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 Health Administration Center 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 veterans may look 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/CHAMPUS 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. Additionally, as the result of a recent policy change, 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. If you have been previously denied CHAMPVA benefits and you believe you would now be qualified, please submit an application following the guidelines as listed on the “How to apply” section.
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 program material that specifically addresses covered and noncovered services and supplies in the form of a CHAMPVA handbook.
Like all health programs there are certain services and supplies that are not covered by our program, some of these are:
For a complete listing of noncovered services and supplies please consult the CHAMVPA handbook.
CHAMPVA is always the secondary payer to Medicare. If you are eligible for CHAMPVA, under age 65 and enrolled in both Medicare Parts A&B, SSA documentation of enrollment in both Parts A&B is required.
For your benefits to be extended past age 65, you must meet the following conditions:
Go to Medicare web site
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 payment of claims for this child is contingent upon his/her eligibility status, as new parents you are encouraged 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 Eligibilty section of the CHAMVPA handbook).|
|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.
Remarriage: 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 55 th birthday, The Veterans Benefit Act of 2002, Public Law 107-330, allows you to keep your CHAMPVA benefits.
Termination of Remarriage: 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.
When sending correspondence, applications or claims to the Health Administration Center, please do not staple, tape or bind the materials together in any manner as this will cause a delay in your correspondence or request being processed.
CHAMPVA is managed by the VA's Health Administration Center. You can call us at 800-733-8387, Monday through Friday from 8:05 AM to 7:30 PM ET. For general questions, contact us via the Inquiry Routing & Information System (IRIS). IRIS is a tool that allows us to communicate in a secure format and will be used instead of our traditional email links. For specific guidance when using IRIS for your inquiry click here. You can also fax us at 1-303-331-7804. PLEASE do NOT fax applications to this number. Online Chat is available Monday, Wednesday, and Friday from 10:00 AM to 6:30 PM ET. We also have an automated web service available 24 hours 7 days a week at MyCHAMPVA
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 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.
If you have a general question, or need information on payment, or need to reprocess a denied claim, please send you request to:
VA Health Administration Center
PO Box 469063
Denver CO 80246-9063
For submitting new health care claims only, please use:
VA Health Administration Center
PO Box 469064
Denver CO 80246-9064
Before you ask us your question, chances are someone else has already asked it. Please check the Frequently Asked Questions (FAQ) first. Thank you.
The CHAMPVA Handbook contains important benefit information that is of interest to you. You are highly encouraged to carefully read the handbook prior to using CHAMPVA benefits.
You can view the online version here.
The CHAMPVA Policy Manual is available online.
The Health Administration Center has received quite a few complaints from beneficiaries who have insurance with Kaiser Permanente; basically, that we have not honored submitted claims. This is due to the fact that Kaiser does not provide beneficiaries the necessary data they need to submit claims for reimbursement of their cost share from CHAMPVA. We recognize that this is, and has been an ongoing problem, however, we are please to announce that we have solved that problem. This is how it works (and please pardon us for sounding so technical): in order to process a claim for a Kaiser Permanente bill that is submitted to CHAMPVA which does not include a medical diagnosis or procedure code, CHAMPVA will default to using the code V70 "General Medical Examination" for the diagnosis, and code 99499 "Unlisted evaluation and Management service" for the procedure. So that the HAC can process these claims using the new method, please provide a copy of your Kaiser Permanente card showing the amount of your copayments with your claims to assist CHAMPVA in calculating reimbursement of your cost share. Although CHAMPVA is providing this method of processing claims for beneficiaries insured by Kaiser, we urge you to request that Kaiser provide a bill that includes the following information: Tax Identification number and address of the Kaiser provider; Date of Service; Medical Code or description for the Diagnosis and the procedure; Patients responsibility or Patient Copayment for services.
The HAC needs your help - if you change your address, it is vital that you let us know your new address.
You can do this by contacting us via the Inquiry Routing & Information System (IRIS). IRIS is a tool that allows us to communicate in a secure format and will be used instead of our traditional email links. For specific guidance when using IRIS for your inquiry click here.
You can mail the information to:
PO BOX 469063
Denver, CO 80246-9063
You can call us at 800-733-8387. Please help us keep our records up to date!
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 Programs. To access the list, use either of the following link: