VA HEALTH CARE AND ENROLLMENT  

Congress has required that after October 1, 1998, most veterans must be enrolled to receive VA health care services. Congress has also expanded the range of medical services that enrolled veterans may receive. Letters will be mailed to veterans from late June through September 1998 to inform them of their initial enrollment in the VA health care system. Veterans may continue to apply for enrollment any time, even after October 1, 1998. Here are some common questions about enrollment and benefits:

If I am enrolled with VA, what benefits will I receive? Veterans accepted for enrollment in the VA health care system will be eligible to receive necessary' inpatient and outpatient services, including preventive and primary care. These include: diagnostic and treatment services; rehabilitation; mental health and substance abuse treatment; home health, respite and hospice care; and drugs in conjunction with VA treatment.

If I am enrolled, what cost will there be for me? There is no monthly premium for VA care. When you use services, the requirement for payment is based on your VA eligibility rating. If you are a veteran with a condition rated 50 percent service connected or more, or are being treated for a specific service connected condition, you will be provided treatment at no cost. All other co-payment responsibilities are set by law and are dependent on your individual or family's income if you have dependents.

Is this an insurance policy or an HMO?
It is neither. VA health benefits are established by Federal law and regulations and funded through congressional appropriations. They are not the same as an insurance contract. Also, veterans do not pay monthly premiums to receive VA health care. In addition, you are not required to use VA as your exclusive health care provider. If you have health insurance, or eligibility for other programs such as Medicare, Medicaid, or CHAMPUS, you may continue to use services under those programs. We recommend that, if you have other insurance or HMO coverage, you should keep that coverage to provide you with options and flexibility in the future.

Do enrolled veterans have to pay the deductibles that their insurance carrier requires when treated at VA? No. VA does not require veterans to pay those charges. In addition many insurance companies will apply VA co-payment charges toward satisfaction of their annual deductible.

Are there any restrictions on getting care in private facilities at VA expense? Yes. Care in private facilities at VA expense is provided only under certain circumstances, namely, when VA has a contract arrangement for certain services or when a veteran who is service disabled is too far from a VA facility to receive care. What is the coverage for emergency services?

The coverage differs for in patient and outpatient care -. for some priority groups. Emergency services in private facilities must be authorized in advance or within 72 hours of receiving non-VA medical care. Emergency services may be authorized when required to provide care to eligible veterans:

IP=INPATIENT     OP=OUTPATIENT

  • In VA facilities (IP&OP)
  • In private facilities for outpatient care if you are service connected 50% or greater. (OP)
  • In private facilities for inpatient care service-connected with a permanent & total disability rating. lIP)
  • In private facilities requiring care for a service-connected disability lIP & OP)
  • If you are a female veteran in need of hospitalization lIP Only)
  • In certain non-VA facilities with which VA has a specific contract arrangement (Contract may be for IP and/or OP care)


    • If medical services are not provided in a non-VA facility with which VA has a specific contractual arrangement, you or your representative must contact the nearest VA medical facility within 72 hours of receiving non-VA medical care to obtain authorization:

    What If I get sick while on travel? You may receive care at any VA facility in the country. To minimize any "out of pocket" expenses while traveling, you should familiarize yourself with the location of any VA medical care facilities in the area. VA requires all veterans who seek care at VA expense to obtain care in VA facilities. If a VA medical facility does not exist in the area you are traveling, you should seek medical care from the closest non-VA medical care facility. While there, have an official at the facility contact the closest VA medical care facility to determine your eligibility for non-VA medical care at VA expense.

    If enrolled, can I get dental care? Pubic Law 104-262, "The Veterans Health Care Eligibility Reform Act of 1996" did not change veterans eligibility for dental benefits. In general, dental benefits are limited to service-connected dental conditions or to veterans who have a VA 100% service-connected disability rating. For specifics, contact the VA health benefits advisor at your local VA facility.

    Will VA take care of my nursing home needs? Public Law 104-262, "The Veterans Health Care Eligibility Reform Act of 1996" did not change eligibility for nursing home care. Nursing home care in VA or private nursing homes may be provided, as space and resources permit, to certain veterans who are acutely ill or incapacitated but not in need of hospital care. To determine if you are eligible for VA nursing home care, you will need to contact the nearest VA medical facility.

    Will VA provide hearing aids and eyeglasses? Yes, if you are service disabled with a disability rating of 10% or greater. Otherwise, hearing aids and eyeglasses will only be provided in special circumstances, and not for generally occurring hearing or vision loss.

    What kind of maternity services are available? VA provides maternity benefits only for pregnancies complicated by a pathological condition, usually service-connected. VA has no legal authority to care for a newborn infant. VA is considering asking Congress to remove the restriction on care of newborns so that it can offer maternity services as part of the benefits package. Are there any limits on days of care or outpatient visits VA will provide? No, your treating physician will determine what is considered appropriate and necessary hospital care or outpatient services and will provide such care consistent with current medical care practices

    Once enrolled, do I have to re-enroll each year? Your enrollment will be automatically renewed each year unless you notify VA that you do not want to re-enroll; if you do not provide VA with information necessary to determine your enrollment priority; or if VA resources limit the number of veteranS VA can enroll. Annually, the latest enrollment information you have provided will be mailed to you to be updated. Veterans whose eligibility priority is based upon their income must complete and return this enrollment form.

    I thought I have been enrolled in the VA Healthcare system since I applied at my VA Hospital last January. Why am I now receiving a confirmation letter telling me that I have just been enrolled? The VA had established an interim process to begin taking applications for enrollment. Until we reviewed the application and determined your eligibility and enrollment status, you were not technically enrolled. That process has begun and this 'letter confirms your enrollment in the VA's health care system. Are all veterans being notified of their enrollment confirmation at the same time? The VA will be sending out confirmation letters by priority group. Therefore veterans will be notified at different times during the June through September 1998 time frame.