H.H. MacKenzie - Chapter #3 - Disabled American Veterans - Roanoke, Virginia

     


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Health Benefits Coverage


Services Covered Under the Medical Benefits Package

  Basic care 

  1. Outpatient medical, surgical, and mental health care, including care for substance abuse.       
  2. Inpatient hospital, medical, surgical, and mental health care, including care for substance abuse.       
  3. Prescription drugs, including over-the-counter drugs and medical and surgical supplies available under the VA national formulary system.       
  4. Emergency care in VA facilities.       
  5. Emergency care in non-VA facilities in certain conditions: This benefit is a safety net for veterans requiring emergency care for a service connected disability or enrolled veterans who have no other means of paying a private facility emergency bill. If another health insurance provider pays all or part of a bill, VA cannot provide any reimbursement. To qualify for payment or reimbursement for non-VA emergency care service for a service-connected disability, you must meet all of the following criteria:   
    1. It must be for a Medical Emergency.   
    2. Department of Veterans Affairs or other Federal facilities are not feasibly available at time of emergency event.   
    3. The emergency was for a service-connected disability. 
    To qualify for payment or reimbursement for non-VA emergency care services for a nonservice-connected condition, you must meet all of the following criteria:   
    1. You are enrolled in the VA Health Care System.   
    2. You have been provided care by a VA clinician or provider within the last 24 months.  
    3. You were provided care in a hospital emergency department or similar facility providing emergency care.  
    4. You have no other form of health insurance.  
    5. You do not have coverage under Medicare, Medicaid, or a state program.  
    6. You do not have coverage under any other VA programs.  
    7. Department of Veterans Affairs or other Federal facilities are not feasibly available at time of emergency event.  
    8. A reasonable layperson would judge that any delay in medical attention would endanger your health or life.  
    9. You are financially liable to the provider of the emergency treatment for that treatment.  
    10. You have no other contractual or legal recourse against a third party that will pay all or part of the bill. 
  6. Bereavement counseling.       
  7. Comprehensive rehabilitative services other than vocational services.       
  8. Consultation, professional counseling, training, and mental health services for the members of the immediate family or legal guardian of the veteran.       
  9. Durable medical equipment and prosthetic and orthotic devices, including eyeglasses and hearing aids.       
  10. Home health services.       
  11. Reconstructive (plastic) surgery required as a result of a disease or trauma but not including cosmetic surgery that is not medically necessary.       
  12. Respite, hospice, and palliative care.       
  13. Payment of travel and travel expenses for eligible veterans.   
    1. A veteran or other person traveling in connection with treatment for a service-connected disability (irrespective of percent of disability).   
    2. A veteran with a service-connected disability rated at 30 percent or more, for treatment of any condition.   
    3. A veteran receiving VA pension benefits.   
    4. A veteran whose annual income does not exceed the maximum annual rate of pension, which would be payable if the veteran were eligible for pension, or who is unable to defray the expenses of travel. 
  14. Pregnancy and delivery service, to the extent authorized by law.       
  15. Completion of forms.
    1. This coverage includes completion of forms such as Family Medical Leave forms, life insurance applications, Department of Education forms for loan repayment exemptions based on disability, and non-VA disability program forms by health care professionals based on an examination or knowledge of the veteran's condition. This does not include the completion of forms for examinations if a third party customarily will pay health care practitioners for the examination but will not pay VA.
Preventive care
  1. Periodic medical exams.       
  2. Health education, including nutrition education.       
  3. Maintenance of drug-use profiles, drug monitoring, and drug use education.       
  4. Mental health and substance abuse preventive services.

 

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(Source - Department Of Veterans Affairs)


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