Department Service Office Business Hours:  The Department Service Office will be open each Monday through Friday from 8:00 AM until 4:00 PM.  Appointments are not necessary for visits. You may contact the Department Service Office by calling (603) 222-5784, faxing (603) 222-5787; or by using the following e-mail address: Gary.Wayman@VA.GOV.

§

 

Beneficiary Travel Benefits: If you meet the criteria below, you may be eligible for mileage reimbursement or special mode transport in association with obtaining VA health care services.

 

You Qualify If:

• you have a service-connected (SC) rating of 30 percent or more, or
• you are traveling for treatment of a SC condition, or
• you receive a VA pension, or
• your income does not exceed the maximum annual VA pension rate, or
• you are traveling for a scheduled compensation or pension examination

 

You Qualify for Special Mode Transportation (Ambulance, Wheelchair van etc.) if:

·         your medical condition requires an ambulance or a specially equipped van as determined by a VA clinician, and

·         you meet one of the eligibility criteria in 1 through 4 above, and

·         the travel is pre-authorized (authorization is not required for emergencies if a delay would be hazardous to life or health)

 

Mileage Rates

General Travel..................$0.285 (28.5 cents) per mile

Scheduled appointments qualify for round-trip mileage. Unscheduled visits may be limited to return mileage only.

 

Deductible...............$7.77 one-way ($15.54 round trip)

Deductible requirement is subject to a monthly cap of $46.62. Upon reaching $46.62 in deductibles or 6 one-way (3 round) trips, whichever comes first, travel payments made for the balance of that particular month will be free of deductible charges.

 

Waiver of Deductible - A waiver of the deductible will be provided if you are eligible for travel and you:

• are in receipt of a VA pension or;
• are a NSC veteran and your previous year’s income does not exceed, or your projected current calendar year’s income, in the year of application will not exceed the applicable VA pension rate, or
• are a SC veteran and your previous year’s income does not exceed, or your projected current calendar year’s income, in the year of application will not exceed the applicable national means test income threshold or,
• are traveling for a scheduled compensation and pension exam

 

Note: For detailed information visit the following links for National Means Test (MT) income thresholds http://www.va.gov/healtheligibility/library/pubs/VAIncomeThresholds/ and Pension income thresholds http://www.vba.va.gov/bln/21/rates/pen01.htm.

 

Additional Information: Further information can be found in the Beneficiary Travel “Frequently Asked Questions” (FAQ) at http://www.va.gov/healtheligibility/Library/FAQs/BeneTravelFAQ.asp.

§

 

Veterans Identification Card: The Department of Veterans Affairs provides eligible veterans a Veterans Identification Card (VIC) for use at VA medical facilities. The VIC protects the privacy of veterans’ sensitive information, as it no longer displays the Social Security number or date of birth on the front of the card. The VIC will only display the veteran’s name, picture, and special eligibility indicators – Service Connected, Purple Heart and Former POW, if applicable, on the front of the card. Only veterans who are eligible for VA medical benefits will receive the card.

 

How to Receive a VIC: Once the veteran has his/her picture taken for the VIC at the VA medical facility, the card will be mailed to the veteran within 7-10 days after the veteran’s eligibility has been verified. To ensure the VIC is received at the appropriate address, it is important that the veteran’s address is verified and the correct address is entered in the VistA computer system. If the U.S. Postal Service cannot deliver the card, it will be returned to the facility where the veteran requested the card.

 

Purpose of VIC:  VIC is only for the purpose of identification and check-in for VA appointments. The VIC cannot be used as a credit card or an insurance card, and it does not authorize or pay for care at non-VA facilities. Veterans should safeguard their VIC similar to other identification cards that contains personal information.

 

What to do if the Card is Lost or Stolen: Veterans should contact the VA medical facility where they took their picture to request a new card be re-issued. Since the photo is retained, there is no need for the veteran to go to the VA to retake a picture for the card. Identifying information such as name and other information will be asked to assure proper identification of the caller.

 

Replacement of the Old VIC: Veterans with the old and outdated version of the VIC (which displays the Social Security Number and date of birth), must replace the card with the new card. Veterans with the old card should report to their local VA medical facility to have a new card issued. Replacing the card will help protect veterans from potential identity theft. Help us protect your identity.

 

What to do with the Old VIC? The old VIC should be disposed of in a secure manner by cutting up the card or shredding the card.

 

What should the Veteran do if he/she does not receive the card in the 7-10 day timeframe?  The veteran should contact the local VA Medical Facility where the card was requested. Or the veteran may also call the Health Benefits Service Center at 1-877-222-VETS (8387). The medical facility staff or the Health Benefits Service Center will be able to determine the status of the card.

 

Does the VIC have other uses? The card cannot be used as a credit or an insurance card and it does not authorize or pay for care at non-VA facilities.

§

 

Reimbursement of Non-va medical expenses for service-connected veterans:

 

Benefit Description: The Department of Veterans Affairs (VA), in limited circumstances, may provide reimbursement of non-VA medical expenses for veterans for their service-connected conditions to include those who are recently granted service-connected awards.

 

General Qualifying Criteria:

• A medical emergency

•VA or other Federal facility not feasibly available

•Care or service was for a service-connected disability

 

Time Limit for Filing Claim of non-VA Medical Expenses: Generally within 2 years of the date of service or notification of the allowance of a service-connected award (which may include care/services back to the effective date of award in cases of retroactive award – see example).

 

Retroactive Award Example: A veteran is awarded service-connected status via a Veterans Benefits Administration award letter dated January 1, 2007. The veteran filed the initial claim for service-connection on May 1, 2006. The service-connected award is retroactive to May 1, 2006.

The veteran may file a claim for private medical expenses care of the service-connected condition from May 1, 2006 forward as long as this claim is filed by January 1, 2009.

 

Where to File Claims: Veterans may file a claim for private medical expenses with their local VA health care facility’s Fee Basis office.

 

For Further Information: Contact your local VA health care facility’s Fee Basis office or the Health Benefits Services Call Center at 1-877-222-VETS (8387).

§

 

Enrollment restriction:  By law, the Secretary of Veterans Affairs is required to review, on an annual basis, the patient enrollment system. The purpose of this review is to ensure that adequate resources are available to provide quality and timely health care to all enrolled veterans. When the demand for services exceeds VA’s ability to provide such care, the Secretary is required to make enrollment adjustments.

 

Demand for VA Health Care: The demand for VA health care has seen a dramatic increase in the past several years. Because of the rapid growth in demand, VA has been unable to provide all enrolled veterans timely access to quality health care. The growth also resulted in veterans being placed on waiting lists for appointments to see a medical care provider.

 

Decision: Effective January 17, 2003, VA suspended NEW enrollment of veterans assigned to Priority Group 8e or 8g (VA's lowest priority group consisting of higher income veterans). These veterans are not eligible for enrollment at this time. Priority Group 8e or 8g assignment is based on the following:

 

• Either the veteran's household income exceeds both the current year VA national income threshold and the geographic income threshold for the veteran's residence, or
• The veteran declined to provide his/her household financial information, and
• The veteran does not have any special qualifying eligibilities such as a compensable VA service-connected disability

 

Veterans enrolled in Priority Group 8a or 8c on or before January 16, 2003, remain enrolled and continue to be eligible for the full-range of VA health care benefits. Changes in VA’s available resources may affect the number of priority groups VA can enroll

 

in a given year. If that occurs, VA will publicize the enrollment changes and notify affected enrollees.

 

Impact: Enrollment of veterans into Priority Groups 1 through 7 is NOT impacted by this suspension and continues without restriction. The decision to suspend new enrollment of veterans in VA’s lowest priority group helps to ensure that quality and timely care will be available to veterans with service-connected conditions, veterans with special authority based on military service, lower-income veterans, and those with special health care needs.

 

To view the VA National Means Test income threshold table, visit our website at http://www.va.gov/healtheligibility/Library/pubs/VAIncomeThresholds/

 

To view the Geographic Means Test income threshold table, visit our website at http://www.va.gov/healtheligibility/Library/pubs/GMTIncomeThresholds/

 

To view a full listing of VA health care enrollment Priority Groups, visit our website at http://www.va.gov/healtheligibility/Library/pubs/EPG/

 

For more information:  Contact the Health Benefits Service Center at 1-877-222-VETS (8387).

§

 

Geographic Means Test (GMT) and Copays:  Recognizing that the cost of living can vary significantly from one geographic area to another, Congress enacted legislation adding income thresholds based upon geographic locations to the existing VA National Means Test income thresholds for financial assessment purposes. This assists lower-income veterans who live in high-cost areas by providing an enhanced enrollment priority (Priority Group 7) and reducing the amount of their inpatient copay by 80% for treatment of non-service connected conditions. The copay reduction applies only to inpatient services. Outpatient services, long-term care, as well as medication copays are not affected by a Geographic Means Test (GMT) determination.

 

Priority Group: Priority Group 7 was established for GMT-qualifying veterans while veterans with the highest incomes are now classified in Priority Group 8. Priority Group 7 consists of veterans with household income and/or net worth ABOVE the VA National income threshold and income BELOW the geographically-based income threshold for their resident location who do not otherwise qualify for placement in a higher enrollment priority group.

 

Address Used: The address used to determine your geographically-based income threshold is your permanent address. Typically, it is the location in which you declare residency for voting and tax purposes.

 

GMT Calculation: The veteran’s income is based on the previous calendar year’s income that the veteran, the spouse and dependent children earned (household income). The number of persons in the veteran’s family will be factored into the calculation to determine the applicable low-income threshold for the veteran’s geographic region. At the veteran’s request, VA may use projected income for the current year on a case-by-case basis to avoid a hardship to a veteran. For more information about hardship, contact the Enrollment Coordinator at your local VA.

 

Example: Veterans living in Dupage County, Illinois 60504 would qualify for placement in Priority Group 7 and be GMT Copay Required; if gross household income is above the 2008 VA National income threshold of $28,429 but below the 2008 GMT threshold of $41,700, for their area. Not Depot Stocked Local Reproduction Authorized.

 

GMT Income Thresholds: The GMT income threshold tables can be viewed on the internet at http://www.va.gov/healtheligibility/Library/pubs/GMTIncomeThresholds/GMT2007.pdf.

 

Because VA uses prior year income for financial assessment purposes, the income threshold used for current year financial assessments will always indicate the prior calendar year (for example, 2007 GMT income thresholds is used for financial assessments completed in calendar year 2008).

 

VA National Income Thresholds: The VA National income thresholds can be viewed on the internet at http://www.va.gov/healtheligibility/Library/pubs/VAIncomeThresholds/. These income levels are updated each year.

 

Current Inpatient Copay: Because of the annual changes to the copay rates – including the annual cap on medication copays – they are published separately. Current year rates can be obtained at any VA health care facility or on the eligibility page on our web site at http://www.va.gov/healtheligibility/costs/.

 

Apply or Enroll for VA Medical Benefits: Veterans can apply for enrollment by completing VA Form 10-10EZ, Application for Health Benefits, at http://www.va.gov/1010ez.htm which can be obtained on the Internet, or from the nearest VA health care facility.

 

Questions: Contact the VA Health Benefits Service Center at 1-877-222-VETS (8387) or visit VA’s website at http://www.va.gov/healtheligibility/.

§

 

2008 Copay Requirements at a Glance:  On January 28, 2008, the President signed the National Defense Authorization Act (NDAA) for fiscal year 2008.  This letter provides guidance regarding those statutory changes that impact delivery of VA disability benefits. 

 

Basic Business Rule:  Cost Free Care and Medication for SC treatment, SC 50% or more, ex POWs, VA pensioners, under Special Authorities (e.g. PG 6, military sexual trauma, nasopharyngeal radium irradiation).

 

OEF/OIF Combat Veterans Enhanced Eligibility for Health Care Benefits:

 

• Combat veterans discharged from active duty on or after January 28, 2003, are eligible for enrollment in Priority Group (PG) 6 for 5 years following discharge unless eligible for a higher enrollment priority (PG 1-5). Combat veterans discharged from active duty before January 28, 2003, who apply for enrollment on or after January 28, 2008, are eligible for enrollment in Priority Group 6 until January 27, 2011. After the special eligibility period ends, these veterans will be reassigned to appropriate PG and subject to copays, if applicable.

 

• Copays only applicable for PG 6 combat veteran enrollees for care related to a condition that is congenital or developmental e.g., scoliosis, existed before military service (unless aggravated by combat service) or has a specific etiology that began after military service, such as a common cold, etc.

 

• See chart below for more information.

 

 

 

Inpatient ($10/day + $1024 for first 90 days and $512 after 90 days – based on 365-day period).

Outpatient Care ($15 Primary Care; $50 Specialty Care; $0 for x-rays, lab, immunizations, etc).

Outpatient Medication ($8 per 30-day supply) PG 2-6 Calendar Year Cap - $960

Extended Care Services Institutional NHCU, Respite, Geriatric Eval - $0-97 per day. Non-Institutional Respite, Geriatric Eval, ADHC - $15 Domiciliary - $5