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CHAMPVA Q & A plus DENTAL

20 Nov 2021 3:44 PM | Nancy Menagh (Administrator)

Dental:

If you have TriCare, open enrollment for dental and vision is November 8th to December 13th.  You have a choice of plans. Find out if you are eligible and sign up here:  www.benefeeds.com

If you have ChampVa, you may enroll in dental anytime, but there are waiting periods for major services:  Find out more info here: https://www.va.gov/health-care/about-va-health-benefits/dental-care/dental-insurance/

Currently those on ChampVa do not have a vision program, but we are hoping to add it in the next contract.

Medical:  Here are the Questions and Answers:

Will ChampVA pay for teleconference doctor visits?  Currently the visit must be virtual, not just by phone in order to be paid.

If I have TriCare and are eligible for ChampVA, may I choose ChampVA?  No, if you are eligible for TriCare then you are NOT eligible for ChampVA.

If I plan to remarry and currently on TriCare, how do I line up the coverage? (assuming you are over 55 and eligible).  The ChampVa coverage will be effective when the TriCare terminates.  You may not apply prior to the TriCare termination as the system will show that you are on TriCare. 

If I have Medicare Part A and B, and ChampVA for Life, do I need supplemental coverage?  While nobody will ever tell you NOT to purchase extra insurance, those of us on the call testified that everything was covered without purchasing a supplement.  Some felt that there might be certain providers or “extras” offered by a supplement – massages?

Did Walmart and Sam’s Club drop off the pharmacy for ChampVA?  There were no changes to ChampVA.  However, if you have TriCare, then Walmart and Sam’s Club are no longer available after December 15, 2021.  Walgreens and CVS have been added to the TriCare pharmacy network.

My spouse passed in 2012 and I never signed up for ChampVa.  What can I do to get reimbursed for medical claims?  Apply for ChampVA.  As soon as approved that will do two things. It will be effective back to 2012 (date of death) AND will open a 180 day window to submit all those claims.  So, you should start gathering the claim information and have it ready for when you apply.

How long do I have to submit claims?  I had them denied because we had a Level 5 Hurricane and was unable to get them submitted within the 180 days.  You should file an appeal citing the circumstances.

How do I sign up for HeatheVet so that I can order my meds by mail online?  I received a letter saying I have to update somehow.  Go to and follow instructions: https://www.myhealth.va.gov/mhv-portal-web/home  You may also phone them in if you prefer.

Should you use Meds by Mail or just go to the pharmacy?  Go to your pharmacy for anything urgent such as antibiotics.  If you go to a pharmacy you will pay a 25% cost share and your annual deductible. But get any nonurgent of long term from Meds by Mail such as maintenance medications, which are taken for longer periods of time such as blood pressure, hypertension, arthritis and chronic pain medications.

Other MbM info:

Medications included in the CHAMPVA pharmacy policy. Over-the-counter (OTC) items that do not need a prescription are not covered (exception for insulin and insulin supplies).

Insulin and other refrigerated medications can only be mailed to a physical address within the continental United States; we cannot mail refrigerated items to post office boxes.

Generic medications. To find out if your medication is available, call your MbM servicing center.

Brand name medications are limited as Meds by Mail promotes generic medications. Call your MbM servicing center to see if the brand name is available. If it is not, you will have to use your local pharmacy and pay the 25% cost share and annual deductible.

Certain controlled maintenance medications in Schedule 3, 4 and 5. For example, generic equivalents of Tylenol No. 3, Valium, Klonopin, Ultram and many others are available. All Schedule 2 narcotic medications such are Percocet, Ritalin, Hydrocodone and Oxycontin are NOT available and must be filled at your local pharmacy.

 Can I use Meds by Mail if I have other Rx coverage?  No, you cannot.

How do I send in a prescription?

Have your doctor send your prescription electronically
If your doctor has the capability to e-prescribe, this is the fastest, safest, most convenient way to get new prescriptions to Meds by Mail. Your doctor can find MbM in their e-prescribing software by searching “Meds by Mail CHAMPVA” or by searching for telephone number 888-385-0235.

Send your new prescriptions by mail
Complete the Meds by Mail Prescription Order Form, VA Form 10-0426 and mail in the original prescription (not a copy) with the completed form. Make sure the patient's Social Security number is included on the form and that the prescription has the doctor's name, phone number and mailing address printed on it.

How do I contact Meds by Mail with questions:  All the phone numbers, forms, etc. are here:  https://www.va.gov/COMMUNITYCARE/programs/dependents/pharmacy/meds_by_mail.asp


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