Guide for Veterans Health Benefits

Health Care for Veterans

Our Mission
Our Service members and Veterans have sacrificed to keep our country – and everything it represents – safe. We honor and serve those men and women by fulfilling President Lincoln’s promise“ to care for him who shall have borne the battle, and for his widow, and his orphan.”

We strive to provide Service members and Veterans with the world-class benefits and services they have earned, and will adhere to the highest standards of compassion, commitment, excellence, professionalism, integrity, accountability, and stewardship.

Thank you for your service.

Now let us serve you.

Table of Contents

Chapter 1    Welcome
Overview of VA’s Nationwide Health Care System
Overview of VA’s Medical Benefits Package
VA Provides Health Services at Facilities Across the Nation
What to Know About Primary Care
Your Eligibility Information
Health Benefits Are Different for Each Veteran
Important Phone Numbers

Chapter 2    Eligibility
Basic Eligibility
Minimum Duty Requirements
Enrollment Begins with the Application Process
Catastrophically Disabled Veterans
Combat Veterans
Financial Assessment (Means Testing)
Income Verification

Chapter 3    VA Health Benefits
Preventive Care Services
Inpatient Care Services
Ancillary Services
Specialty Care Services
Mental Health Care
Veterans Crisis Line (for all Veterans regardless of enrollment status)
Veterans Health Benefits Guide
Homeless Services
Women’s Health
Transplant Services
Dental Services
Health Promotion and Disease Prevention
Healthy Living
What are VA’s Health Registries?
Toxic Embedded Fragments
Home Health Care
Skilled Home Health Care (SHHC) Services
Homemaker/Home Health Aide (H/HHA) Services
Family Caregivers Program
Geriatrics and Extended Care Services
Geriatric Evaluation
Hospice Services
Respite Care Program
Domiciliary Care
Adult Day Health Care
Nursing Home Placement
State Veterans Homes
Medically Related Travel, Lodging, and Per Diem
Mileage Reimbursement
Specialized Transportation (Ambulances, Wheelchair Vans)
Lodging and Per Diem
Hoptel Services
Fisher Houses
Medical Equipment/Prosthetic Items and Aids
Does VA Provide Eyeglasses?
Does VA Provide Hearing Aids?
Automobile Adaptive Equipment Program
Automobile Access Equipment
Home Improvement and Structural Alteration (HISA) Grants
Clothing Allowance Benefit
Dependents’ Health Care
Spina Bifida/Children of Women Vietnam Veterans
Medical Benefits Package Exclusions

Chapter 4    Getting Started with VA Health Care
The First Appointment
How to Get a Veterans Identification Card
Is a VIC Like an Insurance or Credit Card?
How Can My Heal the Vet Improve Quality of Care?
Why Should I Keep a Personal Health Journal?
What if I Move or Live in More Than One Location?

Chapter 5    Accessing VA Health Care Services
Scheduling an Appointment and Canceling Appointments
How to Schedule or Cancel Appointments
Are There Walk-in Appointments?
Emergency Care and Non-VA Facilities
Urgent and After-Hours Care (Evenings, Nights, Weekends, Federal Holidays)
Social Work Services
Interpreter Services

Chapter 6    Coordination of Care
How Does VA Coordinate Care for Veterans Who are Traveling or Living at a Temporary Address?
Coordination of Care with Providers Outside the VA Network (Co-managed/Dual Care)
Coordination of Care Among VA Facilities
Specialized Outpatient Care Not Offered at the Local Health Care Facility
Disagreements Between VA Providers and Private Providers

Chapter 7    Pharmacy Services
What is VA’s Prescription Benefit?
VA’s Drug Formulary
Does VA Maintain a List of Preferred Medications?
How Do Enrolled Veterans Know if a Medication is on VA’s National Formulary?
Are There Some Drugs on the VA National Formulary That Should Not be Substituted with
 Another Drug?
Can Enrolled Veterans Receive a Drug That is Not on the VA National Formulary?
Why Doesn’t VA Provide the New Medications Seen on Television?
Non-VA Physicians and Prescriptions
Tips for Understanding Your Medication
Always Read Your Prescription Label Carefully
Why am I Taking This Medication?
How Will I Know Whether the Medication is Working?
What if I Think My Medication is Causing a Side Effect or a Drug Interaction?

Chapter 8    Patient Rights and Responsibilities
Respect and Nondiscrimination
Keeping Health Information Private and Secure
Partnering in Care
Concerns, Complaints, and Compliments
Patient Advocate
Family Involvement in Your Health Care
Can My Family Take an Active Role in My Treatment Decisions?
How Can My Family Members Share Their Concerns or Complaints About My Care?
What if I am an Inpatient at a VA Medical Facility or a Community Living Center (Formerly Known as a VA Nursing Home) Resident?
Advance Directives: What Are They and Why Are They Important?
What is a Durable Power of Attorney for Health Care?
What is a Living Will?
Should I Have an Advance Directive?
What Should I Do with My Advance Directive?
Can My Advance Directive be Changed?
Where Can I Get the Advance Directive Form?

Chapter 9    VA Copayments and Insurance
Overview of Copayments
Outpatient Services
Inpatient Services
Long-Term Care
Insurance and Other Third Party Payments: Why Does VA Bill Insurance Companies?
Overview of VA Billing
Does VA Bill for Service-Connected Conditions?
Does VA Bill Medicare?
Offsetting Your VA Copayments with Insurance Premiums
Do VA medical centers accept TRICARE?
Where can I get more information about TRICARE?
How Do I Pay My VA Bill?
Retroactive Award of Service-Connection or VA Pension Benefit

Chapter 10    Care Outside the VA System: What VA Covers
Pre-Authorized Non-VA Care
Emergency Care
VA Payment for Emergency Care of Service-Connected Conditions Without Prior Authorization
VA Payment for Emergency Care of Nonservice-connected Conditions Without Prior Authorization
Veterans Who are Living or Traveling in a Foreign Country

Chapter 11    Appeals
Administrative Appeals
Can I Appeal an Administrative Determination That Denies Me a Health Care Benefit?
Can I Request Reconsideration of a VA Decision?

Chapter 12    Vet Centers
Introduction to Vet Centers
What Services Do Vet Centers Provide?
How Do I Gain Access to Vet Center Services?

Chapter 13    VA Health Care and Medicare