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VHA Office of Community Care

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CHAMPVA

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 CC) 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 while 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 or 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 and cannot choose between the two programs.

 Benefits  |  Other Health Insurance  |  Change of Address  |  Contacting CHAMPVA
 

CHAMPVA and the Affordable Care Act

The Affordable Care Act (ACA) is a health care law that was created to expand access to affordable health care coverage for all Americans, lower costs, and improve quality and care coordination. Under the health care law, people will have health coverage that meets a minimum standard (called "minimum essential coverage"). The health care law designates CHAMPVA as fulfilling the minimum essential coverage requirement.

If you are enrolled in CHAMPVA, you do not need to take additional steps to meet the health care law coverage standards. The ACA does not change CHAMPVA benefits or out-of-pocket costs. For additional information, view the ACA information on the VA website at http://www.va.gov/aca or call our customer service center at 1-800-733-8387.

•  Fact Sheet 01-19: CHAMPVA and the Affordable Care Act (ACA)
•  Fact Sheet 01-19A: CHAMPVA and the ACA–Frequently Asked Questions

CHAMPVA will send IRS Form 1095-B, Health Coverage, annually. For 2016, the IRS has extended the deadline for filing Form 1095-B. For more information, please visit https://www.irs.gov.


Benefits

In general, CHAMPVA 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. For a complete listing of non-covered services and supplies please consult the CHAMPVA Policy Manual.

You can also find more information about CHAMPVA in one of our CHAMPVA Fact Sheets and other CHAMPVA documents available on our Publications page.


Pharmacy Benefits

Meds by Mail: Meds by Mail is a voluntary service that provides a safe, easy and cost-free way for eligible CHAMPVA and Spina Bifida beneficiaries to receive non-urgent maintenance medications delivered right to your door.

OptumRx (formerly Catamaran) Retail Pharmacy Network: OptumRx electronically processes pharmacy claims nationwide, including Puerto Rico, Guam, and the Virgin Islands. Beneficiaries are serviced through a network of more than 82,000 retail pharmacies. When you use a OptumRx pharmacy, the pharmacy may collect a 25 percent cost share (after the annual deductible has been met) before submitting the claim – saving you time.

Visit our Pharmacy Benefits page for more information.


Other Health Insurance (OHI)

If you have any other health insurance (OHI), you must notify us of any changes (dropped insurance, changes in health plans, etc.) immediately upon those changes taking effect so that proper payment can be made on your claims. If you obtain a major medical policy, you must also notify us that you have a new policy and when it takes effect. We offer several methods to update your other health insurance file. You can fax a signed, completed Other Health Insurance (OHI) Certification, VA Form 10-7959c to 303-331-7808, or mail it to:

CHAMPVA
POB 469063
Denver, CO 80246-9063

You can also call our Customer Service Center at 800-733-8387 with the name of the insurance company, type of policy and effective dates of the policy.

More information about OHI


Change of Address

If you change your address, it is vital that you update your address with CHAMPVA by using one of the three contact options below. Please sign and date mailed address change requests. If calling to update your address, please have available your old address information, as our customer service representatives will need to verify this information before updating your file.

Contacting CHAMPVA

Phone 800-733-8387
8:05 a.m. to 7:30 p.m. EST
Monday through Friday
Email Inquiry Routing & Information System (IRIS)
Mail CHAMPVA
POB 469063
Denver CO 80246-9063

Self-Service Options for CHAMPVA Providers

Eligibility, Other Health Insurance (OHI) Coverage, and Claims Interactive Voice Response (IVR) System
800-733-8387
 
Payments Vendor Inquiry System
https://www.vis.fsc.va.gov/login.aspx
 
Eligibility/Claims Status Inquiry
(Payer ID: VAHAC)
and
Medical Claims/Electronic Remittance
Advice (ERA) (Payer ID: 84146)
Change Health Care (formerly Emdeon Inc.) Electronic Claim Submissions
http://changehealthcare.com/ or 800-845-6592
For more information on receiving ERAs, please refer to Electronic Claims—Information for Providers.

More information

You can also find a list of addresses and phone numbers for all of the Office of Community Care’s various health care programs at Contact Us.