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Health Benefits Coverage
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Services
Covered Under the Medical Benefits
Package |
Basic
care
- Outpatient medical, surgical,
and mental health care, including care for substance
abuse.
- Inpatient hospital, medical,
surgical, and mental health care, including care for substance
abuse.
- Prescription drugs, including
over-the-counter drugs and medical and surgical supplies available under
the VA national formulary
system.
- Emergency care in VA
facilities.
- 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:
- It must be for a Medical
Emergency.
- Department of Veterans
Affairs or other Federal facilities are not feasibly available at time
of emergency event.
- 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:
- You are enrolled in the VA
Health Care System.
- You have been provided care
by a VA clinician or provider within the last 24
months.
- You were provided care in a
hospital emergency department or similar facility providing emergency
care.
- You have no other form of
health insurance.
- You do not have coverage
under Medicare, Medicaid, or a state program.
- You do not have coverage
under any other VA programs.
- Department of Veterans
Affairs or other Federal facilities are not feasibly available at time
of emergency event.
- A reasonable layperson
would judge that any delay in medical attention would endanger your
health or life.
- You are financially liable
to the provider of the emergency treatment for that
treatment.
- You have no other
contractual or legal recourse against a third party that will pay all
or part of the bill.
- Bereavement
counseling.
- Comprehensive rehabilitative
services other than vocational
services.
- Consultation, professional
counseling, training, and mental health services for the members of the
immediate family or legal guardian of the
veteran.
- Durable medical equipment and
prosthetic and orthotic devices, including eyeglasses and hearing
aids.
- Home health
services.
- Reconstructive (plastic)
surgery required as a result of a disease or trauma but not including
cosmetic surgery that is not medically
necessary.
- Respite, hospice, and
palliative care.
- Payment of travel and travel
expenses for eligible veterans.
- A veteran or other person
traveling in connection with treatment for a service-connected
disability (irrespective of percent of
disability).
- A veteran with a
service-connected disability rated at 30 percent or more, for
treatment of any condition.
- A veteran receiving VA
pension benefits.
- 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.
- Pregnancy and delivery
service, to the extent authorized by
law.
- Completion of forms.
- 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
- Periodic medical
exams.
- Health education, including
nutrition education.
- Maintenance of drug-use
profiles, drug monitoring, and drug use
education.
- Mental health and substance abuse preventive services.
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