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Service Officer

SERVICE OFFICER

Here is the first installment of Post 233’s “VA Benefits” series. This series is copied and pasted right out of the VA’s, “Federal Benefits for Veterans Dependents and Survivors” Handbook. There is no attempt to interpret or explain these benefits.

VA Health Care Benefits

VA operates the nation’s largest integrated health care system with more than 1,500 sites of care, including hospitals, community clinics, community living centers, domiciliaries, readjustment counseling centers, and various other facilities. For additional information on VA health care, visit: www.va.gov/health.

Basic Eligibility

A person who served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable may qualify for VA health care benefits. Reservists and National Guard members may also qualify for VA health care benefits if they were called to active duty (other than for training only) by a Federal order and completed the full period for which they were called or ordered to active duty.

Minimum Duty Requirements:

Veterans who enlisted after Sept. 7, 1980, or who entered active duty after Oct. 16, 1981, must have served 24 continuous months or the full period for which they were called to active duty in order to be eligible. This minimum duty requirement may not apply to Veterans discharged for hardship, early out or a disability incurred or aggravated in the line of duty.

VA Enrollment

For most Veterans, entry into the VA health care system begins by applying for enrollment. Veterans can now apply and submit their application for enrollment (VA Form 1010EZ), online at www.1010ez.med.va.gov/sec/vha/1010ez/. If assistance is needed while completing the on-line enrollment form, an online chat representative is available to answer questions Monday – Friday between 8 a.m. and 8 pm EST. Veterans can also enroll by calling 1-877-222-VETS (8387) Monday through Friday, 8 a.m. to 8 p.m. Eastern time, or at any VA health care facility or VA regional benefits office. Once enrolled, Veterans can receive health care at VA health care facilities anywhere in the country.

Veterans enrolled in the VA health care system are afforded privacy rights under federal law. VA’s Notice of Privacy Practices, which describes how VA may use and disclose Veterans’ medical information, is also available on line at:

www.va.gov/vhapublications/viewpublication.asp?pub_ID=1089

The following four categories of Veterans are not required to enroll, but are urged to do so to permit better planning of health resources:

1. Veterans with a service-connected disability of 50 percent or more.

2. Veterans seeking care for a disability the military determined was incurred or aggravated in the line of duty, but which VA has not yet rated, within 12 months of discharge.

3. Veterans seeking care for a service-connected disability only.

4. Veterans seeking registry examinations (Ionizing Radiation, Agent Orange, Gulf War/Operation Iraqi Freedom/Operation New Dawn and Depleted Uranium).

Priority Groups

During enrollment, each Veteran is assigned to a priority group. VA uses priority groups to balance demand for VA health care enrollment with resources. Changes in available resources may reduce the number of priority groups VA can enroll. If this occurs, VA will publicize the changes and notify affected enrollees. A description of priority groups follows:

Group 1:

  • Veterans with service-connected disabilities rated 50 per- cent or more and/or Veterans determined by VA to be unemployable due to service-connected conditions.

Group 2:

  • Veterans with service-connected disabilities rated 30 or 40 percent.

Group 3:

  • Veterans who are former POWs.
  • Veterans awarded the Purple Heart Medal.
  • Veterans awarded the Medal of Honor.
  • Veterans whose discharge was for a disability incurred or aggravated in the line of duty.
  • Veterans with VA service-connected disabilities rated 10 percent or 20 percent.
  • Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation.”

Group 4:

  • Veterans receiving increased compensation or pension based on their need for regular aid and attendance or by reason of being permanently housebound.
  • Veterans determined by VA to be catastrophically disabled.

Group 5:

  • Nonservice-connected Veterans and noncompensable service-connected Veterans rated 0 percent, whose annual income and/ or net worth are not greater than the VA financial thresholds.
  • Veterans receiving VA Pension benefits.
  • Veterans eligible for Medicaid benefits.

Group 6:

  • Compensable 0 percent Service-connected Veterans.
  • Veterans exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki. Project 112/SHAD participants.
  • Veterans who served in the Republic of Vietnam between Jan. 9, 1962 and May 7, 1975.
  • Veterans who served in the Southwest Asia theater of operations from Aug. 2, 1990, through Nov. 11, 1998.
  • Veterans who served in a theater of combat operations after Nov.11, 1998, as follows:
  • Veterans discharged from active duty on or after Jan. 28, 2003, for five years post discharge;
  • Veterans who served on active duty at Camp Lejeune for not fewer than 30 days beginning Jan. 1, 1957 and ending Dec. 31, 1987.

Group 7:

  • Veterans with incomes below the geographic means test income thresholds and who agree to pay the applicable copayment.

Group 8:

  • Veterans with gross household incomes above the VA national income threshold and the geographically-adjusted income threshold for their resident location and who agrees to pay copayments. Veterans eligible for enrollment: Noncompensable 0-percent service-connected and:

 

o    Subpriority a: Enrolled as of Jan. 16, 2003, and who have remained enrolled since that date and/ or placed in this subpriority due to changed eligibility status.

o    Subpriority b: Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10 percent or less

Veterans eligible for enrollment:

o    Nonservice-connected and Subpriority c: Enrolled as of Jan. 16, 2003, and who remained enrolled since that date and/ or placed in this subpriority due to changed eligibility status

o    Subpriority d: Enrolled on or after June 15, 2009 whose income exceeds the current VA National Income Thresholds or VA National Geographic Income Thresholds by 10 percent or less

Veterans NOT eligible for enrollment:

o    Veterans not meeting the criteria above:

o    Subpriority e: Noncompensable 0 percent service-connected

o    Subpriority f: Nonservice-connected

VA’s current income thresholds can be located at: www.va.gov/healtheligibility/Library/AnnualThresholds.asp

Recently Discharged Combat Veterans

Veterans, including activated reservists and members of the National Guard, are eligible for the enhanced Combat Veteran benefits if they served on active duty in a theater of combat operations after Nov. 11, 1998, and have been discharged under other than dishonorable conditions.

Effective Jan. 28, 2008, combat Veterans discharged from active duty on or after Jan. 28, 2003, are eligible for enhanced enrollment placement into Priority Group 6 (unless eligible for higher enrollment Priority Group placement) for five-years post discharge.

Veterans receive VA care and medication at no cost for any condition that may be related to their combat service.

Veterans who enroll with VA under this Combat Veteran authority will remain enrolled even after their five-year post discharge period ends. At the end of their post discharge period, VA will reassess the Veteran’s information (including all applicable eligibility factors) and make a new enrollment decision. For additional information, call 1-877-222-VETS (8387), Monday through Friday between 8:00 a.m. and 8:00 p.m. Eastern time.

Special Access to Care Service

Disabled Veterans: who are 50 percent or more disabled from service-connected conditions, unemployable due to service-connected conditions, or receiving care for a service-connected disability receive priority in scheduling of hospital or outpatient medical appointments. Women Veterans Women Veterans are eligible for the same VA benefits as male Veterans. Comprehensive health services are available to women Veterans including primary care, specialty care, mental health care, residential treatment and reproductive health care services

VA provides management of acute and chronic illnesses, preventive care, contraceptive and gynecology services, menopause management, and cancer screenings, including pap smears and mammograms. Maternity care is covered in the Medical Benefits package. Women Veterans can receive maternity care from an OB/GYN, family practitioner, or certified nurse midwife who provides pregnancy care.

VA covers the costs of care for newborn children of women Veterans for seven days after birth. Infertility evaluation and limited treatments are also available. Women Veterans Program Managers are available at all VA facilities to assist women Veterans in their health care and benefits. For more information, visit http://www.womenshealth. va.gov/.

Military Sexual Trauma

Military sexual trauma (MST) is the term that the Department of Veterans Affairs uses to refer to sexual assault or repeated, threatening sexual harassment that occurred while the Veteran was serving on active duty (or active duty for training if the service was in the National Guard or Reserves). VA health care professionals provide counseling and treatment to help Veterans overcome health issues related to MST. Veterans who are not otherwise eligible for VA health care may still receive these services. Appropriate services are provided for any injury, illness or psychological condition related to such trauma. For additional information visit: http://www.mentalhealth. va.gov/msthome.asp

Veterans with Spinal Cord Injury/Disorders There are 24 VA medical centers in the United States with specialized centers (called Spinal Cord Injury Centers) for Veterans with spinal cord injuries and disorders (SCI/D). Comprehensive rehabilitation, SCI/D specialty care, medical, surgical, primary, preventive, psychological, respite, and home care are provided at these centers by interdisciplinary teams which include physicians, nurses, therapists (physical, occupational, kinesiotherapists, therapeutic recreation), psychologists, social workers, vocational counselors, dieticians, respiratory therapy, and other specialists as needed.

There are five Spinal Cord Injury (SCI) Centers that provide long term care for Veterans with SCI/D. In VA facilities that do not have SCI Centers, there is a designated team that consists of a physician, nurse, and social worker to address primary care needs for Veterans with SCI/D and to make referrals to SCI Centers. These SCI Centers and the teams in facilities that do not have centers, comprise the VA SCI System of Care. Some of the services provided in this system of care include rehabilitation, prosthetics and durable medical equipment, orthotics, sensory aids, assistive technology, environmental modifications, telehealth, ventilator weaning and care, chronic pain management, mental health treatment, drivers training, peer counseling, substance abuse treatment, vocational counseling, and care- giver training and support.

There is a long-standing Memorandum of Agreement between VA and the Department of Defense (DoD) to provide specialized care at VA medical facilities for Active Duty Servicemembers who have sustained a spinal cord injury. Ongoing collaboration and education between VA and DoD ensures continuity of care and services.   For more information about SCI/D care and the eligibility requirements for the above benefits and services, contact your local VA SCI/D Center and/or visit http://www.sci.va.gov.

OEF/OIF/OND Care Management

Each VA medical center has an OEF/OIF/OND Care Management team in place to coordinate patient care activities and ensure that

Servicemembers and Veterans are receiving patient-centered, integrated care and benefits.  OEF/OIF/OND clinical case managers screen all returning combat Veterans for the need for case management services to identify Veterans who may be at risk so VA can intervene early and provide assistance.  Severely ill or injured Servicemembers/Veterans are provided with a case manager and other OEF/OIF/OND Servicemembers/Veterans are assigned a case manager as indicated by a positive screening assessment or upon request. OEF/OIF/OND case managers are experts at identifying and accessing resources within their health care system as well as in the local community to help Veterans recover from their injuries and readjust to civilian life.

Financial Assessment

Most Veterans not receiving VA disability compensation or pension payments must provide a financial assessment to determine whether they are below VA income thresholds. VA is currently not enrolling new applicants who decline to provide financial information unless they have a special eligibility factor exempting them from disclosure. VA’s income thresholds are located at: www.va.gov/healtheligibility/ Library/AnnualThresholds.asp

The financial assessment includes all household income and net worth, including Social Security, retirement pay, unemployment insurance, interest and dividends, workers’ compensation, black lung benefits and any other income. Also considered are assets such as the market value of property that is not the primary residence, stocks, bonds, notes, individual retirement accounts, bank deposits, savings accounts and cash. Medical Services and Medication Copayments Some Veterans are required to make copayments (copays) to receive VA health care and/or medications.

Inpatient Care:

o    Priority Group 7 and certain other Veterans are responsible for paying 20 percent of VA’s inpatient copay or $236.80 for the first 90 days of inpatient hospital care during any 365-day period. For each additional 90 days, the charge is $118.40. In addition, there is a $2 per diem charge.

o    Priority Group 8 and certain other Veterans are responsible for VA’s inpatient copay of $1,184 for the first 90 days of care during any 365-day period. For each additional 90 days, the charge is $592. In addition, there is a $10 per diem charge. Extended Care: Veterans may be subject to a copay for extended care services. The copay is determined by a calculation using information from completion of VA Form 10-10EC, Application for Extended Care Services.

VA social workers or case managers will counsel Veterans or their family representatives on their eligibility and copay requirements. The copay amount is based on the Veteran’s financial situation deter- mined upon application for extended care services and can range from $0 to a maximum copayment amount of $97 a day.

NOTE:  Veterans determined to be catastrophically disabled are exempt from copays applicable to the receipt of noninstitutional respite care, noninstitutional geriatric evaluation, noninstitutional adult day health care, homemaker/home health aide, purchase skilled home care, home-based primary care, hospice services and any other noninstitutional alternative extended care services.

Outpatient Care:

While many Veterans qualify for free healthcare services based on a VA compensable service-connected condition or other qualifying factor, most Veterans are asked to complete an annual financial assessment, to determine if they qualify for free services. Veterans whose income exceeds the established VA Income Thresholds as well as those who choose not to complete the financial assessment must agree to pay required copays to become eligible for VA healthcare services.

o    Primary Care Services: $15

o    Specialty Care Services: $50

NOTE:  Copay amount is limited to a single charge per visit regardless of the number of health care providers seen in a single day. The copay amount is based on the highest level of service received.

Outpatient Visits Not Requiring Copays:

Certain services are not charged a copay. Copays do not apply to publicly announced VA health fairs or outpatient visits solely for preventive screening and/or vaccinations, such as vaccinations for influenza and pneumococcal, or screening for hypertension, hepatitis B, tobacco, alcohol, hyperlipidemia, breast cancer, cervical cancer, Human papillomavirus (HPV), colorectal cancer by fecal occult blood testing, education about the risks and benefits of prostate cancer screening, HIV testing and prevention counseling (including the distribution of condoms), and weight reduction or smoking cessation counseling (individual and group). Laboratory, plain film radiology, electrocardiograms, and hospice care and in-home video telehealth are also exempt from copays. While hepatitis C screening and HIV testing and counseling are exempt, medical care for HIV and hepatitis C are NOT exempt from copays.

Medication:

While many Veterans are exempt for medication co-pays, nonservice-connected Veterans in Priority Groups 7 and 8 are charged $9 for each 30-day or less supply of medication provided on an outpatient basis for the treatment of a nonservice-connected condition. Veterans enrolled in Priority Groups 2 through 6 are charged $8 for each 30-day or less supply of medication; the maximum copay for medications that will be charged in calendar year 2013 is $960 for nonservice-connected medications.

NOTE:  Copays apply to prescription and over-the-counter medications, such as aspirin, cough syrup or vitamins, dispensed by a VA pharmacy. Copays are not charged for medical supplies, such as syringes or alcohol wipes. Copays do not apply to condoms.

Health Savings Accounts (HSA) can be utilized to make VA copayments. HSAs are usually linked to High Deductible Health Plans (HDHPs). Private Health Insurance Billing VA is required to bill private health insurance providers for medical care, supplies and medications provided for treatment of Veterans’ non-service connected conditions. Generally, VA cannot bill Medicare, but can bill Medicare supplemental health insurance for covered services.  VA is authorized to bill and accept reimbursement from High Deductible Health Plans (HDHPs) as well as employer- sponsored Health Reimbursement Arrangements (HRAs) for care provided for non-service connected conditions.

All Veterans applying for VA medical care are required to provide information on their health insurance coverage, including coverage provided under policies of their spouses. Veterans are not responsible for paying any remaining balance of VA’s insurance claim not paid or covered by their health insurance, and any payment received by VA may be used to offset “dollar for dollar” a Veteran’s VA copayment responsibility.

Permanent link to this article: http://myvfw.org/fl/post3270/service-officer/