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 Chief Business Office Purchased Care and our offices are located in Denver, Colorado.
Due to the similarity between CHAMPVA and the Department of Defense (DoD) TRICARE program (sometimes referred to by its old name, CHAMPUS) the two are often mistaken for each other. CHAMPVA is a Department of Veterans Affairs program whereas TRICARE is a regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors. In some cases a Veteran may appear to be eligible for both/either program on paper. However, if you are a military retiree, or the spouse of a Veteran who was killed in action, you are and will always be a TRICARE beneficiary, you can´t choose between the two.
To be eligible for CHAMPVA, you cannot be eligible for TRICARE, and you must be in one of these categories:
An eligible CHAMPVA sponsor may be entitled to receive medical care through the VA health care system based on his or her own Veteran status. If the eligible CHAMPVA sponsor is the spouse of another eligible CHAMPVA sponsor, both may now be eligible for CHAMPVA benefits. In each instance 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.
CHAMPVA is always the secondary payer to Medicare. If you are under age 65 and eligible for CHAMPVA and Medicare, you must enroll in Medicare Part A and Medicare Part B to keep your CHAMPVA benefits. Social Security Administration documentation of enrollment in both Part A and Part B is required by CHAMPVA.
To continue to receive CHAMPVA benefits after age 65, you must meet the following conditions:
For more information on Medicare, please visit Medicare website
If you are expecting and you need to establish CHAMPVA eligibility for your new child, the following must be accomplished before you can submit an application.
Since the medical claims cannot be paid until the child is verified as eligible by CHAMPVA, we encourage you to take the above action as early as possible.
|Beneficiary||A CHAMPVA-eligible spouse, widow(er), or child.|
|Child||Includes birth, adopted, stepchild, or helpless child as determined by a VA regional office (see the “Rules that Impact CHAMPVA Eligibility” section of the CHAMPVA Program Guide).|
|Dependents||A child, spouse, or widow(er) of a qualifying sponsor.|
|Qualifying Sponsor||A Veteran who is permanently and totally disabled from a service-connected condition, died as a result of a service-connected condition, was rated permanently and totally disabled from a service-connected condition at the time of death, or died on active duty and whose dependents are not otherwise entitled to DoD TRICARE benefits.|
|Service-connected||A VA regional office determination that a Veteran's illness or injury is related to military service.|
|Spouse||The wife or husband of a qualifying sponsor.|
|Widow(er)||The surviving spouse of a qualifying sponsor.|
NOTE: The eligibility of a child is not affected by the divorce or remarriage of the spouse except in the case of a stepchild. When a stepchild leaves the sponsor's household, the child is no longer eligible for CHAMPVA.
Eligibility for CHAMPVA ends at midnight on the date of your remarriage, if you remarry prior to age 55. If you remarry on or after your 55TH birthday, The Veterans Benefit Act of 2002, Public Law 107-330, allows you to keep your CHAMPVA benefits.
If you are a widow(er) of a qualifying sponsor and you remarry and the remarriage is later terminated by death, divorce, or annulment you may reestablish CHAMPVA eligibility. The beginning date of your re-eligibility is the first day of the month after termination of the remarriage or December 1, 1999, whichever date is later. To reestablish CHAMPVA eligibility, copies of the marriage certificate and death, divorce, or annulment documents (as appropriate) must be provided.
In general our CHAMPVA program covers most health care services and supplies that are medically and psychologically necessary. Upon confirmation of eligibility, you will receive a CHAMPVA Program Guide that specifically addresses covered and non-covered services and supplies.
Like all health programs there are certain services and supplies that are not covered by CHAMPVA, some of these are:
For a complete listing of non-covered services and supplies please consult the CHAMPVA Program Guide.
We do not maintain a provider listing. Most Medicare and TRICARE providers will also accept CHAMPVA (but be sure you ask the provider). To find a provider, we recommend you visit the Medicare website or the TRICARE website 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 to CHAMPVA for reimbursement. Remember that CHAMPVA payments are based on the CHAMPVA allowable amount, and you may receive a reimbursement from CHAMPVA that is considerably less than you paid to the provider.
You can read more about CHAMPVA by visiting the Fact Sheets posted on our website.
For CHAMPVA contact information, please visit Contact Us
Kaiser does not provide beneficiaries the necessary information needed to submit claims for reimbursement to CHAMPVA. To process a claim for a Kaiser Permanente bill, which does not include a medical diagnosis or procedure code, CHAMPVA can use code V70 for the diagnosis and code 99499 for the procedure.
So that the Purchased Care can process claims using this method, please provide a copy of your Kaiser Permanente card showing the amount of your co-payments with your claims. Although CHAMPVA is providing this method of processing claims for beneficiaries insured by Kaiser, we urge you to request a bill from Kaiser that includes the following information:
Many claims never reach CHAMPVA because they are sent to the incorrect address. Please ensure that you have the most current address information on file for CHAMPVA.
The Department of Health and Human Services, Office of Inspector General (HHS OIG) maintains and publishes a monthly list of individual medical providers that are not allowed to provide medical services and supplies to Federal health care program participants. Medical providers on this list have been convicted in State or Federal court of certain felonies, criminal offenses, or have had other offenses toward Federal Agencies related to the delivery of health care. Mandatory exclusions include, but are not limited to, convictions related to patient abuse or neglect, felony convictions related to health care fraud, and controlled substances.
Excluded individual medical providers and medical institutions cannot, by law, receive payments for health care services or supplies from any Federal health care program. That exclusion includes programs funded by the Department of Veterans Affairs such as CHAMPVA, Foreign Medical Program (FMP), Spina Bifida, and the Children of Women Vietnam Veterans Health Care Program. To access the list, use either of the following link: