Background

HISTORY

In 1973, the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) was established as a health benefits program for dependents of permanently and totally disabled veterans, as well as the survivors of veterans who died from a service-connected condition, or who at the time of death, were rated permanently and totally disabled from a service-connected condition.

From 1973 through 1986, CHAMPVA application processing and eligibility determinations were completed by VA medical centers. In 1986, the Veterans Health Administration (VHA) established the CHAMPVA Center in Denver and transferred the responsibility of determining beneficiary eligibility to this center.

From 1973 through 1990, the VA contracted with the Department of Defense’s (DoD) Office of Civilian Health and Medical Program of the Uniformed Services OCHAMPUS to process all CHAMPVA claims. In December 1990, the DoD began transferring claims processing responsibilities from OCHAMPUS to the CHAMPVA Center.

By January 1, 1994, the CHAMPVA Center was fully operational and processed all claims, beneficiary eligibility determinations and payments for beneficiaries. In 1996, the CHAMPVA Center was officially renamed the Health Administration Center (HAC).

ADMINISTRATION

CHAMPVA is administered by the Health Administration Center (HAC) of the Department of Veterans Affairs. HAC administers all CHAMPVA activities, including the verification of eligibility of benefits, authorization of benefits and services, vendor certification and approval, payment methodologies and the authorization of medical services and supplies.

FUNDING

CHAMPVA is funded through federal appropriations from Congress.

Summary of CHAMPVA

The Civilian Health and Medical Program (CHAMPVA) is a comprehensive fee-for-service health insurance plan for the dependents and caregivers of certain U.S. veterans. It covers most healthcare services and supplies that are medically and psychologically necessary.

To be eligible for CHAMPVA an individual must be a qualifying spouse, surviving spouse, or the child of a veteran who is rated permanently and totally disabled due to a service-connected disability, or was rated permanently and totally disabled due to a service-connected condition at the time of death, or died of a service-connected disability, or died on active duty. In addition, the dependents cannot be eligible for TRICARE benefits. Eligible dependents must apply for CHAMPVA.

The information contained in this chapter does not cover the many complexities that exist in with the CHAMPVA program. There may be exceptions to eligibility that are not listed in this chapter. Therefore it is advisable to find additional information if a dependent does not meet the criteria listed in this chapter.