CHAMPVA Health Coverage for a Veteran’s Family

If you are the spouse or dependent child of a disabled veteran, you may be eligible to receive VA health coverage benefits.  The Civilian Health and Medical Program of the Veterans Affairs, or CHAMPVA, is a comprehensive health coverage program for families of certain qualifying veteran sponsors.  CHAMPVA is similar to TRICARE – formerly CHAMPUS – and is often confused with the same.

Overview of CHAMPVA

CHAMPVA is a cost-sharing program that works much like a commercial health insurance.  Generally speaking, VA pays three-quarters of the cost of covered medical services, while the beneficiary pays the last 25%/  There is no monthly fee or premium to be paid in order to get CHAMPVA.  You can enroll and stay enrolled in the program for as long as you meet its eligibility criteria.

Some of the key benefits of CHAMPVA are:

  • A free prescription refill mailing service called Meds by Mail (MbM)
  • Access free care at VA health facilities through the CHAMPVA In-house Treatment Initiative (CITI)
  • Discounted medicine at participating network of pharmacies
  • Reduced provider charges
  • Annual cap on beneficiary’s out-of-pocket expenses
  • Reimbursement for covered medical services abroad
  • No preexisting condition clause and no medical exams prior to approval
  • Retroactive coverage period

In order to use CHAMPVA, you must find a provider that accepts it.  You can search among TRICARE or Medicare providers, who will often also accept CHAMPVA.

Eligibility Criteria for CHAMPVA

Is your spouse or parent qualified to sponsor you for CHAMPVA?  Yes, if he or she is any of the following:

  • A veteran who is rated permanently and totally disabled (P&T) by VA
  • A deceased veteran who was rated permanently and totally disabled at the time of death
  • A deceased veteran died due to a service-connected disability
  • A deceased service-member who died on active duty, but not because of misconduct, and not eligible for TRICARE benefits

Are you eligible for CHAMPVA benefits received through your veteran spouse/parent?  Yes, if you are:

  • The spouse of a veteran sponsor
  • The widow or widower of a veteran sponsor, and you have not remarried before age 55
  • The unmarried child of a veteran sponsor, under 18 if not a full-time student in an accredited school
  • The unmarried child of a veteran sponsor, under 23 if a full-time student in an accredited school
  • The unmarried child of a veteran sponsor, rated a “helpless child” by VA before 18, of any age

A spouse or widow/widower must be of the opposite sex as the veteran.  A child can be either a biological child, an adopted child or a stepchild.

[stextbox id="warning"]In all cases, you must NOT be eligible for TRICARE. If you are, you become automatically ineligible for CHAMPVA and must use TRICARE instead.[/stextbox]

Applying for CHAMPVA Coverage

To apply for CHAMPVA benefits, have the veteran add dependents to VA disability compensation through to your local VA Regional Office (VARO).  Then submit at least these required documents to CHAMPVA:

  • VA Form 10-10d, Application for CHAMPVA Benefits
  • VA Form 10-7959c, Other Health Insurance Certification
  • CHAMPVA Marriage Status Application Attachment
  • Copy of Medicare card if you are Medicare-eligible, or (if you are over 65) a letter from Social Security Administration saying you are ineligible for Medicare

You can help speed things up by also sending these optional documents:

  • Veteran spnsor’s DD214 or Report of Separation
  • VBA rating decision that shows veteran’s disability rating or death rating
  • Marriage certificate of sponsor and spouse
  • Birth certificates, adoption decrees, of children

[stextbox id="info"]You will need a valid Social Security Number for each applicant. For a newborn child, apply for an SSN as soon as possible.[/stextbox]

Address your paperwork to:

PO Box 469028
Denver, CO 80246-9028

Processing can take 4-6 weeks (all documents sent) or 2-8 months (if minimum documents only).  Upon approval, coverage begins immediately and is backdated to the first day the beneficiary was eligible for CHAMPVA.  This can be the marriage date or the day the veteran was rated permanently and totally disabled, or the birth day of a child.