Combat Eligibility for Health Care Benefits
Wednesday, February 27, 2008 at 07:36 PM
by District 2
__VA_HEALTH_c4REFact Sheet 16-4
January 2008
Combat Veteran Eligibility
Enhanced Eligibility for Health Care Benefits: On January 28, 2008, “Public Law 110- 1 8V tilled the “National Defense Authorization Act of 2008” was signed into law. Section
1707 amended Title 38, United States Code (U Section 1710(e)(3), extending the period of eligibility for health care for veterans who served in a theater of combat operations after November 11, 1998, (commonly referred to as combat veterans or OEF/OIF veterans).
Under the Combat Veteran authority, the Department of Veterans Affairs (VA) provides cost-free health care services and nursing home care for conditions possibly related to military service and enrollment in Priority Group 6, unless eligible for enrollment in a higher priority to:
• Currently enrolled veterans and new enrollees who were discharged from active duty on or after January 28, 2003, are eligible for the enhanced benefits, for 5 years post discharge.
• Veterans discharged from active duty before January 28, 2003, who apply for enrollment on or after January 28, 2008, are eligible for the enhanced benefit until January 27, 2011.
Combat veterans, while not required to disclose their income information, may do so to determine their eligibility for a higher priority status, beneficiary travel benefits and exemption of copays for care unrelated to their military service.
Who’s eligible: Veterans, including activated Reservists and members of the National
Guard, are eligible if they served on active duty in a theater of combat operations after
November11, 1998, and have been discharged under other than dishonorable conditions.
Documentation used to determine service in a theater of combat operations:
• Military service documentation that reflects service in a combat theater, or
• receipt of combat service medals and/or,
• receipt of imminent danger or hostile fire pay or tax benefits.
Health benefits under the “Combat Veteran” authority:
• Cost-free care and medications provided for conditions potentially related to combat service.
• Enrollment in Priority Group 6 unless eligible for enrollment in a higher priority group.
• Full access to VA Medical Benefits Package.
What happens after the enhanced eligibility period expires: Veterans who enroll with VA under this authoflty will continue to be enrolled even after their enhanced eligibility period ends. At the end of their enhanced eligibility period, veterans enrolled in Priority Group 6 may be shifted to Priority Group 7 orB, depending on their income level, and required to make applicable copays.
What about combat veterans who do not enroll during their enhanced authority period: For those veterans who do not enroll during their enhanced eligibility period, eligibility for enrollment and subsequent care is based on other factors such as: a compensable service-connected disability, VA pension status, catastrophic disability determination, or the veteran’s financial circumstances. For this reason, combat veterans are strongly encouraged to apply for enrollment within their enhanced eligibility period, even if no medical care is currently needed.
Copays: Veterans who qualify under this special eligibility are not subject to copays for conditions potentially related to their combat service. However, unless otherwise exempted, combat veterans must either disclose their piior year gross household income OR decline to provide their financial information and agree to make applicable copays for care or services VA determines are clearty unrelated to their military service.
Note: While income disclosure by a mcenlly discharged combat veteran is not a requirement, this disclosure may pmvide additional benefits such as eligibility for travel reimbursement, cost-free medication and/or medical care for services unrelated to combat.
Dental Care: Eligibility for VA dental benefits is based on very specihc guidelines and differs significantly from eligibility requirements for medical care. Combat veterans may be authorized dental tieaftnent as reasonably necessary for the one-time correction of dental conditions if.
• They served on active duty and were discharged or released from active duty under conditions other than dishonorable from a period of service not less than 90 days and
• The certificate of discharge or release does not bear a certification that the veteran was provided, within the 90-day period immediately before the date of such discharge or release, a complete dental examination (including dental X-rays) and all appropriate dental service and treatment indicated by the examination to be needed and
• Application for VA dental treatment is made within 180 days of discharge or release
Additional Information: Additional information is available at the nearest VA medical facility. VA facilities listing and telephone numbers can be found on the internet at www.va.nov/directorv or in the local telephone directory under the “U.S. Governmen listings. Veterans can also call the Health Benefit Service Center toll free at 1-877-222-VETS (8387) or visit the VA health eligibility website at www.va.povlhealthelinibility
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