active duty for training, or inactive duty training

• • Provided direct emergent medical care or mortuary services to the casualties of war while serving on the active military duty of war

• • Served as a member of an unmanned aerial vehicle crew that provided direct support to operations in a combat zone or area of hostility

• Individual, group, marriage, and family counseling in addition to referral and connection to other VA and community benefits and services are offered at no cost and without time limitation.

• Services are available to family members when it is found to aid in the readjustment of the Veteran or service member, including getting through a deployment.

• Bereavement counseling is also offered for families who experience an active duty death.

• Vet Centers are separate from VA Medical Centers and release no information to any person or agency without the individual’s written consent, except in serious circumstances when there is an intent to harm.

• 300 Vet Centers and 83 Mobile Vet Centers are in all 50 states, the District of Columbia, Guam, Puerto Rico, and American Samoa, and offer non-traditional hours, including evenings and weekends to accommodate busy schedules.

• Visit www.vetcenter.va.gov to find a Vet Center nearest you or call the 24/7 Vet Center Call Center at 1-877-927-8387.

18  |  Home Improvements and Structural Alterations

• VA provides up to $6,800-lifetime benefits for service-connected Veterans and up to $2,000-lifetime benefits for nonservice-connected Veterans to make home improvements and/or structural changes.

• Necessary for the continuation of treatment or for disability access to the Veterans home and essential lavatory and sanitary facilities.

• For application information, contact the prosthetic representative at the nearest VA medical center.

Downloadable PDF | A Veteran’s Guide

19  |  Special Eligibility Programs

• VA provides comprehensive health care benefits, including:

• • Outpatient

• • Inpatient

• • Pharmacy

• • Prosthetics

• • Medical equipment

• • Supplies for certain Korea and Vietnam Veterans’ birth children diagnosed with Spina Bifida (except Spina Bifida oc culta)

20  |  Services for Blind and Visually Impaired Veterans

• Severely disabled blind Veterans may be eligible for case management services at a VA medical center and for admission to an inpatient or outpatient VA blind or vision rehabilitation program.

21  |  Mental Health Care Treatment

• Veterans eligible for VA medical care may receive general and specialty mental health treatment as needed.

• Mental health services are available in primary care clinics (including Home Based Primary Care), general and specialty mental health outpatient clinics, inpatient mental health units, residential rehabilitation and treatment programs, specialty medical clinics, and Community Living Centers.

• For more information on VA mental health services, visit www.va.gov/healthbenefts/access/mentalhealthcare.asp and www.mentalhealth.va.gov, or contact your local VA health care facility’s Enrollment Office.

22  |  Veterans Crisis Line

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

• Veterans and their loved ones can call 1-800-273-8255 and Press 1, chat online at veteranscrisisline.net, or send a text message to 838255 to receive confidential support 24-hours a day, 7-days a week, 365-days a 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 that were never addressed to Veterans struggling with relationships or the transition back to civilian life.

• European access: Veterans and members of the military community in Europe may dial 0800-1273-8255 or DSN 118. For more information about VA’s suicide prevention program, visit: www.Veteranscrisisline.net.

23  |  VA Dental Insurance Program

• VA would like all Veterans to have access to good oral health care; however, VA is limited to providing dental benefits to those Veterans who meet certain eligibility criteria.

• To help Veterans who are not eligible for VA dental benefits or need more comprehensive dental care, VA offers enrolled Veterans and beneficiaries of CHAMPVA the opportunity to purchase dental insurance at a reduced cost through its VA Dental Insurance Program (VADIP).

Downloadable PDF | A Veteran’s Guide

• VADIP has been extended for an additional five years, until Dec. 31, 2021, by the VA Dental Insurance Reauthorization Act of 2016.

• Delta Dental of California and MetLife will be of caring for private dental insurance plans for enrolled Veterans and beneficiaries of CHAMPVA for VADIP.

• For more information about this program, call toll-free 1-877-222- VETS (8387) Monday through Friday between 8 a.m. and 8 p.m. EST or visit www.va.gov/healthbenefts/vadip.

24  |  Long-term Services

• VA provides institution-based services (nursing home level of care) to Veterans through three national programs: VA-owned and operated Community Living Centers (CLC), State Veterans’ Homes owned and operated by the states, and the community nursing home program.

• Each program has admission and eligibility criteria specific to the program.

• VA is obligated to pay the full cost of nursing home services for enrolled Veterans who need nursing home care for a service-connected disability or Veterans who have a 70 percent or greater service-connected disability, and Veterans with a rating of total disability based on individual unemployability.

• VA-provided nursing home care for all other Veterans is based on available resources. For more information on Extended Care Services and Geriatrics, visit www.va.gov/GERIATRICS/index.asp.

• For more information about this program, call toll-free 1-877-222- VETS (8387) Monday through Friday between 8 a.m. and 8 p.m. EST or visit www.va.gov/healthbenefts/vadip.

25  |  Emergency Medical Care in U.S. Community Facilities

• A medical emergency is generally defined as a condition of such a nature that a sensible person would expect that a delay in seeking immediate medical attention would be hazardous to life or health.

• Eligible Veterans may receive emergency care at a community health care facility, possibly at VA expense, when a VA facility (or other Federal health care facility with which VA has an agreement) cannot furnish efficient care due to the distance from the facility, or when VA is unable to furnish the needed emergency services.

Downloadable PDF | A Veteran’s Guide

• A medical emergency is generally defined as a condition of such a nature that a sensible person would expect that a delay in seeking immediate medical attention would be hazardous to life or health.

• Eligible Veterans may receive emergency care at a community health care facility, possibly at VA expense, when a VA facility (or other Federal health care facility with which VA has an agreement) cannot furnish efficient care due to the distance from the facility, or when VA is unable to furnish the needed emergency services.

• Since payment may be limited to the point when the condition is stable enough for the Veteran to travel to a VA facility, a family member or friend must contact the closest VA medical facility within 72 hours of the emergency.

• The emergency is deemed to have ended when a VA provider has determined that, based on sound medical judgment; the Veteran could be transferred from the community facility to a VA medical center.

• For more information on emergency care, visit www.va.gov.

26  |  Urgent Care

• A offers urgent care benefits that provide eligible Veterans with greater choice and access to timely, high-quality care.

• Urgent care providers treat injuries and illnesses that require immediate attention but are not life-threatening.

• The benefit supplements care Veterans may also have access to at a VA medical facility.

• When using the urgent care benefits, Veterans must go to an urgent care provider in VA’s network.

• Upon arriving, Veterans must state they are using their VA urgent care benefit.

• The urgent care provider will verify the Veteran’s eligibility before providing care.

• If a Veteran arrives at an urgent care network location and has any difficulty receiving care, they can call 866-620-2071 to receive assistance.

• To find an urgent care location in VA’s contracted network, Veterans can use the VA Urgent Care Locator at www.va.gov/COMMUNITYCARE/programs/veterans/UrgentCare.asp.

27  |  Foreign Medical Program

• VA’s Foreign Medical Program (FMP) provides health care payment/reimbursement for U.S. Veterans with VA-rated service-connected conditions who live or travel abroad.

• Veterans may also register by email at IRIS.va.gov.

• All other Veterans living or planning to travel outside the U.S. should register with the Foreign Medical Program, P.O. Box 469061, Denver, CO 80246-9061, USA; telephone 303-331-7590.

• For information, visit: www.va.gov/COMMUNITYCARE/programs/Veterans/fmp/index.asp.

28  |  Caregiver Programs and Services

• Caregivers are eligible for a host of VA services including services offered under the Program of General Caregiver Support Services (PGCSS).

• These services are available to eligible Veterans of any era. PGCSS includes training, education, respite care, self-care courses, and the Caregiver Support Line 1-855-260-3274 (Monday through Friday 8:00 a.m. to 8:00 p.m. EST).

• These services are available to support all caregivers, where the Veteran is enrolled for healthcare at any Veterans Health Administration facility, regardless of illness or injury.

• In addition to services offered under the PGCSS, caregivers in the Program of Comprehensive Assistance for Family Caregivers (PCAFC) may also receive a monthly stipend, beneficiary travel, mental health counseling, enhanced respite services, and health insurance, if applicable.

• Under the MISSION Act, the Department of Veterans Affairs ( VA) is working to give more family caregivers access to the PCAFC and support them as they care for Veterans of all eras.

• Currently, the PCAFC is only available to eligible Veterans injured in the line of duty on or after September 11, 2001.

• Prior to expanding eligibility for the PCAFC, VA must upgrade its information technology (IT) system and implement other improvements to strengthen the program. For detailed information about VA’s CSP and the full range of services available to caregivers, visit www.caregiver.va.gov/. For information on the MISSION Act, visit missionact.va.gov/.

29  |  Camp Lejeune Family Member Program

• The Camp Lejeune Family Member Program (CLFMP) is a medical care cost reimbursement program for family members of Veterans who were stationed at Camp Lejeune between August 1, 1953, through December 31, 1987.

• VA will reimburse eligible Camp Lejeune Family Members for health care costs related to one or more of 15 specified illnesses or medical conditions.

• For more information visit www.clfamilymembers.fsc.va.gov or call the toll-free CLFMP customer service line at 1-866-372-1144.

30  |  Traveling Veterans

• Enrolled Veterans, who receive their health care with VA, will receive the same, coordinated care, whether at their local VA treatment site or an alternate VA site of care.

• In order to help VA ensure Veterans receive consistent care while they are traveling, Veterans are asked to notify their VA Patient Aligned Care Team (PACT) and specialty care provider(s) four to six weeks before traveling, or as soon as possible.

• Early planning will allow time for PACT and the Traveling Veteran Coordinator to coordinate care at an alternate VA facility.

Downloadable PDF | A Veteran’s Guide

• VA providers at the alternate site will record the care in the Veteran’s electronic medical record for follow-up treatment options with their PACT.

• To coordinate health care with another VA health care facility, Veterans should inform their PACT of the following:

• • Travel destination(s), and temporary address

• • Valid telephone number

• • Arrival and departure dates

• • Specific care concerns

• Their PACT will contact the Traveling Veteran Coordinator, who will assist in coordinating care at the alternate facility.

• For more information, contact PACT or a Traveling Veteran Coordinator at the local VA facility.