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The Civilian Health & Medical Program of the Department of Veterans Affairs ( is a health benefits program in which the Department of Veterans Affairs ( shares the cost of certain health care services & supplies with eligible beneficiaries.

Bạn đang xem: Đồ đôi mẹ và bé chất lượng, giá cạnh tranh, với nhiều ưu is managed by the Veterans Health Administration Office of Integrated Veteran Care (VHA IVC) in Denver, Colorado. We verify eligibility, authorize benefits, & process medical claims.

To be eligible for, the beneficiary cannot be eligible for TRICARE. provides coverage khổng lồ the spouse or widow(er) và to the children of a Veteran who:

is rated permanently & totally disabled due to a service-connected disability, ORwas rated permanently & totally disabled due to a service-connected condition at the time of death, ORdied of a service-connected disability, ORdied on active duty và the dependents are not otherwise eligible for Department of Defense TRICARE benefits.

Effective October 1, 2001, benefits were extended lớn those age 65 & older. Lớn be eligible for, you must also meet the following conditions:

If the beneficiary was 65 or older prior lớn June 5, 2001, and was otherwise eligible for, và was entitled lớn Medicare Part A coverage, then the beneficiary will be eligible for without having to have Medicare Part B coverage.If the beneficiary turned 65 before June 5, 2001, and has Medicare Parts A and B, the beneficiary must keep both Medicare Parts A và B khổng lồ be eligible for the beneficiary turned age 65 on or after June 5, 2001, the beneficiary must be enrolled in Medicare Parts A and B khổng lồ be eligible for

In most cases,"s allowable amount—what we pay for specific services & supplies—is lớn Medicare/TRICARE rates. has an outpatient deductible ($50 per beneficiary per calendar year or a maximum of $100 per family per calendar year) và a patient cost mô tả of 25% of our allowable amount up lớn the catastrophic cap ($3,000 per calendar year). Beneficiaries should NOT send checks to VHA OCC for their annual deductible; as claims are processed, charges are automatically credited to individual and family deductible requirements for each calendar year.

If your provider accepts assignment, which means the provider accepts, the provider agrees lớn accept our allowable amount as payment in full. A provider cannot bill you for the difference between our allowable amount and their normally billed amount.

If the patient has other health insurance, then pays the lesser of either 75% of the allowable amount after the $50 calendar year deductible is satisfied, or the remainder of the charges và the beneficiary will normally have no cost share. Review the Deductibles & Copays fact sheet for further information regarding payment on other than outpatient type of services.

Fact Sheet: Deductibles and Copays

Yes. If the beneficiary has other health insurance (OHI), the OHI should be billed first. The explanation of benefits (EOB) from the OHI should then be submitted with the claim for reimbursement khổng lồ

By law, is always the secondary payer except khổng lồ Medicaid, State Victims of Crime Compensation Programs, Indian Health Services, and supplemental policies.

How can I locate a provider?

Information about providers can be found on our Locating a Provider page.

What is the impact of Medicare on

As a result of a federal law passed June 5, 2001, expanded benefit coverage lớn eligible family members and survivors of qualifying Veteran sponsors effective October 1, 2001.

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If the beneficiary is eligible for & also has Medicare Part A entitlement (premium-free hospitalization coverage) và Medicare Part B (outpatient coverage), we will cover many of the costs not covered by Medicare. will pay after Medicare & any other insurance, such as Medicare HMOs and Medicare supplemental plans, for health care services và supplies. does not pay Medicare Part B premiums.

Although similar, is a completely separate program with a totally different beneficiary population than TRICARE — a Department of Defense health care program formerly called CHAMPUS.

While the benefits are similar, the programs are administered separately with significant differences in claim filing procedures and preauthorization requirements.

There are a couple ways khổng lồ obtain an Application for Benefits, form 10-10d:

Online: Application for Benefits, khung 10-10d

Call VHA Office of Integrated Care at 800-733-8387, 8:00 a.m. To lớn 7:30 p.m. ET, Monday through Friday.When calling, select the "Application Form" option from the Interactive Voice Response menu.

From the time an application is submitted, how long before I can expect a response from the VHA Office of Integrated Veteran Care?

Generally, applicants can expect to lớn receive written notification from the VHA Office of Integrated Veteran Care within 45 days after mailing their application. To lớn streamline the process, applicants are encouraged khổng lồ complete the Application for Benefits in its entirety và to attach all required documents. As further explained on the application, required documents include a copy of each applicant"s Medicare card (if eligible for Medicare) and a School Enrollment Certification Letter for all applicant children between the ages of 18 & 23 years.

Are benefits to lớn beneficiaries with other health insurance who choose khổng lồ receive covered services from a provider who is not in their primary insurance network? will deny payment on a claim if the beneficiary’s OHI denied payment because the beneficiary obtained the medical services or supplies outside the OHI (HMO, PPO, và Medicare) provider"s plan.

Under the In-house Treatment Initiative (CITI), beneficiaries may receive cost-free health care services at participating facilities.

Although some facilities are not In-house Treatment Initiative (CITI) participants due to the volume of Veterans they are responsible for serving, many are. Lớn find out if your local facility is participating, view our online CITI Participating Facilities list. However, beneficiaries who are also covered by Medicare cannot use a medical center because Medicare does not pay for services provided by a Medical Center.

Participating CITI Facilities List

None. beneficiaries don’t pay out-of-pocket expenses when receiving services under the In-house Treatment Initiative (CITI) program.