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Veterans enrolled in the VA health care system are eligible to receive necessary hospital and outpatient services, including preventive and primary care. These services include: diagnostic and treatment services; rehabilitation; mental health; substance abuse treatment; home health, prosthetic equipment, respite and hospice care; and medications in conjunction with VA treatment. 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 TRICARE, 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.
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Priority Group 8 and certain other veterans are responsible for VA's inpatient copay of $1,068 for the first 90 days of care during any 365-day period. For each additional 90 days, this charge is $534. In addition, there is a $10 per diem charge.
NOTE: VA's inpatient copay rate is based on the current Medicare deductible of $1,068.
A three-tiered copay system is used for all outpatient services. The copay is $15 for a primary care visit and $50 for some specialized care. Certain services are not charged copays.
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VA asks you to identify the health care facility where you would like to receive your primary care. A preferred facility may be any VA health care location, for example, VA health care facility, independent clinic, or community based outpatient clinic. If VA is unable to provide your needed health care, that facility will make arrangements to refer you to another VA health care facility or to one of VA’s private sector affiliates to provide the required care.
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Yes, generally, to receive medications from a VA pharmacy, the prescriptions must be written by a VA health care provider. Most veterans are currently charged $8 for each 30-day or less supply of medication provided by VA for treatment of conditions that are not service-connected. For veterans enrolled in Priority Groups 2 through 6, the maximum copay for medications that will be charged in calendar year 2009 is $960.
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There are three options. The first option is to request a Waiver from paying your current debt. If you request a waiver, you must submit sufficient proof that you cannot financially afford to make payment to VA. For assistance in applying for a waiver, contact the Revenue Coordinator at the VA health care facility where you receive care. The second option is to request a Hardship Determination to avoid future medical care copay charges. You will need to submit specific financial information about your current year income. If you are approved for a hardship determination, your copay status will change and your enrollment priority will improve. For further information on applying for a hardship determination, contact your Enrollment Coordinator. The third option is to request an Offer in Compromise, which is an offer for past debts only and acceptance of a partial payment in settlement and full satisfaction of the debt at the time the offer is made. If you request an offer in compromise, you must submit sufficient proof that you cannot financially afford to make payment to VA. For assistance in applying for an offer in compromise, contact the Revenue Coordinator at the VA health care facility where you receive care.
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To schedule an appointment, contact your local VA health care facility.
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In general, dental benefits are limited to dental conditions determined by VA to be service-connected, veterans who were Prisoners of War, and veterans who are receiving 100% SC disability compensation. For specifics, contact the VA health benefits advisor at your local VA health care facility.
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The following veterans will be offered nursing home care when appropriate:
- Veterans requiring nursing home care for a SC disability
- Veterans with service-connected disabilities rated 70% or greater
- Veterans determined by VA to be unemployable or permanently and totally disabled from a service-connected condition.
Most other veterans are eligible for nursing home care as space and resources permit.
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VA provides urgent and limited emergency care in VA facilities. However, VA's ability to pay for emergency care in non-VA facilities is limited to veterans receiving care for a SC condition, or as payor of last resort for a NSC condition but only under the following conditions:
- You do not have coverage under a health insurance plan, and the services are not eligible for payment under Medicare or Medicaid.
- Emergency care was provided in a hospital emergency department or similar facility.
- You are financially liable to the provider of care for payment of the emergency treatment.
- You are enrolled in the VA health care system and receive care from VA within the 24 months preceding the non-VA emergency care.
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Yes. Care in private facilities at VA expense is provided only under certain circumstances. To determine if you are eligible for private care at VA expense, contact your local VA health care facility.
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You should submit appropriate documentation to your local VA health care facility. Appropriate documentation includes a Department of Defense Form DD 214 or, for World War II veterans, a "WD" form, any military service records or orders that document your award of a Purple Heart. If you need to obtain a copy of your military records you may use a Standard Form 180 Request Pertaining to Military Records, available at http://www.archives.gov/st-louis/military-personnel/standard-form-180.html or at VA offices. Veterans who were awarded the Purple Heart are assigned to Priority 3.
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To be considered Catastrophically Disabled, you must have a severely disabling injury, disorder, or disease which permanently compromises your ability to carry out activities of daily living, and:
- requires you to have personal or mechanical assistance to leave home or bed, OR
- requires you to have constant supervision to avoid physical harm to yourself or others.
To request a catastrophic disability evaluation, contact the Enrollment Coordinator at your local VA health care facility. VA will make every effort to schedule your evaluation within 35 days of request. There is no charge for the Catastrophic Disability evaluation.
If it is determined by a VA health care provider that you are Catastrophically Disabled, your priority group assignment will be upgraded to Priority Group 4.
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VA will ensure access to audiology and eye care services including preventive health (care) services and routine vision testing for all enrolled veterans and those veterans exempt from enrollment. Eyeglasses and hearing aids will be provided to the following veterans:
- Those with any compensable service-connected disability.
- Those who are former Prisoners of War (POWs).
- Those who were awarded a Purple Heart.
- Those in receipt of benefits under Title 38 United States Code (U.S.C.) 1151.
- Those in receipt of an increased pension based on being permanently housebound and in need of regular aid and attendance.
- Those with vision or hearing impairment resulting from diseases or the existence of another medical condition for which the veteran is receiving care or services from VHA, or which resulted from treatment of that medical condition, e.g., stroke, polytrauma, traumatic brain injury, diabetes, multiple sclerosis, vascular disease, geriatric chronic illnesses, toxicity from drugs, ocular photosensitivity from drugs, cataract surgery, and/or other surgeries performed on the eye, ear, or brain resulting in vision or hearing impairment.
- Those with significant functional or cognitive impairment evidenced by deficiencies in the ability to perform activities of daily living.
- Those who have vision and/or hearing impairment severe enough that it interferes with their ability to participate actively in their own medical treatment and to reduce the impact of dual sensory impairment (combined hearing and vision loss).
NOTE: The term “severe” is to be interpreted as a vision and/or hearing loss that interferes with or restricts access to, involvement in, or active participation in health care services (e.g., communication or reading medication labels). The term is not to be interpreted to mean that a severe hearing or vision loss must exist to be eligible for hearing aids or eyeglasses.
- Those veterans who have service-connected vision disabilities rated zero percent or service-connected hearing disabilities rated zero percent if there is organic conductive, mixed, or sensory hearing impairment, and loss of pure tone hearing sensitivity in the low, mid, or high-frequency range or a combination of frequency ranges which contribute to a loss of communication ability; however, hearing aids are to be provided only as needed for the service-connected hearing disability.
Veterans meeting the eligibility requirements to receive health care are eligible for diagnostic audiology services and eye & vision care services. Eligibility rules are the same for both inpatient and outpatient medical services. Veterans will not be denied access to audiology services and/or eye & vision care services covered by the Medical Benefits Package (38 CFR ยง17.38) because they do not meet the eligibility criteria for hearing aids and/or eye glasses.
For additional information, veterans can contact the prosthetic representative at the nearest VA health care facility.
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On January 28, 2008, the "National Defense Authorization Act of 2008" was signed into law. This law extends the period of eligibility for health care for veterans who served in a theater of combat operations after November 11, 1998. Under this authority, the Department of Veterans Affairs (VA) provides cost-free health care services and nursing home care for conditions possibly related to military service and enrollment in Priority Group 6 unless eligible for enrollment in a higher priority to:
- Currently enrolled veterans and new enrollees who were discharged from active duty on or after January 28, 2003, are eligible for the enhanced benefits, for 5 years post discharge.
- Veterans discharged from active duty before January 28, 2003, who apply for enrollment on or after January 28, 2008, are eligible for the enhanced benefit until January 27, 2011.
Combat veterans, while not required to disclose their income information, may do so to determine their eligibility for a higher priority, beneficiary travel benefits and exemption of copays for care unrelated to their military service.
For those veterans who do not enroll with VA during their enhanced eligibility period, eligibility for enrollment and subsequent care is based on other factors such as a compensable service connection rating, VA pension status, catastrophic disability determination or the veteran's financial circumstances. For this reason, combat veterans are strongly encouraged to apply for enrollment within their enhanced eligibility period, even if no medical care is currently needed.
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There are many reasons to remain with VA for your health care needs. However, the decision as to whether it is more beneficial for you to find a doctor outside VA system is yours to make.
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On January 17, 2003, the Secretary of Veterans Affairs made the difficult decision to suspend enrollment of veterans applying for enrollment who are determined to be in Priority Group 8. Veterans in Priority Group 8 who enrolled prior to January 17, 2003, are not affected by the Secretary’s decision. If you cancel your enrollment and later decide to re-apply, you may not be eligible for enrollment if VA is not enrolling all priority groups.
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If you no longer wish to be enrolled, you need to submit a signed statement requesting disenrollment to your local VA health care facility or to:
VA Health Eligibility Center (742/006)
2957 Clairmont Road, Suite 200
Atlanta, GA 30329-1647
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If you wish to obtain VA health care in the future, you may reapply at any time by completing VA form 10-10EZR, “Health Benefits Renewal Form.” However, you may not be eligible for re-enrollment if VA continues to implement enrollment restrictions such as the restriction on enrolling new Priority Group 8 veterans.
You may obtain VA Form 10-10EZR by visiting, calling or writing any VA health care facility or veterans’ benefits office. You may also call toll-free 877-222-VETS (877-222-8387). Or access the form on the Internet: http://www.va.gov/vaforms/medical/pdf/vha-10-10ezr-fill.pdf
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