Learn More
About Our Plan
How the CHAMPVA Supplement Works
Termination/Exclusions
Rate Schedule
How To Enroll
Return to IndexLinks
TRICARE Official Site
DEERS Info
Insurance Plan Works
| Inpatient Services Confinement(1) in civilian hospital or skilled nursing facility | DRG(2) rate, less the beneficiary cost share. | The lesser of 1. $535 per day, times number of inpatient days 2. 25% of billed amount, or 3. the DRG rate |
| Inpatient Services Non-DRG (2) based | 75% of the Allowable Amount | 25% of the Allowable Amount |
| Inpatient Physicians Services Visits,surgeons,anesthesiologist, etc. | 75% of the Allowable Amount | 25% of the Allowable Amount |
| Outpatient Services Offic visits, clinics, laboratory and pharmacy services, durable medical equipment (non-VA source) | 75% of the Allowable Amount after the CHAMPVA Annual Outpatient Deductible. | 25% of the Allowable Amount |
We will pay the Inpatient and Outpatient covered medical expenses once the Calendar Year plan deductible of $250 per person and $500 family maximum has been satisfied. Expenses incurred to satisfy the CHAMPVA Calendar Year Outpatient deductible cannot be used to satisfy the CHAMPVA Supplement Plan deductible. (1) Confinement or confined means being an inpatient in a hospital (or skilled nursing facility) due to sickness or injury. And skilled
nursing facility does not mean: a) a hospital; or b) a place for rest, custodial care, or the aged; or c) a place for the treatment of
mental disease, drug addicts or alcoholics. |