VA CHAMPVA plan we can sink our teeth into, dental coverage

All veterans eligible for VA dental coverage
JC Journal
Columnists
Randy Fairchild
Health
April 13, 2014

For the first time in history, the U.S. government has authorized a national dental insurance program for veterans enrolled in Veterans Affairs health care and individuals enrolled in VA’s CHAMPVA program.

Premium rates will vary depending on your geographic region and the plan option you select. There are three options that are available: basic, enhanced and comprehensive. These plans range from about $8 for the basic up to about $27 for comprehensive.

In the Tippecanoe County area there are many dentists who have signed up for this program. Veterans will not be getting dental care done by the VA but veterans must be signed up with the VA for health care to be eligible for the dental insurance plan.

As stated above, this is the first time that the VA has actually assisted veterans with dental care except for those veterans rated at 100 percent service-connected, have a service-connected disability for a dental injury, or on the VA Voc-Rehab program.
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CHAMPVA will cover dental!

VA Offers Dental Insurance Program

WASHINGTON (Nov. 15, 2013) – 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 beginning Nov. 15, VA officials announced today.  

“VA continues to explore innovative ways to help Veterans get access to the care and services they have earned and deserve,” said Secretary of Veterans Affairs Eric K. Shinseki. “This new dental program is another example of VA creating partnerships with the private sector to deliver a range of high-quality care at an affordable cost, for our Nation’s Veterans.”

More than 8 million 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 beginning Nov. 15.  Coverage for this new dental insurance will begin Jan. 1, 2014, and will be available throughout the United States and its territories. 

Also eligible for the new benefits are nearly 400,000 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 and endodontic/restorative treatment.  Enrollment in the VA Dental Insurance Plan (VADIP) is voluntary.  Participants are responsible for all premiums, which range from $8.65 to $52.90 per month for individual plans.  Copayments and other charges may apply.

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.

Bill may finally cover adult children under CHAMPVA

Right now medical insurance is costing us almost $1,000 a month even though my husband is 100% disabled and I get CHAMPVA. My deductible is $2,500 a year if they were my primary insurance but we have two problems. One is Lake Nona Hospital has not opened yet and it is better to have the extra coverage for my husband if something happens and he needs to go to a hospital. The other reason is our adult daughter. Without private insurance, she wouldn't have any coverage. This is yet one more of the untold things disabled veterans families are going through. I was shocked when the VA told me adult children would not be covered under the current rules. This is the right thing to do.

Bill would extend CHAMPVA to adult children
Army Times
By Patricia Kime
Staff writer
Posted : Wednesday Feb 20, 2013

A bill has been introduced in the Senate that would increase the age limit for veterans’ children to get health coverage under the Veterans Affairs’ Department’s Civilian Health and Medical Program, known as CHAMPVA, bringing it in line with the Affordable Care Act.

Sens. Patty Murray, D-Wash., and Jon Tester, D-Mont., introduced legislation Feb. 14 that would allow CHAMPVA beneficiaries to keep coverage until age 26. Currently, beneficiaries lose coverage at age 18 unless they are enrolled as full-time students. Then, they become ineligible at age 23.

The bill would create program parity with age requirements of the Affordable Care Act, which now allows adult children to remain on their parents’ health insurance until age 26.

“As more and more service members return home from Afghanistan, CHAMPVA will continue playing a vital role in caring for veterans’ loved ones,” Murray said in a release. “In our ongoing commitment to keep the faith with our nation’s heroes, this bill ensures CHAMPVA recipients, without regard to their type of coverage, student status, or marital status, are eligible for health care coverage under their parent’s plan in the same way as their peers.”

The bill is similar to a law passed in January 2011 that increased coverage for adult children of Tricare beneficiaries, bringing it on par with the Affordable Care Act.
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What is CHAMPVA?

This is from the VA website. Keep it handy if your spouse is a disabled veteran. You should be getting what goes along with that and not do without what your spouse alredy paid for with his/her service.

Frequently Asked Questions
What is CHAMPVA?
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 (see Eligibility Fact Sheet 01-3 for criteria for CHAMPVA coverage).

CHAMPVA is managed by the VA’s Health Administration Center (HAC) in Denver, Colorado. We process CHAMPVA applications, determine eligibility, authorize benefits, and process medical claims.

Who is eligible for CHAMPVA?
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.

How Can I Locate a Provider?
We do 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 (http://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.

What does CHAMPVA pay?
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. See Payment Methodology Fact Sheet 01-11 for further information regarding payment on other than outpatient type of services.

Can a beneficiary have other insurance and use CHAMPVA?
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.

What is the impact of Medicare on CHAMPVA?
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.

How do I get more information?
Mail: VA Health Administration Center
CHAMPVA
PO Box 409028
Denver, CO 80206-9028

Phone: 1-800-733-8387
Monday - Friday

FAX: 1-303-331-7804

Inquiry Routing & Information System (IRIS). For specific guidance when using IRIS for your inquiry click here.

Website: www.va.gov/hac


What is the difference between CHAMPVA and TRICARE (formerly CHAMPUS)?
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.

How can I obtain an application for CHAMPVA benefits?
There are a couple ways to obtain an Application for CHAMPVA Benefits (VA Form 10-10D):

Fillable Application
Call the Health Administration Center 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.

From the time an application is submitted, how long before I can expect a response from the Health Administration Center?
Generally, applicants can expect to receive written notification from the Health Administration Center 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)

Why is CHAMPVA the secondary payer when beneficiaries have other health insurance (OHI)?
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 benefits available from the enrollment in a health maintenance organization (HMO), preferred provider organization (PPO), Medicare or other health insurance. Exceptions to CHAMPVA's secondary payer status are supplemental CHAMPVA policies, Medicaid, and State Victims Compensation Programs - CHAMPVA becomes the primary payer in these cases.

Are CHAMPVA benefits available to beneficiaries with other health insurance (OHI) coverage through a Health Maintenance Organization (HMO), who elect to receive HMO-covered services outside of the HMO network?
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.

Are healthcare services at VA facilities available to CHAMPVA beneficiaries?
Under the CHAMPVA Inhouse Treatment Initiative (CITI for short), CHAMPVA beneficiaries may receive cost-free healthcare services at participating VA facilities.

How can I find out if the local VA facility is participating in the CITI program?
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.

What out-of-pocket expenses can a CHAMPVA beneficiary expect under CITI?
None - CHAMPVA beneficiaries don’t pay a thing when receiving services under the CITI program.

Isn’t it unfair that some VA facilities are offering CITI services, while others aren’t? Shouldn’t they all participate?

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.

How does my annual deductible and catastrophic cap work?
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.
go here for links and to find answers to your questions

http://www.va.gov/hac/forbeneficiaries/champva/faqs.asp