Community Care

Family Member Care–Information for Providers

In some cases, VA offers health care and services for a Veteran’s family members and dependents (beneficiaries) based on certain conditions and eligibility requirements. VA serves more than 360,000 beneficiaries through its family member and dependent health care benefit programs. These programs reimburse the costs of specific types of covered services. Information about the specific programs is provided below.

• Camp Lejeune Family Member Program
• Children of Women Vietnam Veterans
• Pharmacy Benefits

Camp Lejeune Family Member Program

The Camp Lejeune Family Member Program (CLFMP) is for family members of Veterans that lived or served at U.S. Marine Corps Base Camp Lejeune, North Carolina, between August 1, 1953, and December 31, 1987, and were potentially exposed to drinking water contaminated with industrial solvents, benzene, and other chemicals. The program provides reimbursement to eligible Camp Lejeune family members for health care costs related to one or more of 15 specified illnesses or medical conditions specified in law.

For more information, visit the Camp Lejeune Family Member Program website.

For information on submitting claims for payment, review the CLFMP–Information for Providers fact sheet.

Children of Women Vietnam Veterans Health Care Benefits Program

The Children of Women Vietnam Veterans (CWVV) Health Care Benefits Program provides health care benefits to women Vietnam Veterans’ birth children who the Veterans Benefits Administration (VBA) has determined to have a covered birth defect. This program is not a comprehensive health care plan and only covers those services necessary for the treatment of a covered birth defect and associated medical conditions.

Individuals whose biological mother entered the Republic of Vietnam between February 28, 1961 and May 7, 1975 may be eligible. The VHA Office of Community Care manages the CWVV Health Care Benefits program, including the authorization of eligible medical benefits and the processing of claims. Eligibility must first be established for a monetary award under the VBA. The Denver VA Regional Office makes the determination regarding that entitlement.

To learn more, please visit Children of Women Vietnam Veterans.

Providers should bill the Office of Community Care for eligible CWVV services. Mail claims for payment to:

VHA Office of Community Care
CWVV Health Care Benefits Program
P.O. Box 469065
Denver, CO 80246-9065

The determined allowable amount for payment is considered payment in full, and a provider may not bill the beneficiary for the difference between the billed amount and the VA-determined allowed amount.

For additional information about filing claims for payment, review the Family Member Programs–Participating Providers fact sheet.

Pharmacy Benefits

Family members who receive care through the CHAMPVA program, Spina Bifida program, or the Children of Women Vietnam Veterans program can access pharmacy benefits through the Meds by Mail program, or by visiting a pharmacy in the OptumRx network.

Providers should alert individuals who receive family member care that if they go to a pharmacy outside the OptumRx network, they will have to pay the full cost of the medication and submit a claim to the VHA Office of Community Care.

To learn more, please visit Pharmacy Benefits.

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