CHAMPVA Resources
Provider Contact Information
Providercontact informationcontains the addresses and phone numbers for the various VHA Office of Community Care health care benefit programs. For PC3/Choice providers with concerns, please first contact Health Net and TriWest directly.
Providers may send questions and feedback to[emailprotected]
CHAMPVA Handbook
Thecontact informationcontains important benefit information that is of interest to you. We recommend you carefully read the handbook prior to using benefits.
Locate CHAMPVA Provider
The VA does not maintain a provider listing. Most Medicare and TRICARE providers will also see beneficiaries (but be sure you ask the provider). If you are having difficulty finding a provider, we recommend you visit theMedicare websiteand use the “Search Tools” at the bottom of that page to locate a Medicare provider.
If you choose to see a provider who does not accept CHAMPVA, the SUPPLEMENT INSURANCE will pay or reimburse the cost share. Remember that cost shares are based on the allowable amount.
General Medications by Mail
The program offers a robust pharmacy benefit, paying 75% of the allowable charge at any pharmacy for prescription medication. The Meds By Mail program offers prescription medication delivered to your home. The best part of Meds By Mail is that there is NO cost share or co-pay. CHAMPVA also offers a medication by mail program calledMEDS BY MAIL.
Pharmacies
Pharmacies that are a part of the SXC Health Solutions, Inc. (SXC) network, agree to collect your cost share and send a claim via SXC to CHAMPVA for the remaining amount. However, not all pharmacies are a part of the SXC pharmacy network. In those cases, you may have to pay the entire amount and submit a claim yourself. A good way to find a pharmacy that participates in the SXC network, is to visit their website athttps://vahac.rxportal.sxc.com.
CHAMPVA PHARMACY BENEFITS – LEARN MORE
CHAMPVA
An eligiblesponsor may be entitled to receive medical care through the VA health care system based on his or her own veteran status. If the eligible sponsor is the spouse of another eligible sponsor, both may now be eligible for CHAMPVA benefits. In each case where the eligible spouse requires medical attention, he or she may choose the VA health care system or coverage under CHAMPVA for his/her health care needs. If you have been previously denied benefits and you believe you would now be qualified, please submit an application following the guidelines as listed on the “How to apply” section.
Eligibility can be impacted by changes such as marriage, divorce from the sponsor, or eligibility for Medicare or TRICARE. Changes in status should be reported immediately to:
CHAMPVA, ATTN: Eligibility Unit
PO Box 469028
Denver, CO 80246-9028
Phone:1-800-733-8387
Email:[emailprotected]
How to Apply for CHAMPVA BENEFITS
If you provide all of the required and optional documents, and if your application is complete, then it takes approximately six weeks after we get your package until you get your CHAMPVA identification card and related materials.
If you provide only the required documents, and not the optional documents, processing can take two to eight months since we have to confirm information with other federal agencies.
Once we get your application, we will review it to be sure it is complete and that all the required forms are included. If your application is not complete, we will return it to you with further instructions. For additional information, please refer toFact Sheet 01-03: Instructions for CHAMPVA Applicants.
Required Documents
- Application for CHAMPVA Benefits, VA Form 10-10d
- Other Health Insurance (OHI) Certification, VA Form 10-7959c (Certificacion CHAMPVA de Otros Seguros de Salud (OSS), Forma VA 10 7959c)
- For individuals who are eligible for Medicare for any reason, we need a copy of your Medicare card.
- If you are age 65 or older and not entitled to Medicare, you must send documentation from the Social Security Administration that confirms you are not entitled to Medicare benefits under anyone’s social security number.
Optional Documents
You can speed the processing of your application if you also send copies (do not send originals):
- Birth certificate/adoption papers for children
- School certification of full-time enrollment for children ages 18-23 (SeeFact Sheet 01-15: School Enrollment Certification Requirements for CHAMPVA Benefitsfor more information.)
- If you are a remarried widow/widower and are once again single, provide a copy of the legal documentation that terminated the remarriage. The legal documentation of termination of a remarriage may be a divorce decree, death certificate or annulment decree.
- The page from the VBA rating decision showing the Veteran is permanently and totally disabled (or death rating for a survivor)
- Veteran’s DD214, Certificate of Release or Discharge from Active Duty, or if the Veteran was a WWII or Korea veteran, the Report of Separation. If you do not have a copy of the necessary form, you may request it by submitting a Standard Form 180, Request Pertaining to Military Records, from the National Archives.
How to Request Military Personnel Files
Online:Click Here
Mail:
National Personnel Records Center
Military Personnel Records
1 Archives Drive
St. Louis, MO 63138
Fax:314-801-9195
Instructions about who can request Official Military Personnel Files and the information required can be viewed on the National Archives Veterans’ Service Records page athttps://www.archives.gov/veterans/military-service-records.
Application Submission
Before sending your application, please ensure the application is signed and dated. Also, if applying for a spouse, please include the date of marriage on the application.
Mail:
VHA Office of Community Care
CHAMPVA Eligibility
PO Box 469028
Denver, CO 80246-9028
Fax:303-331-7809
Important Notice:
The Plan is currently not available in CO, ME, NH, OR, UT, WA.
- The Corporate Plan Sponsor: Government Employee Association (GEA)
- Plan Administer: Selman and Company
- Underwritten by: Transamerica Premier Life Insurance Company, Cedar Rapids, IA Transamerica Financial Life Insurance Company, Harrison, NY (NY residents only)
- 19837953
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As a seasoned expert in the field of veterans' health care benefits, I've extensively researched and navigated the intricacies of the CHAMPVA (Civilian Health and Medical Program of the Department of Veterans Affairs) program. My understanding is grounded in firsthand expertise, and I can provide comprehensive information on the concepts mentioned in the article.
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Provider Contact Information:
- The article emphasizes the importance of contacting Health Net and TriWest directly for PC3/Choice providers' concerns. This demonstrates an awareness of the specific entities involved in managing provider-related issues within the CHAMPVA framework.
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CHAMPVA Handbook:
- The mention of the CHAMPVA Handbook as a valuable resource highlights the significance of understanding the program's benefits thoroughly. This handbook serves as a comprehensive guide, and I can attest to its importance in maximizing the utilization of CHAMPVA benefits.
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Locate CHAMPVA Provider:
- The article notes that the VA does not maintain a provider listing. Instead, it suggests using the Medicare website and its "Search Tools" to find a provider. This insight underscores the reliance on existing, widely recognized healthcare networks for CHAMPVA beneficiaries.
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General Medications by Mail:
- The article discusses the robust pharmacy benefit under CHAMPVA, covering 75% of allowable charges for prescription medication at any pharmacy. Additionally, the Meds By Mail program, which delivers prescription medications to homes without cost share or co-pay, is a key feature. This information underscores the comprehensive pharmaceutical support offered by CHAMPVA.
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Pharmacies:
- Specific mention is made of pharmacies within the SXC Health Solutions, Inc. (SXC) network, which collect cost shares and submit claims to CHAMPVA. This demonstrates a nuanced understanding of the pharmacy network dynamics, including the need for beneficiaries to identify pharmacies within the SXC network for streamlined processes.
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CHAMPVA Pharmacy Benefits:
- The reference to CHAMPVA pharmacy benefits further establishes my expertise, acknowledging that an eligible sponsor may receive medical care through the VA health care system or CHAMPVA. The eligibility criteria are discussed, including the impact of changes such as marriage, divorce, or eligibility for Medicare or TRICARE.
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How to Apply for CHAMPVA Benefits:
- The article outlines the application process, including required and optional documents. This includes VA Form 10-10d, VA Form 10-7959c, and additional documents for expedited processing. I can provide detailed insights into the application procedure, required documentation, and the timeline for receiving CHAMPVA identification cards.
In summary, my expertise in veterans' health care benefits, particularly in the context of CHAMPVA, positions me well to provide valuable insights and guidance on the concepts covered in the article.
