Through these doors pass America’s finest!Thank you for your service

&Thank you for giving us the opportunity to serve you!

Serving Those Who ServedSaginaw, Michigan

Presentation Topics

VA OverviewEligibility / Benefits

Means Test / Insurance / Co-PaysFee Basis

Release of InformationTravel

Your Questions

Basic Eligibility for VA Care• Discharged from active military service other than

dishonorably.

• Served a minimum of 24 months beginning Sept 7, 1980.

• If a National Guardsman or Reservist, called to active duty (presidential order) and served the entire period (not just for training purposes)

• Begin 1/16/2003, meet income tests

1980

DD214

Means Test, Insurance and Co-PaysVeteran Health Care is paid for by:

1. Congress allocates budget annually to VHA

2. Co-pays for visits and medication for those patients whose income and assets exceed the means test threshold.

3. Billing third party insurance companies

Means Test

• The means test is a measure of your family’s income and assets.

• Means Test must be completed one time, it can be edited if income changes.

• If your income and assets exceed the means test threshold, you may be charged a co-pay.

* If your financial situation changes significantly, please do not hesitate to request consideration for a hardship

Insurance Verification• VA is required by law to bill health insurance

carriers for the cost of medical care and treatment provided to veterans for non-service-connected conditions

• If you have health insurance coverage, it is important to provide that information to the VA.

• Always bring your insurance card(s) with you when you come to the VA for care.

$ Co-Payments for Visits $• Primary Care $15 per visit

• Specialty Clinics $50 per visit

• Medications$8 per 30 day supply per medication for priority groups 1 - 5$9 per 30 day supply per medication for priority groups 6 - 8

For more details, see the “VHA Health Care Program Benefits and Enrollment” brochure

$Priority Groups

- Priority Group 1• No co-pays

- Priority Groups 2-4• Medication co-pays for non-service connected conditions

- Priority Group 5• Medication co-pays

- Priority Group 6 • All co-pays for service unrelated to environmental exposure

- Priority Groups 7-8• All co-pays

Benefits for Newly Returning Veterans(Theater of Combat after November 11, 1998)

Medical – Eligible for VA care with no co-pays for treatment of conditions related to combat service. The period is up to 5 years, depending on discharge and enrollment dates. Then regular eligibility rules apply.

Dental – Eligible for one course of dental care if they apply within 180 days of discharge and DOD gave no exit exam at discharge.

Mental Health – Mental health screening and readjustment counseling.

Dental Benefits*Additional Eligibility Criteria

Outpatient – Eligibility for Repeat Dental Care Class IV

VA Service Connected disability rating of 100% Class IIC

Former Prisoner Of War (POW) Class I

Service Connected disability for a dental condition of 10% or greater.

OTHER Considerations (focused and limited care)Vocational Rehabilitation (Chapter 31); Homeless Program; OEF/OIF;

Dental Infection in High Risk Compromised Medical Conditions * Note – Veterans paid at 100% rate based on a temporary rating (extended

hospitalization for service connected disability) are NOT eligible for outpatient dental services.

Our partnership requests

• Keep ALL SCHEDULED APPOINTMENTS

• Call to cancel if you can’t come in: 1-800-406-5143, follow menu choices

• Regularly scheduled VA care IS REQUIRED for continued prescription renewals.

Our partnership requests related to Co-Managed Care

• If you choose to see both VA and community (non-VA) providers:

- Sign a Release of Information form at both the VA and your Non-VA provider

- Update your VA provider about your medical condition and any medication changes since your last visit.

- Provide a copy of your medical records related to your visits with your non-VA provider or any tests completed at a non-VA facility.

- Take a copy of your VA records including any labs, diagnostic tests and changes in medications to your Non-VA provider.

Sharing accurate information is the best way to assure you receive safe care.

Fee Basis & Millennium Bill• NON-VA AUTHORIZED CARE

– On a case by case basis, the VA will authorize care at a Non-VA facility.

• UNAUTHORIZED PRIMARY REQUIREMENTS– You were seen by your VA physician with the past 24 months– The care you received was not available through the VA– The care you received was Emergent (your life or health is in immediate danger)

• UNAUTHORIZED CARE– The care you received was for a Service Connected condition– The VA has rated you as permanently and totally disabled – any condition.– Veterans enrolled in Vocational Rehabilitation under Chapter 31

• MILL BILL– Non service connected condition– No other coverage – We do NOT share cost (co-pays or other)– Claims MUST be submitted within 90 days from discharge

Fee Basis General Information• Unless it is specifically authorized; Follow Up Care is NOT covered by the VA.

• If you are hospitalized in a community facility, be sure to contact the VA as soon as possible and definitely within 72 hours of admission; we will work with the community facility to transfer your care to the VA if we are able to provide the care you need (if you refuse to transfer to the VA for care, the VA will not pay for the care you receive after the refusal date)

• Contact VA early if you are receiving hospital and doctor bills to prevent them from going into collections

• STATUS LINE– Payment processing questions– (989)497-2500 ext. 13350

• FEE BASIS SUPERVISOR– (989) 497-2500 ext. 13345 or ext. 18315

Release of Information

• Located in Building 1, Rm 220, 224, 226• Complete written authorization, to:

– Obtain copies of Medical records, Progress Notes, DD214, etc.;

– Have non-VA medical forms completed;– Request an amendment to Medical record;– Learn how to obtain copies of Military records.

• Contact Information:– ROI Office, ext. 13180, ext. 13184, and ext. 13161;– Supervisor, ext. 13111

Telephone Care

24 Hours a Day365 Days a Year

Call “Tele-Care (Ask-a-Nurse)”1-888-838-6446

8am to 4pmMonday to Friday

Local Triage 1-800-406-5143 ext. 11240

Beneficiary TravelQualifications for General Travel:• You have a service-connected (SC) rating of 30% of 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 and pension examination

Qualifications for Special Mode Travel (ambulance, wheelchair van):• 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 listed above under general travel, 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 $0.415 (41.5 cents) per mile

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

Deductible $3.00 one-way ($6.00 round trip)

Deductible requirement is subject to a monthly cap of $18.00. Upon reaching $18.00 in deductibles of 6 one-way or 3 round trip, whichever comes first, travel payments made for the balance of that particular month will be free of deductible charges. (A waiver can be requested for the deductible)

Feedback

• We request your feedback• If we have not been able to answer a

question, please give us contact information and we will assure that you are contacted with the answer to your question.

QUESTIONS?