CHAMPVA

HOW TO APPLY FOR CHAMPVA

• APPLICATION: https://www.va.gov/vaforms/medical/pdf/vha-10-10d-fill.pdf 

• OTHER HEALTH INSURANCE CERTIFICATION: https://www.va.gov/find-forms/about-form-10-7959c/

• 18-23 SCHOOL ENROLLMENT CERTIFICATION INFO: School Enrollment Certification Requirements for CHAMPVA Benefits 

FAX OR MAIL: 303-331-7809

VHA Office of Community Care

CHAMPVA Eligibility

PO Box 469028

Denver CO 80246-9028

To speed up processing of your application, you can send copies (not originals) of these optional documents:

• The page from the VBA rating decision showing your Veteran is permanently and totally disabled (or the death rating if you’re a survivor). 

• 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 don’t 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.

• Find out how to request military service records online, by mail, or by fax https://www.archives.gov/veterans/military-service-records

• Documents related to any dependent children you’re including in your application:

• A copy of each child’s birth certificate or adoption papers

• School certification of full-time enrollment for children ages 18-23. Download the fact sheet on school enrollment certification requirements (PDF) https://www.va.gov/.../pub.../factsheets/FactSheet_01-15.pdf

CHAMPVA

(The Civilian Health and Medical Program of the Department of Veterans Affairs):

CHAMPVA is for dependents of Permanent & Total (P&T) Veterans, approved Care Givers receiving the care giver stipend, and survivors receiving DIC (Dependent Indemnity Compensation).

• CHAMPVA is a cost share program in which the VA pays 75% of the allowable amount (Medicare rate) and you are responsible for 25% of the allowable amount for all medical procedures, prescriptions and durable medical equipment.

• CHAMPVA is for dependents, not the Veteran unless the Veteran's spouse is P&T.

• CHAMPVA is always the payer of last resort.

• If you are TRICARE eligible you cannot use CHAMPVA and you cannot choose between the two if you meet the eligibility criteria for both programs

• For a single dependent there is a $50 annual deductible, $100 for a family.

• Looking at the 25% above, once you have paid $3,000 in the calendar year out of pocket, the 75%/25% now becomes 100%. So, CHAMPVA will pay 100% for the rest of the calendar year.

• The initial application normally takes about 8 weeks to process. You must have a separate application for each dependent. Upon receiving your CHAMPVA card you have 180 calendar days to gather and submit all medical/pharmacy/durable medical equipment receipts going back to the date the veteran was awarded “Permanent and Total” disability status by the VA.

• CHAMPVA is available for children qualified veterans up to the age of 18. If the child is enrolled full time in an accredited learning institution, eligibility is extended to 23 years. Verification is made by submitting a letter from the school’s registrar indicating full time enrollment and prospective graduation date. You must self-certify every subsequent year or if the child changes schools.

• CHAMPVA is not an insurance since it has NO MONTHLY PREMIUMS and NO PRE-APPROVED LIST OF PROVIDERS.

• You may use any provider that is not on the Medicare Exclusion List. The preferred method is for the provider to bill CHAMPVA electronically, but if the provider refuses, you may submit a paper claim to CHAMVPA for reimbursement. NOTE: Never pay the billed amount from the provider. This is rarely the allowable amount (Medicare rate) and generally greatly exceeds that amount. If you pay the billed amount CHAMPVA will only reimburse you 75% of the allowable amount, same as the provider and you will have no recourse to get your money back from the provider. Once the provider has received payment from CHAMPVA and yourself, they cannot demand payment on the balance of the billed amount. That is illegal and in violation of the Balanced Billing Act of 1993. Contact CHAMVPA if this is happening.

• If you are eligible for Medicare at any time in your life you are required to accept and maintain both Medicare Part A (inpatient) and Part B (outpatient). Part B has a premium which will be taken from your Social Security payment monthly. You are not required to accept Medicare Part D (pharmacy) because CHAMVPA has a pharmacy benefit.

• In some areas, CHAMPVA recipients can use VA facilities for free. This is called CITI. Call your VAMC Community Care office to see if this is an option in your area.

• CHAMPVA has a no cost mail out pharmacy program called Meds by Mail. MBM is not available if you have other health insurance covering prescriptions.

• The Payer ID for electronic claims submission is 84146 for medical claims.

CHAMPVA Guide : https://www.va.gov/COMMUNITYCARE/docs/pubfiles/programguides/champva_guide.pdf

Phone Numbers

CHAMPVA/CHAMPVA Authorization 1-800-733-8387

Mental Health 1-800-424-4018

Meds-By-Mail (MbM) 

East Coast 1-866-229-7389

West Coast 1-888-385-0235

Refills  1-888-370-1699

Medicare Helpline 1-800-MEDICARE (1-800-633-4227)

TTY 1-877-486-2048

Social Security Administration - For help with questions about Medicare, social Security for retirement benefits or disability benefits

1-800-772-1213

TTY 1-800-325-0778

OptumRx Retail pharmacy network 1-888-546-5502