A standard enhanced health benefits plan is generally available to all enrolled veterans. Like other standard health care plans, the Medical Benefits Package emphasizes preventive and primary care, offering a full range of outpatient and inpatient services. The following is a summary of the Veteran's Medical Benefits Package:
- Veteran's Medical Benefits Package Overview
- Veteran's Medical Benefits Package Eligibility
- Services Covered
- Preventative Care
- Services Not Covered
Veteran's Medical Benefits Package Overview
In October 1996, Congress passed the Veterans' Health Care Eligibility Reform Act of 1996. This legislation paved the way for the creation of a Medical Benefits Package - a standard enhanced health benefits plan generally available to all enrolled veterans. Like other standard health care plans, the Medical Benefits Package emphasizes preventive and primary care, offering a full range of outpatient and inpatient services.
VA places a priority on improved veteran satisfaction maintains that their goal is to ensure the quality of care and service that veterans receive is consistently excellent, in every location, in every program.
Veteran's Medical Benefits Package Eligibility
The Medical Benefits Package will generally be provided to all enrolled veterans regardless of your priority group.
Public Law calls for VA to provide you hospital care and outpatient care services that are defined as "needed". VA defines "needed" as care or service that will promote, preserve, and restore health. This includes treatment, procedures, supplies, or services. This decision of need will be based on the judgment of your health care provider and in accordance with generally accepted standards of clinical practice.
The following three categories contain a list of health care services that are provided under the Medical Benefits Package, a list of some that are not covered by VA, and a list of other services that are provided under special authority.
VA Provided Care Under the Medical Benefits Package
- 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:
- You were provided care in a hospital emergency department or similar emergency care facility
- You are enrolled in the VA health care system
- You have been provided care by a VA health care provider within the last 24 months.
- You are financially liable to the provider of the emergency treatment for that treatment.
- You have no other form of health care insurance.
- You do not have coverage under Medicare, Medicaid, or a state program.
- You do not have coverage under any other VA programs.
- You have no other contractual or legal recourse against a third party that will pay all or part of the bill.
- Department of Veterans Affairs or other Federal facilities were not feasibly available at time of the emergency.
- The care must have been rendered in a medical emergency of such nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health.
- 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.
- Pregnancy and delivery service, to the extent authorized by law.
- Completion of forms.
- Periodic medical exams
- Health Care Assessments
- Health education, including nutrition education
- Screening Tests
VA cannot provide the following services:
- Abortions and abortion counseling
- Cosmetic surgery except where determined by VA to be medically necessary for reconstructive or psychiatric care
- Drugs, biologicals, and medical devices not approved by the FDA unless the treating medical facility is conducting formal clinical trials under an Investigational Device Exemption (IDE) or an Investigational New Drug (IND) application, or the drugs, biologicals, or medical devices are prescribed under a compassionate use exemption.
- Gender alteration
- Health club or spa membership
- In vitro fertilization
- Services not ordered and provided by licensed/accredited professional staff
- Special private duty nursing
- Hospital and outpatient care for a veteran who is either a patient or inmate in an institution of another government agency if that agency has a duty to give the care or services.