Beneficiary: a CHAMPVA-eligible spouse, surviving spouse, child, stepchild, or an adopted child. Chapter 1, Section 2.3
CHAMPVA: CHAMPVA is an acronym for Civilian Health and Medical Program of the Department of Veterans Affairs. The program is a federal health care plan for the spouse and child of a CHAMPVA qualified veteran sponsor. Chapter 1, Section 1.1
Child: includes birth, adopted, stepchild, or helpless child as determined by a VA Regional Office (see the Rules that Impact CHAMPVA Eligibility section of this handbook). Note: Helpless child status is determined by Veterans Benefits Administration (VBA). Chapter 1, Section 2.5
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 at the time of
death, or died on active duty and whose dependents are not otherwise
entitled to DoD TRICARE benefits.
Chapter 1, Section 2.2
An award of permanent
and total disability under 38 USC 1151 or 1160 is not a
basis for determining a veteran's eligibility as a
qualifying sponsor for CHAMPVA.
38 USC 1151 relates to
awards for injuries incurred
aggravation of an injury as a result of hospitalization, medical or surgical treatment, through the pursuit of a course of vocational rehabilitation under 38 USC, Chapter 31
or while in a
VA vocational rehabilitation program.
38 USC 1160 relates to
an award for a veteran who has a service connected
disability for a paired organ or extremity as a result of a service-connected disability and subsequently loses the use of or function of the organ or extremity, although such a loss is not service-connected, may receive an award of P&T disability. However, an award of P&T disability under 38 USC, Section 1160, does not qualify a veteran as a CHAMPVA sponsor.
Service Connected Disability: a VA Regional Office determination that a veteran's illness or injury is related to military service.
Chapter 1, Section 2.2
Widow(er):
A spouse or surviving spouse of a qualifying CHAMPVA sponsor is entitled to coverage for medical services as described in Chapter 2 of the CHAMPVA Policy Manual. Chapter 1, Section 2.4
Veteran: A person who served in one of the seven branches of active military services (Air Force, Army, Coast Guard, Marine Corps, Navy, and commissioned officers of Public Health Service and National Oceanic and Atmospheric Administration), and who was discharged or released from active duty services under conditions other than dishonorable.
Chapter 1, Section 2.2
Who is Eligible for CHAMPVA:
CHAMPVA provides coverage to the spouse or widow(er) and to the children of a veteran who:
is rated permanently and totally disabled due to a service-connected disability, and the dependents are not otherwise eligible for DoD TRICARE benefits
was rated permanently and totally disabled due to a service connected condition at the time of death, and the dependents are not otherwise eligible for DoD TRICARE benefits
died of a service-connected disability, and the dependents are not otherwise eligible for DoD TRICARE benefits
died on active duty, and the dependents are not otherwise eligible for DoD TRICARE benefits.
NOTE:
CHAMPVA Qualified Spouse, Widow/er, Child, or Surviving Child who is incarcerated are not eligible for CHAMPVA benefits during the period of time of incarceration.
CHAMPVA Qualified Spouse, Widow/er, Child, or Surviving Child who is a fugutive felon are not eligible for CHAMPVA benefits during the period of time of being a fugitive felon.
If the CHAMPVA Qualified Veteran Sponsor is incarcerated, CHAMPVA benefits are still available to the CHAMPVA qualifying spouse and child of the veteran.
If the CHAMPVA Qualified Veteran Sponsor is a fugitive felon, CHAMPVA benefits are not available to the CHAMPVA qualifying spouse and child of the veteran during the period of time the sponsor is a fugitive felon.
In most cases, the dependents of service members who die while on active duty are covered under DoD TRICARE. Dependents are generally TRICARE eligible except in the case of a widow/er who remarries.
when a reservist is on active duty or active duty for training.
7. Who is eligible for CHAMPVA:
When a reservist is on active duty or active duty for training
Note: When the reservist turns age 60, and receives a retired status, the reservist and eligible family members become TRICARE eligible.
CHAMPVA 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, P.O. Box 469028, Denver, CO 80246-9028 or call 1-800-733-8387.
