Health Benefits

By Ted Daywalt   

The VHA Health Administration Services is the organization within VA responsible for implementing all VA health care benefits provisions. They are the eligibility experts, answering questions for VA staff and veterans alike.

In October 1996, Congress passed Public Law 104-262, the Veterans’ Health Care Eligibility Reform Act of 1996. This legislation paved the way for the creation of a Medical Benefits Package – a standard enhanced health benefits plan available to all enrolled veterans. Like other standard health care plans, the Medical Benefits Package emphasizes preventive and primary care, offering a full range of outpatient and inpatient services.

Under the VA Medical Benefits Package, VA offers veterans a comprehensive health care plan that provides needed care. Once you apply for enrollment, your eligibility will be verified. Based on your specific eligibility status, you will be assigned a priority group.

The priority groups are as follows, ranging from 1-7 with 1 being the highest priority for enrollment. Under the Medical Benefits Package, the same services are generally available to all enrolled veterans.

Priority Group 1

    • Veterans with service-connected disabilities rated 50% or more, or
    • Veterans determined by VA to be unemployable due to service-connected conditions

Priority Group 2

    • Veterans with service-connected disabilities rated 30% or 40%

Priority Group 3

    • Veterans who are former POWs
    • Veterans with service-connected disabilities rated 10% or 20%
    • Veterans discharged from active duty for a disability incurred or aggravated in the line of duty
    • Veterans who received the Purple Heart
    • Veterans awarded special eligibility classification under 38 U.S.C., Section 1151, “benefits for individuals disabled by treatment or vocational rehabilitation”

Priority Group 4

    • Veterans who are receiving aid and attendance or housebound benefits
    • Veterans who have been determined by VA to be catastrophically disabled

Priority Group 5

    • Veterans receiving VA pension benefits
    • Veterans who are eligible for Medicaid programs
    • Veterans with income and assets below the VA Means Test Thresholds

Priority Group 6

    • World War I and Mexican Border War veterans
    • Veterans seeking care solely for disorders associated with: exposure to herbicides while serving in Vietnam; or exposure to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki; or for disorders associated with service in the Gulf War; or for any illness associated with service in combat in a war after the Gulf War or during a period of hostility after November 11, 1998
    • Veterans with 0% service-connected conditions, but receiving VA compensation

Priority Group 7

  • Non-service-connected veterans and non-compensable 0% service-connected veterans with income and net worth above the established dollar thresholds and who agree to pay specified co-payments

Veterans Health Administration sponsors and participates in a host of programs that increase the quality of health care for our patients. While not all programs have Web sites at this time, links are provided for those that do.

Blind Rehabilitation Services
This service includes adjustment to blindness counseling, patient and family education, benefit analysis, comprehensive residential inpatient training, outpatient rehabilitation services, the provision of assistive technology, and research.

Agent Orange Health Effects and Vietnam Veterans
Information on health issues for Vietnam veterans exposed to the herbicide Agent Orange during the Vietnam War. This site features current and back issues of VA’s publication Agent Orange Review, and current issues of Agent Orange Fact Sheets, other publications, and answers to frequently asked questions. These publications can be searched by key-word or information on specific health concerns, Vietnam veterans and Agent Orange compensation policy developments, and other specific Vietnam War and Agent Orange activities.

HIV/AIDS Program
The program disseminates a biweekly newsletter, publicizes new items available on the Internet, announces AIDS Service activities, and distributes other relevant HIV/AIDS information.

Cancer Program
The VA cancer program ensures that users of the veterans health care system have easy access to consistently high quality cancer prevention, detection, and treatment services. Its Web site offers cancer facts, information about care, a list of VHA designated comprehensive cancer centers, and the VA’s national cancer strategy

Cardiac Surgery Consultants Committee
Provides information on the criteria and standards for cardiac care and has an advisory committee on policy issues surrounding cardiac surgery.

The CARES program is designed to assess veterans’ health care needs and identify delivery options to meet those needs in the future. CARES is about planning for veterans’ health care and making sure that quality and access are given the highest consideration. CARES stands for Capital Asset Realignment for Enhanced Services.

Centers of Excellence in Hepatitis C Research and Education
Learn more about the Centers of Excellence in Hepatitis C Research and Education. Health care providers and veterans can find current information on hepatitis C virus (HCV) infection.

CHAMPVA is a healthcare benefits program for 1) dependents of veterans who have been rated by VA as having a total and permanent disability, 2) survivors of veterans who died from VA-rated service-connected conditions, or who at the time of death, were rated permanently and totally disabled from a VA-rated service-connected condition; and 3) survivors of persons who died in the line of duty and not due to misconduct.

Cold Injury
Study this material to learn more about long-term effects of cold injury.

Diabetes Program
The Web site for the Diabetes Program provides clinical guidelines, fact sheets, links to Web sites, and other information concerning the cost and management of diabetes.

Foreign Medical Program (FMP)
The Foreign Medical Program is a healthcare benefits program for US veterans with VA-rated service-connected conditions who are residing or traveling abroad (Canada and Philippines excluded).

Gulf War Veterans’ Health
Information on health issues for veterans who served in the Gulf War. This site features current and back issues of VA’s publication Gulf War Review, other publications, and answers to frequently asked questions. These publications can be searched by key-word for information on specific health concerns, Gulf War environmental exposures, Gulf War veteran compensation policy, research on Gulf War health, or other specific Gulf War activities.

Health Administration Center
Home of the following Healthcare Benefit Programs – CHAMPVA, Foreign Medical Program (FMP), Spina Bifida.

Health Care Programs for Elderly Veterans
The VA advances quality care for aging and chronically ill veterans by offering hospice care, home based primary care, geriatric evaluation and management, domiciliary care, Alzheimer’s/dementia program, adult day health care, and respite care.

Kidney Diseases Program
The VA kidney diseases program ensures that users of the veterans health care system have easy access to consistently high quality renal diseases prevention, detection, and treatment services. Its Web site offers facts, information about care, a list of VHA dialysis centers, and the VA’s clinical practice guidelines.

National Center for Ethics
The National Center for Ethics is VHA’s primary office for addressing the complex ethical issues that arise in patient care, health care management, and research.

National Center for Health Promotion & Disease Prevention
The NCHP offers a wealth of information, including health promotion and disease prevention strategies, the Vet Health Survey, research, and a list of special initiatives.

National Center for Post Traumatic Stress Disorder
The center carries out a broad range of multidisciplinary activities in research, education, and training to understand, diagnose, and treat PTSD. The Web site targets information to different groups, such as veterans and their families, women, clinicians, researchers, journalists, librarians, and students.

Some PTSD cases arise from sexual trauma. For more information on this topic, consult the Web site of the Center for Women Veterans.

National Chaplain Center
Resources offered by the center include support for community disaster management, mediation and alternate dispute resolutions, research and development, prayer, and links.

Programs & Initiatives for Women
While the Center for Women Veterans is not part of VHA, health care is one of it critical components. The center’s Web site includes information on Women Veterans’ Comprehensive Health Centers, sexual trauma counseling, the VA Mammography Office, and how to apply for benefits.

Recreational Therapy Service
Recreation Therapy provides quality clinical treatment interventions for veterans and other beneficiaries. Some of its programs include recreation/creative arts therapy, National Veterans Creative Arts Festival, Very Special Arts Program, National Veterans Wheelchair Games, National Disabled Veterans Winter Sports Clinic, National Veterans Golden Age Games, and the Training-Exposure-Experience (T.E.E.) Golf Tournament.

Redeployment Clinical Practice Guidelines – DRAFT
New standardized clinical practice guidelines to help health care providers screen and evaluate service members following deployment are currently under development, and are made available here for comments from veterans.

Spina Bifida
In addition to monetary allowances, vocational training and rehabilitation, the Department of Veterans Affairs (VA) also provides VA-financed healthcare benefits to Vietnam veterans’ birth children diagnosed with spina bifida.

State Veterans Home Program
The State Home Program is a partnership between the U.S. Department of Veterans Affairs and the States to construct or acquire nursing home, domiciliary and/or adult day health care facilities. Hospital care may be included when provided in conjunction with nursing home or domiciliary care. VA also provides per diem payments to States for the care of eligible veterans in State homes.

Tele-Medicine Initiative
Tele-Medicine uses electronic information and communication technologies to support health care over long distances through such applications as teleconferences or retrieval of networked records.

Veterans Affairs Voluntary Service
VAVS volunteers assist veteran patients by augmenting staff in such settings as hospice programs, foster care, hospital-based home care, hospital wards, nursing homes, and veteran outreach centers.

VHA Mammography
The VHA Mammography web site is a means of communicating specific and general information about VA’s breast imaging program. Mammography (breast imaging) is the only Federally regulated radiology procedure in the United States. VA facilities that perform this imaging on-site must meet specific equipment requirements, staff must achieve and maintain specific credentials and annual inspections are conducted at VA sites by the Food and Drug Administration.

VHA Revenue Office
The VHA Revenue Office seeks to maximize the recovery of funds due to the VA for the provision of health care services to veterans, family members, and others who use the VA system.

Virtual Learning Center
The Virtual Learning Center provides a mechanism for individuals to share their innovative programs and lessons learned, as well as use the innovations of others to save time and resources rather than starting from the beginning to address similar needs.

The Veterans Health Information Systems and Technology Architecture is a rich, automated environment that supports day-to-day operations at local VA health care facilities.