Paul Sanchez
If you're the spouse, dependent, or survivor of a veteran who meets certain service-connected disability requirements, you may qualify for health care benefits through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). You can apply for CHAMPVA online, by mail, or by fax. To apply, you'll need to fill out an Application for CHAMPVA Benefits (VA Form 10-10d) and submit supporting documents, including a completed CHAMPVA-Other Health Insurance Certification (VA Form 10-7959c) and a copy of your health insurance or Medicare card. After applying, you'll receive a CHAMPVA ID card by mail, which can take up to 6 weeks. CHAMPVA covers most health care services and supplies, including prescription medications, skilled nursing care, and limited vision coverage. It's important to note that CHAMPVA doesn't cover eyeglasses or contact lenses except in certain cases. Additionally, certain types of care and services require advance approval or preauthorization.
| Characteristics | Values |
|---|---|
| Who is eligible for CHAMPVA? | Spouse, dependent, or survivor of a Veteran who meets certain service-connected disability requirements. |
| Who is not eligible for CHAMPVA? | Military retirees, or the spouse of a veteran killed in action. |
| How to apply for CHAMPVA? | Online, by mail, or by fax. |
| What to submit with the application? | Completed CHAMPVA-Other Health Insurance Certification (VA Form 10-7959c), a copy of the front and back of your health insurance card or Medicare card, and a copy of the front and back of your Medicare Part D card (if you have Medicare Part D for prescription coverage). |
| What happens after applying for CHAMPVA? | You will receive an ID card by mail within 6 weeks. |
| What is covered under CHAMPVA? | Prescription medications, skilled nursing care, dental insurance, and limited vision coverage. |
| What is not covered under CHAMPVA? | Eyeglasses or contact lenses except in certain cases. |
| What is the cost-sharing under CHAMPVA? | The beneficiary's share is usually 25%, and CHAMPVA pays the remaining 75%. |
| What is the CHAMPVA supplemental insurance plan? | A plan designed to provide protection from out-of-pocket costs, doctor bills, hospital and pharmacy costs, and catastrophic expenses. |
| Who is the CHAMPVA program administered by? | The Veterans Health Administration Office of Community Care (VHA OCC) in Denver, Colorado. |
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What You'll Learn
Who qualifies for CHAMPVA insurance?
If you are the spouse, dependent, or survivor of a Veteran who meets certain service-connected disability requirements, you may qualify for health care benefits through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA).
You may be eligible for CHAMPVA if you don't qualify for TRICARE (the Defense Department's health care program for service members and their families) and one of the following descriptions is true for you:
- You are the spouse or dependent child of a Veteran who has been rated permanently and totally disabled from a service-connected disability.
- You are the surviving spouse or dependent child of a Veteran who died from a service-connected disability.
- You are the surviving spouse or dependent child of a Veteran who, at the time of their death, was rated permanently and totally disabled from a service-connected disability.
- You are the surviving spouse or dependent child of a service member who died in the line of duty, not due to misconduct.
If you are covered under CHAMPVA as a dependent child and you turn 18 years old, you will need to send proof that you are enrolled full-time in high school, college, or another educational institution to keep receiving benefits. You must also recertify at least once a year.
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How to apply for CHAMPVA insurance
CHAMPVA is a health insurance program provided by the Department of Veterans Affairs to Dependency and Indemnity Compensation recipients. It is a cost-sharing program where the VA shares the cost of certain healthcare services and supplies with eligible beneficiaries.
Who is eligible for CHAMPVA insurance?
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program for the spouse, widow(er), dependent, or survivor of a Veteran who meets certain service-connected disability requirements. You may be eligible for CHAMPVA if you don’t qualify for TRICARE (the Defense Department’s health care program for service members and their families).
You can apply for CHAMPVA online, by mail, or by fax. You will need to fill out an Application for CHAMPVA Benefits (VA Form 10-10d) and submit the required supporting documents. The supporting documents include:
- A completed CHAMPVA-Other Health Insurance Certification (VA Form 10-7959c)
- A copy of the front and back of your health insurance card or Medicare card
- If you have Medicare Part D for prescription coverage, you’ll also need to submit a copy of the front and back of your Medicare Part D card.
You can submit your documents online by filling out VA Form 10-7959c and uploading copies of your cards. Alternatively, you can download a PDF of VA Form 10-7959c, fill it out, and send the completed, signed form along with copies of your cards to the address listed on the PDF.
After you apply for CHAMPVA, you will receive an ID card by mail, which can take up to 6 weeks to arrive.
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Documents required for CHAMPVA insurance
To apply for CHAMPVA insurance, you must fill out an Application for CHAMPVA Benefits (VA Form 10-10d). You must also submit the following supporting documents:
- A completed CHAMPVA-Other Health Insurance Certification (VA Form 10-7959c)
- A copy of the front and back of your health insurance card or Medicare card. If you have Medicare Part D for prescription coverage, you must also submit a copy of the front and back of your Medicare Part D card.
- If you are eligible for Medicare for any reason, you must submit a copy of your Medicare card. If you are 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.
- If you are covered under CHAMPVA as a dependent and you turn 18, you must send proof that you are enrolled full-time in high school, college, or another educational institution to keep receiving benefits. You must recertify at least once a year.
- If you are a remarried widow/widower and are once again single, you must provide a copy of the legal documentation that terminated the remarriage.
- 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.
CHAMPVA is a health benefits program for the spouses, dependents, and survivors of Veterans who meet certain service-connected disability requirements.
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Cost and coverage of CHAMPVA insurance
The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. The program is administered by the Veterans Health Administration Office of Community Care (VHA OCC) in Denver, Colorado.
CHAMPVA covers most health care services and supplies. Some of the types of care CHAMPVA covers include:
- Prescription medications through Meds by Mail and local pharmacies
- Skilled nursing care (medical care by licensed providers to help with medications, wound care, and other recovery and medical needs)
CHAMPVA offers limited vision coverage and does not cover eyeglasses or contact lenses except in certain cases. If you have other health insurance with prescription coverage, you cannot use Meds by Mail. This includes prescription coverage through Medicare. For urgent prescriptions, you can go to a local pharmacy in the OptumRx network. You’ll need to pay 25% of the cost of prescriptions through OptumRx. If you go to a pharmacy that’s not in the OptumRx network, you’ll need to pay out of pocket for the prescription. Then you can file a claim for reimbursement.
If you’re covered under CHAMPVA as a dependent child and you turn 18 years old, you’ll need to send proof that you’re enrolled full-time in high school, college, or another educational institution to keep getting benefits. To avoid a gap in benefits between your high school graduation and your first college term, you can send your college acceptance letter. You must send a school certification letter within 1 month after your first school term begins. You’ll need to recertify at least once a year.
The CHAMPVA Supplemental Insurance Plan is a private insurance plan designed to supplement your CHAMPVA benefit insurance coverage. It assists the spouses and dependents of 100% Service-Related Disabled Veterans. The plan will pay your cost share for both covered inpatient and outpatient medical expenses after you satisfy the calendar year plan deductible of $250 per person, $500 family maximum.
The GEA CHAMPVA Supplemental Insurance Plan, when combined with your CHAMPVA benefits, is designed to provide peace of mind and help protect you from out-of-pocket costs, doctor bills, hospital, pharmacy costs, and catastrophic expenses when you need them. The plan will pay your cost share (25%) for both covered inpatient and outpatient medical expenses after you satisfy the calendar year plan deductible.
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CHAMPVA insurance for dependent children
CHAMPVA, or the Civilian Health and Medical Program of the Department of Veterans Affairs, is a cost-sharing program that provides healthcare coverage for eligible dependents of qualifying veterans. This includes dependent children under the age of 18 or those under 23 if enrolled in school full-time.
To apply for CHAMPVA benefits for a dependent child, you need to submit the CHAMPVA application form VA Form 10-10d, along with the required documentation. The required documents include the Veteran's information, the child's birth certificate, and proof of the child's dependency. You can find the form on the VA's website—download, fill, and submit it by mail, online, or by fax.
CHAMPVA covers most medically necessary services and supplies, including inpatient and outpatient care, prescription medications, mental health care, maternity and newborn care, and preventive services. It also provides limited dental care for children. However, it is important to note that CHAMPVA does not cover eyeglasses or contact lenses except in certain cases.
If you are covered under CHAMPVA as a dependent child and you turn 18 years old, you must provide proof of full-time enrollment in high school, college, or another educational institution to continue receiving benefits. You must also recertify at least once a year.
The CHAMPVA Supplemental Insurance Plan is also available to GEA members and their dependents. This plan helps protect against out-of-pocket costs, doctor bills, hospital and pharmacy costs, and catastrophic expenses. It pays the cost-share (25%) for covered inpatient and outpatient medical expenses after satisfying the calendar year plan deductible.
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Frequently asked questions
CHAMPVA stands for the Civilian Health and Medical Program of the U.S. Department of Veterans Affairs (VA). It is a comprehensive health care program for the spouse or widow(er) and children of an eligible Veteran.
You may qualify for CHAMPVA if you are the spouse, dependent, or survivor of a Veteran who meets certain service-connected disability requirements. You may also be eligible if you don't qualify for TRICARE, the Defense Department's health care program for service members and their families.
You can apply for CHAMPVA online, by mail, or by fax. You'll need to fill out an Application for CHAMPVA Benefits (VA Form 10-10d) and submit the required supporting documents.
You will need to submit a completed CHAMPVA-Other Health Insurance Certification (VA Form 10-7959c) and a copy of the front and back of your health insurance card or Medicare card. If you have Medicare Part D for prescription coverage, you'll also need to submit a copy of your Medicare Part D card.
CHAMPVA covers most health care services and supplies, including skilled nursing care and prescription medications. It also offers limited vision and dental coverage.
