Serving Veterans and Government Employees Since 1965
The plan is designed to wrap around your current CHAMPVA benefit insurance coverage. As a result, in most cases, you will obtain reimbursement for out-of-pocket expenses not paid for by CHAMPVA.
The supplement, like the CHAMPVA health insurance program itself, assists the spouses and dependents of 100% Service Related Disabled Veterans.
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. CHAMPVA is administered by the Veterans Health Administration Office of Community Care (VHA OCC) in Denver, Colorado.
In general, the CHAMPVA program covers most health care services and supplies that are medically and psychologically necessary.
Upon confirmation of eligibility, you beneficiaries receive program material that specifically addresses covered and non-covered services and supplies in the form of a CHAMPVA handbook from U.S. Department of Veterans Affairs. For more information about CHAMPVA and the U.S. Department of Veterans Affairs, visit the VA website at https://www.va.gov/.
Doctor Office Visits
Hospitalizations
Pharmacy
Doctor Office Visits
Hospitalizations
Pharmacy
on Covered Medical Expenses*
| CHAMPVA Pays | Supplement Pays | You Pay | ||
|---|---|---|---|---|
| CHAMPVA Deductible | Individual $50 / Family $100 | $0 | $0 | $50 / $100 |
| Supplemental Plan Deductible | Individual $250 / Family $500 | $0 | $0 | $250 / $500 |
| Doctor Visits | 75% | 25% | $0 | |
| Hospital Stay | 75% | 25% | $0 | |
| Ambulance | 75% | 25% | $0 | |
| Emergency Room | 75% | 25% | $0 | |
| Medications | 75% | 25% | $0 |
| Age of Beneficiary | Quarterly Rate with First Year Discount | Base Rate*** |
|---|---|
| Under 40 | $96.12 | $108 |
| 40 - 44 | $106.80 | $120 |
| 45 - 49 | $122.82 | $138 |
| 50 - 54 | $157.53 | $177 |
| 55 - 59 | $186.90 | $210 |
| 60 - 64 | $224.28 | $252 |
| Each Child | $74.76 | $84 |
Any injuries or sickness whether diagnosed or undiagnosed, for which a covered person received medical care or treatment within the 6-month period preceding the effective date of his or her insurance will not be covered until the coverage has been in effect for 6 months. However, treatment related to new conditions will be covered immediately.
These conversations are fictitious and for illustrative purposes. Have additional questions? Call a CHAMPVA Supplement Insurance Plan Specialist at 888-214-0794.
Customer: How does the CHAMPVA Supplement work with drug co-pays?
CHAMPVA Supplement: If CHAMPVA covers that prescription, we will reimburse the co-pays after your deductibles are met.
Customer: Our son has been recently diagnosed as a Type 1 diabetic. We’re looking for insurance assistance for glucose monitors and insulin pumps. He is age 15.
CHAMPVA Supplement: We can definitely help your family! There is a six-month waiting period for preexisting conditions†, but once that time has passed, we will pick up the portion that CHAMPVA does not pay.
Customer: My husband is going through a psychiatric treatment of about 39 treatments. A co-pay every time. How would we be reimbursed?
CHAMPVA Supplement: Co-payments are paid when a claim is submitted after a deductible(s) is met (if applicable). After the co-payments are paid, submit the claim to be reimbursed.
Customer: I recently got a prescription and CHAMPVA didn’t pay any of it. Will my CHAMPVA Supplemental Plan cover it?
CHAMPVA Supplement: CHAMPVA Supplement covers most prescription drugs approved by the Food and Drug Administration. Unfortunately, if CHAMPVA does not cover your prescription, your Supplemental Plan will not either.
