VHA Veterans Benefits Handbook

DEPARTMENT OF VETERANS AFFAIRS

(COVER DESIGN TO BE DETERMINED)

VETERANS HEALTH ADMINISTRATION

VETERANS BENEFITS
HANDBOOK

Table of Contents
Chapter 1 Welcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Overview of VA’s Nationwide Health Care System . . . . . . . . . . . . . . . . . . . . . . 2
Overview of VA’s Medical Benefits Package . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
VA Provides Health Services at Facilities across the Nation . . . . . . . . . . . . . . . 4
What Do I Need to Know About Primary Care? . . . . . . . . . . . . . . . . . . . . . . . . . 4
Your Primary Care Provider and Team Information . . . . . . . . . . . . . . . . . . . . . . . 5
Your Eligibility Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Health Benefits Are Different for Each Veteran — Including You . . . . . . . . . . . . 5
Chapter 2 Your Eligibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Your Priority Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Your Eligibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Benefits at a Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Enrollment Priority Groups . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Chapter 3 Your VA Health Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Preventive Care Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Inpatient Care Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Ancillary Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Specialty Care Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Mental Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Homeless Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Transplant Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Dental Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Pharmacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Health Promotion and Disease Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Home Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Geriatrics and Extended Care Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Medically Related Travel, Lodging, and Per Diem . . . . . . . . . . . . . . . . . . . . . . 23
Medical Equipment/ Prosthetic Items and Aids . . . . . . . . . . . . . . . . . . . . . . . . 24

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Veterans Health Benefits Handbook

Dependents’ Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Medical Benefits Package Exclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Chapter 4 Getting Started with VA Health Care . . . . . . . . . . . . . . . . . . . . . . . . . 27
Your First Appointment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
My HealtheVet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
If You Move, Your VA Health Care Services Move with You . . . . . . . . . . . . . . . 30
Chapter 5 Accessing Your VA Health Care Services . . . . . . . . . . . . . . . . . . . . . 31
Important VA Health Care Facility Phone Numbers . . . . . . . . . . . . . . . . . . . . . 31
VA Health Care Facility Address and Locations . . . . . . . . . . . . . . . . . . . . . . . . 31
Scheduling an Appointment and Canceling Appointments . . . . . . . . . . . . . . 32
Emergency Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Social Work Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Interpreter Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Chapter 6 Coordination of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Coordination of Care While Traveling or Living at a Temporary Address . . . . . 37
Coordination of Care with Providers Outside the VA Network (Co-managed/
Dual Care) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Coordination of Care among VA Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Chapter 7 Your Pharmacy Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
What is VA’s Prescription Benefit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Understanding Your Medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Filling Your Prescriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Refilling Your Prescriptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Chapter 8 Your Patient Rights and Responsibilities . . . . . . . . . . . . . . . . . . . . . 51
Respect and Nondiscrimination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Obtaining and Transferring Your Health Records . . . . . . . . . . . . . . . . . . . . . 52
Keeping Health Information Private and Secure . . . . . . . . . . . . . . . . . . . . . . 52
Partnering in Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

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Concerns, Complaints, and Compliments . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Keeping Your Information Up to Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Family Involvement in Your Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Advance Directives: What Are They and Why Are They Important? . . . . . . . . 58
Chapter 9 VA Copayments and Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Overview of VA Copayments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Insurance and Other Third Party Payments: Why Does VA Bill Insurance
Companies? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Retroactive Award of Service-Connection or VA Pension Benefit . . . . . . . . . . 62
Chapter 10 Care Outside the VA System:
What VA Covers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Pre-authorized non-VA Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Emergency Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
Chapter 11 Appeals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Administrative Appeals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Clinical Appeals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Health Care Ethics Consultation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Chapter 12 Vet Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Introduction to Vet Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Chapter 13 VA Health Care and Medicare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Privacy

Notice of Privacy Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77

How VHA May Use or Disclose Your Health Information . . . . . . . . . . . . . . . . . 78
Your Privacy Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Complaints . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Contact Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
When We May Use or Disclose Your Health Information . . . . . . . . . . . . . . . . . 81

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Veterans Health Benefits Handbook

Family Members or Others Involved in Your Care . . . . . . . . . . . . . . . . . . . . . . 88
Other Uses and Disclosures with Your Authorization. . . . . . . . . . . . . . . . . . . . 89
Revocation of Authorization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Your Privacy Rights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Glossary
Commonly Used Terms A-Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

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Chapter 1

Welcome

You have enrolled in the country’s largest and most comprehensive health care
system. The goal of the VA health care system is to achieve excellence in patient
care and customer satisfaction. Our mission is singular — to serve Veterans
by providing the highest-quality health care available anywhere in the world.
America’s Veterans and their families deserve nothing less.
Think of this Veterans Health Benefits Handbook as an extension of our
relationship with you as a member of the VA community. We have organized the
contents so that you can find the information you need quickly, and we have
made it easy to reach us if you need more guidance.

Overview of VA’s Nationwide Health Care System
You can expect VA’s highly qualified and dedicated health care professionals to
meet your needs, regardless of the treatment program, regardless of the location.
New locations continue to be added to the VA system, with the current number of
treatment sites now standing at more than 1,400 nationwide.
Today’s Veterans receive a Medical Benefits Package, which VA administers
through a patient enrollment program. Along with your enrollment in the VA health
care system comes the assurance that health and treatment services will be
available when and where you need them.

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Veterans Health Benefits Handbook

VA’s state-of-the art electronic medical records allow your health care benefits
to be completely portable throughout the system. If you are traveling or living
temporarily at an address far away from your primary treatment facility, you can
seek care at any VA health care facility across the country — without the hassle of
having to reapply.
We have also developed a Website — My HealtheVet — especially for Veterans.
Through My HealtheVet, access to important information about your health is at
your fingertips, 24 hours a day. First, you need to register on the website and be
authenticated in person at a VA facility. The authentication process protects your
privacy and your personal health information. Here’s what to do:
1. Go to the website: http://www.myhealth.va.gov
2. Click on the “Register Today” button and follow the instructions.
3. Go back to the My HealtheVet home page.
4. Click on the “In-Person Authentication” link.
5. Watch the brief orientation video.
6. Print out, complete, and sign the My HealtheVet release of
information form (Form 10-4344a-MHV).
7. Call your health care facility and ask where you can be In-Person
Authenticated. Remember to take your Form 10-4344a-MHV and a
photo ID (Veterans ID card or driver’s license).
Once your identity has been verified through the In-Person Authentication
process, you will have access to portions of your medical information online
through your MHV account. Initially, prescription names for Rx refills are available.
Later, the ability to see appointments, lab reports, and additional functions will
also be available.

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Chapter 1: Welcome | Overview of VA’s Medical Benefits Package

Overview of VA’s Medical
Benefits Package
VA’s comprehensive medical benefits
package offers care and services that
are designed to:
◙◙ Promote good health.
- or ◙◙ Preserve your current health.
- or ◙◙ Restore you to better health.
This includes treating illnesses and
injuries, preventing future health
problems, improving functional abilities
and enhancing quality of life.
We provide a full spectrum of medically
necessary services, based on the
judgment of your VA primary care
provider and in accordance with generally accepted standards of clinical practice.
These services include:
◙◙ Primary Care

◙◙ Critical Care

◙◙ Health Promotion

◙◙ Mental Health Care

◙◙ Disease Prevention

◙◙ Women’s Health Care

◙◙ Diagnosis

◙◙ Orthopedics

◙◙ Palliative Care

◙◙ Radiology

◙◙ Surgery

◙◙ Physical Therapy

◙◙ Prescriptions for Medications

◙◙ Rehabilitation

◙◙ Prosthetics

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Veterans Health Benefits Handbook

VA Provides Health Services at Facilities across the
Nation
VA strives to ensure that you have access to all of your needed services
wherever you receive your VA health care. This may be on-site during inpatient
hospitalization, at one of our primary or specialty care clinics, at a Community
Based Outpatient Clinic (CBOC), in a Community Living Center (formerly known as
a VA nursing home), or in a residential care facility. However, all services may not
be available at every location. Sometimes, you may need to travel to another VA
facility or a community care facility to receive the necessary treatment. If that is
the case, your VA provider will work with you to find the place best suited for you
to obtain the required services.

What Do I Need to Know About Primary Care?
Primary Care serves as the foundation of the VA health care system. Through
Primary Care, you have easy access to skilled medical professionals who are
familiar with the health care needs of Veterans, and who understand the
importance of developing long-term relationships with patients.
Among other things, your Primary Care Team will:
◙◙ Educate you and your family about the health care services available.
◙◙ Coordinate care across a spectrum of treatment options
◙◙ Keep you informed about disease prevention programs
You will be assigned a Primary Care Provider when you come for your first Primary
Care appointment. If you have a spinal cord injury/disorder (SCI), your Primary
Care Provider will be a member of the trained SCI Primary Care Team.

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Chapter 1: Welcome | Your Primary Care Provider and Team Information

Your Primary Care Provider and Team Information
After your first Primary Care appointment, fill in the following information for
future reference:
Your Primary Care Provider is

Your Primary Care Team is

You can reach your Primary Care Team by calling

Your Eligibility Information
The information in this Veterans Health Benefits Handbook reflects the benefits
and services available to you at the time it was published. Since VA policies are
governed by law, changes to programs or your eligibility may occur. We will send
you updates that reflect these changes. If you have questions, contact your local
Enrollment Coordinator or call us at 1-877-222-VETS (8387).

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Veterans Health Benefits Handbook

Health Benefits Are Different for Each Veteran —
Including You
While all enrolled Veterans enjoy access to VA’s comprehensive medical benefits
package, certain benefits (for example, dental care) may vary from individual to
individual, depending on each Veteran’s unique eligibility status. This Veterans
Health Benefits Handbook has been tailored specifically for you: Mr. Veteran
Important Phone Numbers
◙◙ Suicide Prevention

1-800-273-TALK (8255)

◙◙ National Call Center for Homeless Veterans

1-877-424-3838.

◙◙ Health Enrollment Information or Questions
about Bills for your VA Health Care

1-877-222-VETS (8387)

◙◙ VA Compensation, Pension, Education and
Loan Guaranty Programs

1-800-827-1000

◙◙ Foreign Medical Program

1-303-331-7590

◙◙ Health Care Coverage for Eligible Dependents
of Veterans (CHAMPVA)

1-800-733-VETS (8387)

Your Local Health Care Facility Phone Numbers
◙◙ Main Hospital

202-745-8000

◙◙ After Hours

202-745-8236

◙◙ Patient Advocate

202-745-8588

◙◙ Pharmacy

202-745-8235

◙◙ Enrollment Coordinator

202-745-8000 ext. 6333

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Chapter 2

Your Eligibility

Your Priority Group
VA determines your eligibility for VA’s comprehensive medical benefits package
through our patient enrollment system, which is based on Priority Groups from 1
through 8. Our records indicate that you are enrolled in Priority Group 1. You will
find a list of all Priority Groups at the end of this chapter.

Your Eligibilities
Your eligibility for VA health benefits is based on your unique eligibility factors, as
listed below:
◙◙ 100 percent Service-connected
◙◙ Rated as having a total disability permanent in nature resulting from your
Service-connected condition(s)

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Veterans Health Benefits Handbook

Correcting or Updating Your Eligibility Information
VA strives to keep correct and up-to-date eligibility information. However,
there is the rare occasion when you may receive updated information (for
example, a recent award of Pension or Service-connection) before it reaches
your local VA facility. If you think that your eligibility information is incorrect
or requires updating, contact VA at 1-877-222-VETS (8387) or visit your local
health care facility.

Benefits at a Glance
*Health Benefits

*Coverage?

Basic Medical Benefits Package,
includes

Yes

*Chapter(s)
3

◙◙ Preventive Care
◙◙ Hospital (Inpatient) Services
◙◙ Ancillary Services
◙◙ Mental Health
◙◙ Home Health Care
◙◙ Geriatrics and Extended Care
◙◙ Medical Equipment/Prosthetic
Items and Aids
Medications/Supplies

Yes, VA will fill prescriptions
written by a VA provider

3 and 7

Dental

Yes

3

Nursing Home Placement

Yes

3

Medically Related Travel Benefits

Yes

3

Eyeglasses

Yes, If receiving VA care or
services

3

Hearing Aids

Yes, If receiving VA care or
services

3

Automobile Adaptive Equipment

Under certain conditions

3

Home Improvement and Structural
Alteration Grants

Under certain conditions

3

◙◙ Mileage Reimbursement
◙◙ Specialized Transportation
◙◙ Lodging and Per Diem

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Chapter 2: Your Eligibility | Enrollment Priority Groups

*Health Benefits

*Coverage?

*Chapter(s)

Clothing Allowance Benefit

Under certain conditions

3

Dependent’s Health Care

Yes, if not eligible under
TRICARE

3

Emergency Care at a non-VA Facility

Under certain conditions

10

Foreign Medical Care

Yes, for service‑connected
disabilities or any disability
associated with or aggravating
a service‑connected disability

10

Enrollment Priority Groups
Priority Group 1
◙◙ Veterans with VA Service-connected disabilities rated 50% or more.
◙◙ Veterans assigned a total disability rating for compensation based on
unemployability.

Priority Group 2
◙◙ Veterans with VA Service-connected disabilities rated 30% or 40%.

Priority Group 3
◙◙ Veterans who are former POWs.
◙◙ Veterans awarded the Purple Heart Medal.
◙◙ Veterans awarded the Medal of Honor.
◙◙ Veterans whose discharge was for a disability incurred or aggravated in the line of
duty.
◙◙ Veterans with VA Service-connected disabilities rated 10% or 20%.
◙◙ Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151,
“benefits for individuals disabled by treatment or vocational rehabilitation.”

Priority Group 4
◙◙ Veterans receiving increased compensation or pension based on their need for
regular Aid and Attendance or by reason of being permanently Housebound.
◙◙ Veterans determined by VA to be catastrophically disabled.

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Veterans Health Benefits Handbook

Priority Group 5
◙◙ Nonservice-connected Veterans and noncompensable Service-connected Veterans
rated 0%, whose annual income and/or net worth are not greater than the VA
financial thresholds.
◙◙ Veterans receiving VA Pension benefits.
◙◙ Veterans eligible for Medicaid benefits.

Priority Group 6
◙◙ Compensable 0% Service-connected Veterans.
◙◙ Veterans exposed to ionizing radiation during atmospheric testing or during the
occupation of Hiroshima and Nagasaki.
◙◙ Project 112/SHAD participants.
◙◙ Veterans exposed to herbicides while serving in Vietnam.
◙◙ Veterans who served in the Southwest Asia theater of operations from August 2,
1990, through November 11, 1998.
◙◙ Veterans who served in a theater of combat operations after November 11, 1998,
as follows:
◙◙ Veterans discharged from active duty on or after January 28, 2003, for five years
post discharge

—and—
◙◙ Veterans discharged from active duty before January 28, 2003, who enroll after
January 28, 2008, until January 27, 2011.

Priority Group 7
◙◙ Veterans with incomes below the geographic means test (GMT) income thresholds
and who agree to pay the applicable copayment.

Priority Group 8
Veterans with gross household incomes:
◙◙ above the VA Means Test thresholds who were enrolled as of January 16, 2003 and
who agreed to pay the applicable copayment,

—or—

◙◙ not exceeding the VA Means Test thresholds or GMT income thresholds by more
than 10% and who agree to pay the applicable copayment—effective June 15, 2009.

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Chapter 2: Your Eligibility | Enrollment Priority Groups

Notes for Benefits

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Veterans Health Benefits Handbook

Notes

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Chapter 3

Your VA Health Benefits

Your comprehensive VA Health Benefits includes all the necessary inpatient
hospital care and outpatient services to promote, preserve, or restore your health.

Preventive Care Services
Your health benefits include important preventive care services:
◙◙ Periodic medical exams (including gender-specific exams).
◙◙ Health education, including nutrition education.
◙◙ Immunization against infectious disease.
◙◙ Counseling on inheritance of genetically determined disease.

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Veterans Health Benefits Handbook

Inpatient Care Services
VA inpatient care includes a full spectrum of treatment services:
◙◙ Medical
◙◙ Surgical
◙◙ Mental Health
◙◙ Dialysis
◙◙ Acute Care
You also have access to VA’s specialized care units, which includes:
◙◙ Intensive Care Units (medical, surgical, mental health, cardiac)
◙◙ Transplant Care Units
◙◙ Spinal Cord Injury Centers
◙◙ Traumatic Brain Injury Units
◙◙ PolyTrauma Centers

Ancillary Services
VA’s health care providers may employ ancillary services to help diagnose or treat
your medical condition. These services include:
◙◙ Audiology (hearing)
◙◙ Blind and Vision Rehabilitation
◙◙ Chiropractic Services
◙◙ Dental
◙◙ Diagnostic Laboratory
◙◙ Nutrition and Food Service
◙◙ Nuclear Medicine (imaging)
◙◙ Occupational Therapy
◙◙ Pharmacy
◙◙ Physical Therapy

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Chapter 3: Your VA Health Benefits | Specialty Care Services

◙◙ Prosthetics (artificial limbs,
equipment, devices)
◙◙ Radiology (x-rays and imaging)
◙◙ Radiation Oncology (cancer care)
◙◙ Recreation and Creative Arts
Therapies (music, art, dance
and drama)
◙◙ Respiratory Therapy
◙◙ Social Work (housing, discharge
planning, family support)
◙◙ Speech/Language Pathology
(speech, language, voice, fluency,
cognition, and swallowing)
◙◙ Traumatic Brain Injury

Specialty Care Services
Through VA’s specialty care services, you have access to expert knowledge to
optimize treatment in unique or complicated courses of care. Our specialty care
providers focus on particular areas of care in which they have extensive training
and education. VA medical and surgical specialty care services include:
◙◙ Anesthesiology
◙◙ Bariatric surgery (weight loss surgery)
◙◙ Cardiology – Vascular (heart and blood circulation)
◙◙ Chaplain (spiritual support)
◙◙ Critical Care Specialty
◙◙ Dermatology
◙◙ Diabetes and Endocrinology
◙◙ Geriatric Care
◙◙ Gynecology Care
◙◙ Infectious Disease

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Veterans Health Benefits Handbook

◙◙ Nephrology (kidney)
◙◙ Neurology (nerves)
◙◙ Mental Health
◙◙ Oncology (cancer)
◙◙ Optometry & Ophthalmology (eye care)
◙◙ Orthopedic Surgery
◙◙ Orthotic and Prosthetic (amputee care and custom orthotics)
◙◙ Pacemaker (heart)
◙◙ Pain Management
◙◙ Podiatry (feet)
◙◙ Pulmonary (lungs)
◙◙ Robotic-Assisted Surgery
◙◙ Spinal Cord Injury
◙◙ Transplant Surgery (heart, lung, liver, etc.)
◙◙ Urology
◙◙ Vascular Surgery
◙◙ Women’s Care

Mental Health Care
VA provides specialty inpatient and outpatient mental health services at
its medical centers and community-based outpatient clinics (in addition,
readjustment counseling services may be available for you and members of your
family at Vet Centers across the nation).  Our goal is to support recovery and
enable Veterans who experience mental health problems to live meaningful lives
in their communities and to achieve their full potential.
VA provides cost-free military sexual trauma counseling and referral, including
appropriate care and services, to overcome psychological trauma resulting from
a physical assault or battery of a sexual nature or from sexual harassment that
occurred while the Veteran was on active duty, or was on Active Duty for Training
(ADUTRA).

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Chapter 3: Your VA Health Benefits | Mental Health Care

call

Mental health services are available
in specialty clinics, primary care
clinics, nursing homes, and residential
care facilities. Specialized programs,
such as mental health intensive
case management, day centers,
work programs and psychosocial
rehabilitation are provided for those
with serious mental health problems.
The list of services and programs that
Mental Health supports include:

1-800-273-TALK
Press 1 for Veterans

◙◙ Inpatient Care
◙◙ Residential Care
◙◙ Outpatient Mental Health Care
◙◙ Homeless Programs
◙◙ Programs for Incarcerated
Veterans

www.suicidepreventionlifeline.org

◙◙ Specialized PTSD Services
·

◙◙ Military Sexual Trauma
◙◙ Psychosocial Rehabilitation & Recovery Services
◙◙ Substance Use Disorders
◙◙ Suicide Programs
◙◙ Geriatrics
◙◙ Violence Prevention
◙◙ Evidence Based Psychotherapy Programs

◙◙ Mental Health Disaster Response/Post Deployment Activities

Suicide Prevention
Pick up the phone and call for immediate help if you notice any of
these signs:
◙◙ Thinking about hurting or killing yourself or others.
◙◙ Experiencing an emotional crisis.

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Veterans Health Benefits Handbook

◙◙ Hopelessness, feeling like there’s no way out.
◙◙ Talking or writing about death, dying, or suicide.
◙◙ Engaging in self-destructive behavior, such as drug abuse.
The number for the National Suicide Prevention Hotline is 1-800-273-TALK
(8255). Press 1 for Veterans and someone who can help you will answer
right away.
Additional Warning Signs
◙◙ Anxiety, agitation, sleeplessness, mood swings.
◙◙ Feeling like there is no reason to live.
◙◙ Extended periods of anger or rage.
◙◙ Engaging in risky activities without thinking.
◙◙ Increasing alcohol or drug abuse.
◙◙ Withdrawing from family and friends.

Homeless Services
VA provides specialized homeless services at its medical centers and through
community-based partners with a goal that no Veteran will have to become or
remain homeless.
If you are homeless or at risk of becoming homeless pick up the phone and
call for help. The number for the National Call Center for Homeless Veterans is
1-877-424-3838. The call center will connect you with the closest VA Medical
Center to best address your specific needs.

Transplant Services
If the need arises, you are eligible for transplant services. The request will be
coordinated by your Primary Care Team.

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Chapter 3: Your VA Health Benefits | Health Promotion and Disease Prevention

Dental Services
You are eligible for cost-free
comprehensive dental care.

Pharmacy
Your VA provider will order medications
and medical supplies for you as needed.
You will find specific information about
your VA Pharmacy benefits in Chapter 7.

Health Promotion and
Disease Prevention
You receive health promotion and
disease prevention services from your
primary care providers. These services
include immunizations to prevent disease, screening tests to detect disease at an
early stage, and behavioral counseling to avoid or reduce risk factors for disease.
You may also participate in health education programs to help you develop
healthy living skills and manage your health problems.

Healthy Living
There has been a lot of research in recent years on the best ways to take
care of yourself and stay healthy. We encourage you to make healthy living
behaviors part of your daily life.
Talk to your VA provider and check out the following websites:
◙◙ My HealtheVet Healthy Living Centers http://www.myhealth.va.gov.
◙◙ VA MOVE! program website http://www.move.va.gov/.
◙◙ Men: Stay Healthy at Any Age
http://www.ahrq.gov/ppip/healthymen.htm.

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Veterans Health Benefits Handbook

What are VA’s Health Registries?
VA maintains health registries related to environmental and occupational
exposures of U.S. Veterans during military service, including Operation
Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Gulf War, Vietnam,
World War II, and atomic test activities. These registries include a free
specialized and comprehensive health examination provided by a VA
Environmental Health (EH) clinician.
Contact your local EH Coordinator to request information about registry
examinations or visit the Environmental Agents Service (EAS) Web site
www.va.gov/environAgents, where you will also find links to newsletters
covering related topics:
◙◙ Agent Orange Review
◙◙ Operations Iraqi Freedom/Enduring Freedom Review
◙◙ Gulf War Review
◙◙ Ionizing Radiation Review
Another resource is VA’s toll-free special health issues helpline,
1-800-349-8383.

Home Health Care
Home Health Care includes VA’s Skilled Home Health Care Services (SHHC) and
Homemaker and Home Health Aide Services (H/HHA).

Skilled Home Health Care (SHHC) Services
SHHC services are in-home services provided by specially trained personnel,
including nurses, physical therapists, occupational therapists, speech
therapists, and social workers. Care includes clinical assessment, treatment
planning and treatment provision, health status monitoring, patient and family
education, reassessment, referral, and follow-up.

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Chapter 3: Your VA Health Benefits | Geriatrics and Extended Care Services

Homemaker/Home Health Aide
(H/HHA) Services
H/HHA services are personal care
and related support services that
enable frail or disabled Veterans to
live at home.

Geriatrics and Extended
Care Services
The mission of VA’s Geriatrics and
Extended Care is to advance quality
care for aging and chronically ill
Veterans in the most efficient manner.
Through research, education, and
evaluation of new clinical models, VA
has developed innovative and effective
long-term care programs.

Geriatric Evaluation
VA provides assessments and care plan recommendations for the complex
problems of aging.

Hospice Services
The primary goal of Hospice services is to provide comfort rather than cure for
those with an advanced disease that is life-limiting. VA’s interdisciplinary team
of professionals and volunteers focuses on relief of suffering and maintenance
of functional capacity as long as possible. Through integrated management
of the physical, psychological, social, and spiritual needs of the patient, these
programs also give support to the patient’s family or other caregivers, which
includes bereavement counseling following the death of the patient.

Respite Care Program
Respite Care is a program that provides short-term services to give the
caregiver a period of relief from the demands of daily care for the chronically
ill or disabled Veteran.

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Veterans Health Benefits Handbook

Respite Care services may include a short stay by the Veteran in a VA
Community Living Center (formerly known as VA nursing homes) or hospital;
a short stay in a community nursing home; in-home services provided by a
personal care aide; or services provided in an adult day health facility in the
community.
Respite care is generally limited to 30 days per year.

Domiciliary Care
VA offers two distinct types of Domiciliary Care: short-term rehabilitation and
long-term health maintenance care. This program also provides a clinically
appropriate level of care for homeless Veterans whose health care needs are
not severe enough to require more intensive levels of treatment.

Adult Day Health Care
Adult Day Health Care is an outpatient day program consisting of health
maintenance, rehabilitative services, socialization, and caregiver support.
Veterans receiving Adult Day Health Care are often frail, elderly, and
functionally impaired. Adult Day Health Care includes key program elements
to address health needs, physical and cognitive functions, and social support.
The emphasis is on helping participants and their caregivers develop the
knowledge and skills necessary to manage care at home.

Nursing Home Placement
If clinically indicated, you will be provided needed nursing home care either
through VA’s Community Living Centers (CLC) or contract nursing homes.
The mission of the VA Community Living Centers (VACLC) program (formerly
known as VA Nursing Home Care Units) is to provide compassionate care to
veterans with chronic stable conditions – those how suffer from dementia,
who require rehabilitation or short-term specialized services (such as respite
or intravenous therapy), or who need comfort and care at the end of life. For
more information contact your local Social Work Service.

State Veterans Homes
The term “State Home” refers to a VA-recognized home established by a
State, primarily for Veterans disabled by age or disease, whose disabilities
render them incapable of earning a living. A State Home includes facilities for
domiciliary and/or nursing home care. A State Home may also provide care

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Chapter 3: Your VA Health Benefits | Medically Related Travel, Lodging, and Per Diem

to a Veteran’s spouse or a parent
who has suffered the loss of a son
or daughter in service. Eligibility
for State Home placement varies
by state.
For more information about your
State Veterans Home, contact Social
Work Service at your local VA facility.

Medically Related Travel,
Lodging, and Per Diem
Mileage Reimbursement
You will be reimbursed 41.5 cents
per mile, subject to applicable
deductibles, for your travel related to
obtaining VA health care services.

Specialized Transportation (Ambulances, Wheelchair Vans)
VA may arrange or reimburse you for specialized transportation related to
obtaining VA health care services.

Lodging and Per Diem
You may be paid the actual cost for meals, lodging, or both — not to exceed
50 percent of the amount allowed for government employees — when it
is determined that an overnight stay is required for your travel related to
obtaining VA health care services. Factors VA may consider in making that
determination include, but are not limited to:
◙◙ the distance you must travel;
◙◙ the time of day when VA scheduled your appointment;
◙◙ the weather, traffic, or other conditions affecting your travel.
For more information on mileage reimbursement, specialized transportation
or lodging and per diem contact your local Enrollment Coordinator.

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Veterans Health Benefits Handbook

Hoptel Services
Hoptel is VA’s term for temporary lodging. Temporary lodging may be
furnished if you are receiving health care services or a Compensation and
Pension examination at a VA health care facility. If you are undergoing
extensive treatment or procedures (organ transplant, chemotherapy, surgical
intervention, diagnostic work-up, etc.), you and a family member (and/or
caregiver) may be furnished temporary lodging, at the discretion of the facility
Director, for the duration of your treatment. For more information contact your
local Social Work Services.

Fisher Houses
The Fisher House Foundation, a non-profit organization, was created in 1990
by Zachary and Elizabeth Fisher. Fisher Houses are designed for use by family
members of hospitalized Veterans. However, Veterans undergoing outpatient
treatment who do not live within commuting distance of the VHA facility may
also be accommodated at Fisher Houses. For more information contact your
local Social Work Services.

Medical Equipment/Prosthetic Items and Aids
VA Prosthetics furnishes properly prescribed prosthetic equipment, sensory aids,
and other devices to eligible Veterans. Prosthetics serves as the pharmacy for
assistive aids and as the case manager for the prosthetic equipment needs of
disabled Veterans.
Am I eligible for Eyeglasses?
If you are otherwise receiving VA care or services, VA will provide your
eyeglasses based on clinical need.
Am I eligible for Hearing Aids?
If you are otherwise receiving VA care or services, VA will provide your hearing
aids based on clinical need.

Automobile Adaptive Equipment Program
VA’s Automobile Adaptive Equipment program provides equipment and training
to enter, exit, or operate a motor vehicle if your Primary Care Provider decides
that you need it to drive safely and comply with State licensing laws. Note

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Chapter 3: Your VA Health Benefits | Dependents’ Health Care

that only certain Service-connected
conditions qualify. You may also be
eligible for financial assistance, in
the form of a grant, to purchase a
new or used automobile (or other
conveyance). For more information,
contact your local Prosthetic
Representative.

Home Improvement and
Structural Alteration (HISA)
Grants
You may receive a Home
Improvement and Structural
Alteration Grant for improvements
or structural alterations needed
to access your home or essential
bathroom facilities. For more
information, contact your local
Prosthetic Representative.

Clothing Allowance Benefit
If you must wear a prescribed device that causes your clothing to wear or
tear, or if your clothing is damaged due to use of a topical ointment, you may
receive an annual Clothing Allowance payment. For more information, contact
your local Prosthetic Representative.

Dependents’ Health Care
Your dependents may qualify for VA’s Civilian Health and Medical Program of the
Department of Veterans Affairs (CHAMPVA) if they do not have eligibility under
TRICARE. For more information, call 1-800-733-8387 or go to
http://www4.va.gov/hac/forbeneficiaries/champva/champva.asp.

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Veterans Health Benefits Handbook

Spina Bifida/Children of Women Vietnam Veterans
VA provides monetary allowances, vocational training and rehabilitation and
VA-financed health care benefits to certain Korea and Vietnam Veterans’ birth
children who have been diagnosed with spina bifida. For the purpose of this
program, spina bifida is defined as all forms or manifestations of spina bifida
(except spina bifida occulta). For more information, call 1-888-820-1756 or
go to http://www4.va.gov/hac/forbeneficiaries/spina/spina.asp.

Medical Benefits Package Exclusions
The following health care services are not included in your VA Medical
Benefits Package:
◙◙ Abortions and abortion counseling.
◙◙ Cosmetic surgery, except where determined by VA to be medically
necessary.
◙◙ Gender alteration.
◙◙ Health club or spa membership.
◙◙ In-vitro fertilization.
◙◙ Drugs, biological, and medical devices not approved by the Food
and Drug Administration, unless part of formal clinical trial under an
approved research program or when prescribed under a compassionate
use exemption.
◙◙ Inpatient hospital or outpatient care for a Veteran who is either a patient
or inmate in an institution of another government agency, if that agency
has a legal obligation to provide the care or services.
Notes

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Chapter 4

Getting Started with VA Health Care

Your First Appointment
If you requested an appointment when you applied for enrollment, your VA health
care facility will contact you to schedule your first appointment. If not, you may
request an appointment in person or by calling your local VA health care facility.
How Do I Get my Veterans Identification Card?
The Veterans Identification Card (VIC) is your gateway to quick access to benefits
at VA health care facilities. You need to go to your local VA health care facility to
have your picture taken. VA will mail your VIC to you within a few days.
What if my VIC is lost or destroyed?
Contact the VA health care facility where your picture was taken to request
that a new card be re-issued. Since the photo is retained, there is no need for
you to go to the facility to retake a picture.
Is my VIC like a Credit Card?
No. VIC is not a credit card or an insurance card, and it does not authorize or
pay for care at non-VA facilities.
Although your VIC does not contain your Social Security number, date of birth,
or other sensitive information on the face of the card, that information is
coded into the magnetic stripe and barcode — so be careful. Take precautions
to safeguard your VIC.
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Veterans Health Benefits Handbook

My HealtheVet
How Can My HealtheVet Improve the Quality of my Care?
My HealtheVet is a website created especially for Veterans. You can use it to:
◙◙ Get accurate health information from sources you can trust.
◙◙ Link to VA benefits and services.
◙◙ Refill your VA prescriptions and get information about your medicines.
◙◙ Read VA news and feature stories.
◙◙ Create your own personal health journal.

My HealtheVet: Registration and Authentication
To take advantage of all the features of My HealtheVet, you need to
register on the website and be authenticated in person at a VA facility. The
authentication process protects your privacy and your personal health
information. Here’s what to do:
1. Go to the website: http://www.myhealth.va.gov
2. Click on the “Register Today” button and follow the instructions.
3. Go back to the My HealtheVet home page.
4. Click on the “In-Person Authentication” link.
5. Watch the brief orientation video.
6. Print out, complete, and sign the My HealtheVet release of information
form (Form 10-4344a-MHV).
7. Call your health care facility and ask where you can be In-Person
Authenticated. Remember to take your Form 10-4344a-MHV and a photo
ID (Veterans ID card or driver’s license).
Once your identity has been verified through the In-Person Authentication
process, you will have access to portions of your medical information online
through your MHV account. Initially, prescription names for Rx Refill are
available. Later, the ability to see appointments, lab reports, and additional
functions will also be available.

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Chapter 4: Getting Started with VA Health Care | My HealtheVet

Why Should I Keep a Personal Health Journal?
Your personal health journal is the record you keep of your health history and
needs. You can use it to do any of these things:
◙◙ Keep track of all your providers.
◙◙ Keep track of your military health information.
◙◙ Record your personal health history.
◙◙ Keep track of your current vital readings, such as blood pressure or
blood sugar, and monitor them over time.
◙◙ Keep a list of your medicines.
◙◙ Record your physical activity or food intake each day.
◙◙ Record your emergency contacts.

How Do I Keep My Information Up to Date?
Use VA Form 10-10EZR, Health Benefits Renewal Form, if you need to update
or report changes to your address, phone number, name, health insurance or
financial information. Mail the updated form to your health care facility at:

Washington DC VA Medical Center
50 Irving Street, NW Washington, DC 20422
Main Phone Number

(202)745-8000

After Hours Phone Number

(202)745-8236

Patient Advocate Phone Number

(202)745-8588

Enrollment Coordinator Phone Number

(202)745-8000 ext. 6333

Pharmacy Phone Number

(202)745-8235

To request a 10-10EZR call us toll-free 1-877-222-VETS (8387) or go to
www.va.gov/vaforms/medical/pdf/vha-10-10ezr-fill.pdf.

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Veterans Health Benefits Handbook

If You Move, Your VA Health Care Services Move
with You
If you are moving to a new permanent address within the United States or its
territories, please let us know as soon as possible so that we can coordinate your
care with your new location.
What if I move or live in more than one location?
We encourage you to receive the majority of your care through your health
care facility and your primary care provider. But you may receive care at any
VA health care facility.
If you travel a lot or live in more than one location, you may need to arrange for
care at two or more VA facilities. When you plan extended travel outside your
usual VA care area, remember to give your primary care team and pharmacy:
◙◙ Your temporary address and phone number.
◙◙ The starting date at your new address and your expected date
of return.
VA can mail prescription refills to you at your temporary address. Be sure to
allow plenty of time — approximately 2 weeks — for the refills to arrive.

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Chapter 5

Accessing Your VA Health Care Services

Your VA Health Care Facility Address
Washington DC VA Medical Center
50 Irving Street, NW Washington, DC 20422

Important Facility Phone Numbers
Main Number

(202)745-8000

After Hours

(202)745-8236

Patient Advocate

(202)745-8588

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Veterans Health Benefits Handbook

Scheduling an Appointment and
Canceling Appointments
VA is committed to providing high-quality, clinically appropriate health care
— when you want and need it. This commitment includes the ability to make
appointments that meet your needs, with no undue waits or delays. We monitor
the wait times for scheduled appointments, and give you the opportunity to
complete a survey to tell us whether you received an appointment when you
wanted one.
How do I schedule or cancel appointments?
Call your primary care/specialty clinic during regular business hours to:
◙◙ make an appointment,
◙◙ change an appointment, or
◙◙ cancel an appointment.
If you know you are going to miss an appointment, please cancel it as soon as
possible so that another Veteran can get an appointment.
What if I just walk-in without a scheduled appointment?
Although we will evaluate your condition if you decide to “walk in” to a primary
care clinic without a scheduled appointment, you may have a wait, depending
on the severity of your medical situation.

Appointment for:

Date

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Time

Chapter 5: Accessing Your VA Health Care Services | Emergency Care

Emergency Care
What if I think I am having a medical emergency?
Call 911 or go to the nearest emergency room. You do not have to contact VA
in advance.
What is a medical emergency?
A medical emergency is generally defined as a condition that would cause a
prudent layperson (a person who possesses an average knowledge of health
and medicine) to reasonably expect that a delay in seeking immediate medical
attention would be hazardous to life or health.

Non-VA Facilities
You should go to the nearest emergency room whether in a VA or private
facility. If you are in an ambulance, the paramedics will usually take you to
the closest emergency room.
If the doctor wants to admit me to the non-VA hospital, must I obtain
approval from VA?
◙◙ If the admission is for a medical emergency — NO.
◙◙ If the admission is not for a medical emergency — YES. You, a friend,
a family member, or someone from the non-VA hospital should call
the closest VA medical center and speak to the patient transfer or
patient administration representative within 72 hours of your arrival
at the emergency room. You will be offered a transfer to VA if a VA
bed is available and you can be safely transferred.

Does my enrollment in the VA Health Care System change my coverage for
emergency care?
It might. Call your local VA facility’s Enrollment Coordinator to find out what
your options are.
Does my other insurance (TRICARE, Medicare, Medicaid, Blue Cross, etc.)
change my VA coverage for emergency services?
It might. Call your local VA facility’s Enrollment Coordinator to find out what
your options are.

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Veterans Health Benefits Handbook

Urgent and After-Hours Care
(Evenings, Nights, Weekends, Federal Holidays)
If you need non-emergency care, call the after-hours telephone advice care line
to get advice about your health concerns. The advice line is staffed by registered
nurses who will discuss your medical concerns and work with you to determine
the care you need. The registered nurse will document the telephone call in your
electronic medical record and notify the appropriate medical provider.
What if I Require a Hospital Admission?
Your VA provider will make appropriate arrangements to admit you to the
nearest VA hospital that is adequately equipped and staffed to furnish the
care you need. Depending on your eligibility and other factors, VA may admit
you to a non-VA hospital.

Extended-Care Admission
Your VA provider will make appropriate arrangements for needed extendedcare admissions. An admission may be appropriate:
◙◙ if you have chronic stable conditions, including dementia, requiring
rehabilitation or specialized services such as respite or intravenous
therapy; or
◙◙ if needed for comfort and care at the end of life.

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Chapter 5: Accessing Your VA Health Care Services | Interpreter Services

Social Work Services
VA social workers are assigned to all
patient treatment programs, including
community-based outpatient clinics.
They provide social and clinical services
to Veterans and their families in
resolving the social, emotional, and
economic problems associated with
the stresses of illness. Social workers
bring skills in individual, group, and
family treatment to the care of Veteran
patients as they move through the
continuum of care.
VA Social Work Service has
responsibility for the Fisher House
Program, the Temporary Lodging
Program, policies on reporting
suspected abuse and neglect, and
family support for polytrauma patients.
For more information, you can contact
your local Social Work Service.

Interpreter Services
If you think foreign language (or American Sign Language) services would help
you or your family understand your medical or health care benefits, contact your
Patient Advocate.

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Veterans Health Benefits Handbook

Notes

36

Chapter 6

Coordination of Care

How Does VA Coordinate Care If I Am Traveling or Living
at a Temporary Address
Generally, your VA Primary Care Team is responsible for your care even when you
are traveling or temporarily experiencing a change of address — such as living in
one state during the winter and another during summer. Any VA provider you see
while traveling will share information and coordinate treatment options with your
Primary Care Team.

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Veterans Health Benefits Handbook

What About Coordination of Care with Providers Outside
the VA Network (Co-managed/Dual Care)
We strongly encourage you to receive all your health care through VA. However,
if you choose to receive treatment from private doctors, we will work with them
to meet your health care needs and coordinate effective treatment. We call this
Co‑managed Care or Dual Care — which means that your VA and private doctors
will work together to provide safe, appropriate, and ethical medical care.
Your Primary Care Team is responsible for managing all aspects of care and
services available to you through the VA system. Under no circumstances
can your VA provider simply re-write prescriptions, or order diagnostic tests
from an outside provider, without first making a professional assessment
that a particular test or drug prescription is medically appropriate. If your
VA provider does not follow the recommendations of your private provider, s/he
will communicate the reasons for such decisions and may offer alternative
treatment recommendations.
What are my responsibilities if I seek medical care outside the VA system?
◙◙ If you elect to have more than one provider, we will help you
coordinate your care, but you are responsible for keeping both your
VA provider and your private doctor informed.
◙◙ It is important that you tell both your VA provider and your private
provider about all health-related problems and changes in treatment,
including your prescription drugs. Make sure your VA and private
providers have one another’s name, address, and telephone number.
If you would like information from your VA medical record sent to your
private provider, you will need to contact the Release of Information
Office at your VA facility and sign a release form.
◙◙ For your safety, let your VA provider know about all medicines you’re
taking, including prescriptions, over-the-counter medicines, vitamins,
supplements, and herbals. You will also want to tell your private
provider about all of your VA prescriptions.
◙◙ Always feel free to raise questions or concerns with your VA
primary care provider about co-managed/dual care benefits or
potential conflicts.

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Chapter 6: Coordination of Care | Coordination of Care among VA Facilities

Coordination of Care
among VA Facilities
You may receive medical attention in a
variety of VA settings — clinic, hospital,
emergency room, Community Living
Center (formerly known as VA nursing
home), or your own residence. You will
receive care from professionals who
offer diverse specialized treatments
and services. In order to manage the
different aspects of care effectively,
your Primary Care team will use our
electronic medical record system to
ensure the coordination of your care.
What if I need specialized
outpatient care not offered at my
health care facility?
If you need care not offered at your
health care facility, your Primary
Care Team will arrange your care, as
appropriate, at other VA medical centers or, in some cases, in the community.
Generally, your Primary Care provider will coordinate the care you are
receiving at both locations.
What if I am an inpatient and need a transfer to receive specialized care?
VA will coordinate your care and arrange your transportation. In some cases,
a transfer may require changing your Primary Care to the facility where your
specialized care is taking place.
What if my VA provider and private provider disagree?
We will work with you to ensure that your health care needs and preferences
are met, and that you understand your options. Your VA provider has the final
say about how VA will meet your health care needs, including whether or not to
order tests or write prescriptions.

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Veterans Health Benefits Handbook

Notes

40

Chapter 7

Your Pharmacy Services

What is VA’s Prescription Benefit?
VA’s Prescription Benefit provides safe, effective, and medically necessary
medications to ensure the highest quality care for our nation’s Veterans.

VA’s Drug Formulary
Does VA maintain a list of preferred medications?
Yes. This list of medications is called a drug formulary. The organization that
accredits America’s hospitals requires all health care organizations to develop
a list of preferred medications that they keep in stock at all times. Health care
organizations prefer formulary medications because they are:
◙◙ High quality
◙◙ Effective
◙◙ Safe
◙◙ A good value
VA’s National Drug Formulary ensures that Veterans across the country have
access to the same medications at all VA facilities.
How do I know if a medication is on VA’s National Formulary?
The VA National Formulary lists medications alphabetically by generic name,
not by brand name. So instead of Zocor for cholesterol, you would look for

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Veterans Health Benefits Handbook

simvastatin. Or you can look up a medication by drug class. For example,
using the VA Class Index, you would look for penicillin under antimicrobials.
You can find a list of the medications on the VA National Formulary at the
Pharmacy Benefit Management (PBM) Website: http://www.pbm.va.gov/
NationalFormulary.aspx, or you can call your local VA pharmacist to ask
whether a medication is on the formulary.
Are there some drugs on the VA National Formulary that should not be
substituted with another drug?
Yes. In rare instances, there may be a medication that is not recommended for
substitution with another drug. You can find the Do Not Substitute List on the
VA PBM Internet site: http://www.pbm.va.gov/NationalFormulary.aspx.
Can I receive a drug that is not on the VA National Formulary?
Yes — there is a process that permits your VA health care provider to prescribe
a “non-formulary” drug if your special needs require it. The process assures
that a decision to use a non-formulary drug is based on evidence that the drug
is safe and effective.
Here are some of the reasons why your VA healthcare provider might consider
prescribing a non-formulary medication for you:
◙◙ You should not receive the formulary drug for safety reasons.
Common reasons to avoid a particular medication include:
• Certain medical conditions, like kidney disease
• Allergy to the medication or class of medications
◙◙ A side effect prevents you from continuing to use the formulary drug
◙◙ No response or not the desired response to the formulary drug(s)
◙◙ The VA National Formulary offers no acceptable alternatives

For details about how VA’s National Formulary works, see “How VA Ensures the
Quality of Medications for Veterans” at the end of this chapter. You may also
discuss this further with your VA health care provider.
Why doesn’t VA provide me with the new medications I’ve seen on television?
While some new drugs offer important improvements over older drugs, the
new drugs are not always better or safer than older drugs. VA has established

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Chapter 7: Your Pharmacy Services | Understanding Your Medication

a process to review the safety
and effectiveness of VA National
Formulary medications. This process
includes comparing several drugs
within the same class (such as the
statin class for lowering cholesterol
or ACE inhibitors for lowering blood
pressure). Only those drugs that
prove to be the safest and mosteffective and that offer the best
value are listed on the National
Formulary. If a formulary medication
is not appropriate, however, each VA
medical center has procedures in
place to help identify an alternative,
non-formulary medication.
Drug makers heavily promote their
new drug through advertising and
other publicity. But some new drugs
are not studied in large groups
of people or over long periods of time. As a result, we cannot always know
the safety of these medications. You may recall recent news stories about
medications that had to be taken off the market or had to add restrictive
warnings after reports about serious problems. When more is known about
the safety and effectiveness of newer medications, VA may consider adding
them to the National Formulary.

Understanding Your Medication
Always read your prescription label carefully.
When you receive your medication, make sure that you read the instructions
on the prescription label carefully and take your medication exactly as
directed. Also, look for any stickers that have been placed on the bottle
for additional instructions. These may include whether to take with food, or
whether there are any activities to avoid. If you have any questions, contact
your pharmacy at the number listed on the label.

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Why am I taking this medication?
Understanding why you are taking a medication is extremely important. Some
medications are given only for a specific period of time (for example, an
antibiotic taken for a short time for an infection), while others need to be
taken regularly on a long-term basis (for example, diabetes or high blood
pressure). If you are not sure why you are taking a medication or for how long
you should take it, ask your doctor, pharmacist, or other VA provider.
How will I know whether the medication is working?
Some medications are used to treat something you can feel (pain, allergy
symptoms), while others are for conditions that may not have any noticeable
symptoms (high blood pressure, high cholesterol). With many conditions, your
VA provider will be able to determine whether your medication is working — by
doing a physical exam or procedure, or by checking your lab tests. Whether
or not you feel that it is working, do not stop taking your medication or change
the dosage without talking to your doctor, pharmacist, or other VA provider.
Otherwise, they will not be able to provide the care you need.
What if I think my medication is causing a side effect or a drug interaction?
Sometimes, medications prescribed to help treat a certain condition can
also cause negative side effects. If you think you are having a side effect to a
medication or are experiencing a drug interaction, tell your doctor, pharmacist, or
other VA provider immediately. You can then discuss whether it is something that
is tolerable, or whether there is another medication that can be used instead.
Some side effects are mild or go away with continued use, but others can
be serious. In certain cases, medications may interact with other drugs,
supplements, or food in undesirable ways. Common side effects and drug
interactions are generally included in the information that comes with your
prescription. If you think you are experiencing a serious side effect, contact
your VA provider immediately or call for emergency medical care.
Why do these pills look different from the pills I got with my last prescription?
Like many other health care organizations, VA purchases medications made by
different companies. Each manufacturer may make its pill in a different shape
or color. These generic medications contain the same active ingredients and
work the same way as the brand name drug. Generic medications are regulated
by the U.S. Food and Drug Administration and are certified as just as effective
as the brand name product. Check with your pharmacist if you have any
questions about a change in the appearance of your medications or if you are
not sure whether you have received the correct medication.

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Chapter 7: Your Pharmacy Services | How Do I Refill My VA Prescriptions

Filling Your Prescriptions
What happens when I have a new
VA prescription filled?
New prescriptions are usually
prescribed by your doctor in the VA
computer system and processed for
filling by your pharmacist. While you
are waiting for your new prescription
to be filled, the pharmacist will:
◙◙ Check for allergies
◙◙ Make sure your new
medication can be taken
with your other medicines
◙◙ Review the medical
information for the drug and
its common uses
◙◙ Make sure the dose and
strength are appropriate
◙◙ Verify that the prescription is filled with the correct drug
◙◙ Make sure the prescription label has the correct directions on how to
take the drug and how to refill the medication
◙◙ Contact the provider if there are any concerns or questions
When your new prescription is ready for pick-up, the pharmacist is available
to talk to you about your medication and answer any questions. If your doctor
tells you that you don’t need to start taking your medication immediately, you
may contact the pharmacist and ask to have it mailed to you.

How Do I Refill My VA Prescriptions
In order to avoid running out of medication, you may request a refill as soon as
you receive your medication — or at least 14 to 21 days before you will run out.
This allows time for processing and mailing the prescription to you so that you
receive it well before you run out of your current supply.
◙◙ Always keep your mailing address up to date, and make any changes on
the back of the refill request slip. Remember to check the appropriate

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Veterans Health Benefits Handbook

box for address changes. You can also discuss address changes with your
pharmacist or clerk. (Note: VA cannot mail prescriptions to an address in a
foreign country.)
◙◙ Most refills are mailed to keep waiting times at the pharmacy pick-up
window as short as possible. This allows Veterans to pick-up new and
urgent medications more quickly.
◙◙ Remember: Refills are not automatically sent to you. To order refills, you
must use one of the following methods:
1. Use the Internet by enrolling in My HealtheVet, then log on to the Web
site at http://www.myhealth.va.gov.
2. Call the telephone ordering system using a touch-tone phone.
• The refill telephone number is on the top of your prescription bottle,
along with your prescription number
• The automated phone system will give you step-by-step instructions
• Before you start, have your Social Security Number and your
prescription number from the bottle nearby. Only the numbers on
the bottle are necessary to process a refill. Do not enter any letters
that may appear next to the numbers on the bottle.
3. Mail the refill slip that comes with your prescription. (Note: This
takes more time, so make sure you have refills remaining.) If you
have a new mailing address, make any changes on the back of
the refill request slip — and check the appropriate box for address
changes.
4. Drop off your refill slip at the VA pharmacy.
When you receive your medication refill, make sure the information on the
bottle is correct:
◙◙ Your name on the bottle
◙◙ The name of the medicine
◙◙ The amount to take for each dose
◙◙ The directions you need to follow for each dose
You should also note the color and shape of your pills.

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Chapter 7: Your Pharmacy Services | How Do I Refill My VA Prescriptions

How do I request a prescription
refill through My HealtheVet?
Registration and Authentication: To
take advantage of all the features
of My HealtheVet, you need to
register on the website and be
authenticated in person at a VA
facility. The authentication process
protects your privacy and your
personal health information.
Here’s what to do:
1. Go to the website: http://www.
myhealth.va.gov
2. Click on the “Register
Today” button and follow the
instructions
3. Go back to the My HealtheVet
home page
4. Click on the “In-Person Authentication” link
5. Watch the brief orientation video
6. Print out, complete, and sign the My HealtheVet release of
information form (Form 10-5345a-MHV)
7. Bring the form and a photo ID (Veterans ID card or driver’s license) to
your VA facility’s Release of Information Office
8. Call your health care facility and ask where you can be In-Person
Authenticated. Remember to take your form and a photo ID
(Veterans ID card or driver’s license).
Once your identity has been verified through the In-Person Authentication
process your refills are available using My HealtheVet for those prescriptions
that have been filled at least once by the VA pharmacy. To request a refill
through My HealtheVet:
◙◙ Log on to the Web site at http://www.myhealth.va.gov

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◙◙ Click “Pharmacy,” then click “Refill My Prescriptions”
(Please be patient the first time. It may take some time to display your
prescription information.)
◙◙ Use the prescription number on your last prescription label to select
the medication you want refilled
◙◙ On the far right, put a check in the box for the prescription you want
filled 
◙◙ Then click the red “Submit Refill” at the bottom of the window

Remember: four types of information must match VA records before you are
able to view pharmacy refill information:
◙◙ Social Security Number must be present in My HealtheVet
◙◙ Your name in My HealtheVet must be exactly as it appears on your
current prescription label
◙◙ Your date of birth must be correct
◙◙ You must check “VA Patient” in “Personal Information”

What should I do if I run out of my medication?
If your current prescription has no more refills, but your doctor wants you
to stay on your medication, you will need a new prescription. Contact your
VA provider as soon as possible to have the medication renewed. If your VA
facility has the AudioRenewal system, you can use the automated telephone
system to send a message to your provider and request a renewal. Contact
your medical center to find out whether this system is available or for
information on how to use the system.
As soon as you receive your medications, it is a good idea to look at the label
to see how many refills are left. Contact your provider for a renewal if you are
going to run out before your next scheduled appointment.
Certain narcotics and controlled substance medications cannot be refilled. A
new prescription is required for each supply. You and your VA provider can
discuss how and when you can get these prescriptions if there is a continuing
need for them.

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Chapter 7: Your Pharmacy Services | How Do I Refill My VA Prescriptions

My non-VA physician wrote me a
prescription. Will VA fill it?
VA is generally not authorized to
fill prescriptions unless they are
written by a VA provider. This
ensures that VA is able to provide
and track the complete medical
care for all Veteran patients. The
total medication management for
a prescription is the responsibility
of the provider who writes that
prescription.
◙◙ If you are receiving care
from a non-VA physician,
your VA providers need
to know about all of the
medications (prescription,
over-the-counter, and herbal
supplements) that you are
taking. You also need to
make sure that your private
provider is aware of the
medical treatment and medications you are receiving from VA.
◙◙ If your non-VA physician has prescribed a medication that is not on
the VA National Formulary (that is, a “non-formulary” medication),
your VA physician may elect to re-write that prescription for a VA
National Formulary medication. If this switch is made, it is because
your VA health care provider believes the VA National Formulary drug
offers the best safety, effectiveness, and overall value.
◙◙ If your VA health care provider believes that you should not receive
the VA National Formulary medication, an alternative will be sought.
Your VA health care provider may need to contact your non-VA
physician to obtain access to medical documents that support using
a non-formulary medication.

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Notes

How VA Ensures the Quality of Medications
for Veterans
The VA National Formulary includes medications approved by the U.S.
Food and Drug Administration (FDA), as well as over-the-counter (OTC)
medications and supplies. The VA Pharmacy Benefits Management
Services (PBM), in conjunction with VA physicians and pharmacists,
reviews the information about a drug’s safety and effectiveness, and
discusses the drug’s risks and benefits compared to other available
treatments. VA then considers the cost of the drug, relative to other
treatment options. All the information about the drug is then sent to
expert doctors, pharmacists, and other VA providers across the United
States. Observations and suggestions from these experienced health care
professionals help VA decide how best to use the medications to treat
Veteran patients.

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Chapter 8

Chapter Chapter 8: Chapter 8

Your Patient Rights and Responsibilities

Respect and Nondiscrimination
As part of our service to you and other Veterans, we are committed to improving
your health and well-being. In addition to making your visit or stay as pleasant as
possible, our employees will respect and support your rights as a patient.
Some of your rights and responsibilities are outlined in this document, beginning
with the following:
◙◙ You will be treated as an individual — with dignity, compassion, and
respect. You will receive care in a safe environment. We will honor your
personal and religious values, and your privacy will be protected.
◙◙ You — and any persons you choose — will be involved in all decisions about
your care. You can agree to or refuse treatment, and consider options.
Refusing treatment will not affect your rights to future care, but you take
responsibility for the possible results.
◙◙ You will be given the name and title of all providers involved in your
care, including students and trainees. If you believe you cannot follow
the treatment plan, you have a responsibility to notify your provider or
treatment team.
◙◙ You have the right to have your pain assessed, to receive treatment
to manage your pain, and to participate in developing a pain
management plan.

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◙◙ You have the right to choose whether you will participate in any research
project related to your treatment.
◙◙ You will be involved in resolving any ethical issues about your care —
including participation in decision-making and care at the end of life — and
you may seek guidance from your health care facility’s Medical Ethics
Consultation Service.
◙◙ In order to maintain a safe environment in all VA health care facilities, we
expect you to show respect for others — whether patients, residents, or
staff — and to follow the facility’s rules.

Obtaining and Transferring Your Health Records
If you need to obtain or transfer your medical records, contact your health care
facility’s Release of Information (ROI) office, who can also assist you with:
◙◙ requests to amend or correct your medical records;
◙◙ an accounting or list of disclosures of your health information;
◙◙ requests for your military records.

Keeping Health Information Private and Secure
VA will keep all of the information in your medical record confidential. No information
about you will ever be released without your consent unless required or authorized
by law. You will be informed of all outcomes of care, including any potential injuries.
You will be informed about how to request compensation for any injuries.

Know your privacy rights:
◙◙ Right to a Notice of Privacy Practice – You have a right to know how VA
uses and discloses your information. VHA’s Notice of Privacy Practice
outlines all the general purposes for which VA uses or discloses your
information. A copy of this Notice is located at the back of this Handbook.
◙◙ Right to Request Amendment – You have a right to request that
information about you be amended, if you feel that it is incorrect or
inaccurate, not timely, or not relevant to the services you receive from VA.
If you request an amendment and it is not approved, you have the right to
appeal that decision to the VA Office of General Counsel.

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Chapter 8: Your Patient Rights and Responsibilities | Keeping Health Information Private and Secure

◙◙ Right to Access Record – You
have a right to access your
records. VA will provide you with
access to these records in any
reasonable format, or will have
a VA employee show you your
record on a VA computer.
◙◙ Right to Request Restriction –
You have a right to request that
your information not be shared
with certain individuals or
organizations. (There are some
individuals or organizations that
VA cannot withhold information
even if you request it such as
reporting required by law. If you
restriction request is not granted,
VA will let you know and provide
you with appeals rights.)
◙◙ Right to Confidential
Communication – You have a
right to request that VA provide you with a confidential means of getting
information. This may be in the form of a specific address that you wish VA
to use or a particular phone contact number for calls.
◙◙ Right to Opt-out of Facility Directory – If you are admitted to a VA health
care facility as an inpatient, you have the right to request that you not be
included in the facility directory. If you opt-out of the directory, VA will not
acknowledge that you are admitted to that hospital. However, if you do
not want to acknowledge you have been admitted, VA will not be able to
share any information as to your whereabouts — with even your family — or
accept mail or other packages or flowers. Your VA facility will explain this
more fully to you if you are admitted as an inpatient.
◙◙ Right to an Accounting of Disclosures – You have a right to request a list of
all disclosures of your information made to anyone outside of VA. We keep
a record of all disclosures so that it can provide you with an accounting
upon request.
◙◙ Right to File a Privacy Complaint — If you believe that your privacy rights
have been denied, or that VA has not protected your information according
to the law, you have a right to file a complaint in various ways. You may
complain to the Privacy Officer at your local VA Medical Center, or you

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can complain to the VHA Privacy Officer, whose contact information is in
the Notice of Privacy Practices. You may also file a complaint with the
Department of Health and Human Services Office for Civil Rights if you
believe that your privacy rights under the Health Insurance Portability and
Accountability Act (HIPAA) Privacy Rule have been denied.

Protect Your Own Privacy
Never just throw away a
Know your
prescription bottle or papers.
Privacy Officer
Never give out your social
security number over the
telephone – even if someone
Your Privacy Officer’s job is to
claiming to be from VA calls you.
help resolve privacy complaints.
VA will never ask you for your
For more information, call your
Social Security Number over
local health care facility.
the telephone. If you request
copies of your records, keep
them in a safe and secure
place; people could learn things
about you or you care that you do not want them to know.

Partnering in Care
VA is committed to providing Veteran-centered care. We will focus our efforts on
giving you what you need. We will coordinate your care to make sure you receive
the right care, at the right time, in the right setting. In addition to explaining your
health problems and treatment options in language you can understand, our
care providers will teach you about self-care and help you learn to manage your
health problems.
The clinicians on the team have expertise in preventing, diagnosing, and treating
illness. You have expertise about your body and your life. Together, we can
design a care plan that works best for you.
We know that patients who are actively involved in their health care will
experience better results and feel more satisfied with their care. There are
many ways for you and your VA providers to work together, and the approaches
to treatment may change over time. By keeping the communication channels
open, we can build a partnership that meets your needs and offers you the best
possible outcomes.

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Chapter 8: Your Patient Rights and Responsibilities | Concerns, Complaints, and Compliments

How can I take an active role in
partnering with my VA providers?
You can take an active role in your
health care in many ways. For
starters, you need to give your
Primary Care team accurate and
complete information about:
◙◙ Your current health
problems and concerns
◙◙ Past illnesses and injuries
◙◙ Hospitalizations
◙◙ Your medicines, including
over-the-counter and
herbals
◙◙ Other matters related to
your health
◙◙ Plan ahead for your visits by
writing down any thoughts you
want to raise, and share them
with your provider at the beginning of each visit. (You can have a family
member or friend come with you, if you wish.)
◙◙ Ask questions about anything that’s not clear to you — or if you think
something is wrong — and get the information in writing so that you can
refer to it later or share it with your family.
◙◙ Make sure you have the name and telephone number of a person to call
if you have a problem, and let your team know if you face any obstacles
to your care — or if your condition changes. Gather information about your
health problems from your treatment team, the VA library, and websites
such as My HealtheVet.

Concerns, Complaints, and Compliments
We encourage you to seek help from your treatment team or a Patient Advocate if
you have problems or complaints — or if you believe that you have been neglected,
abused, or exploited.

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Patient Advocate
The Patient Advocate’s job is to help resolve your issues.  We want you and
your family to have someone to go to for open discussion about your concerns
and complaints — or to offer a compliment.

Keeping Your Information Up-To-Date
It is your responsibility to keep your information such as address, insurance
policy, or care provided by your community provider up-to-date.

Family Involvement in Your Health Care
Support from family members can help you recover from or manage serious
health problems, and they can assist you in maintaining healthy living habits. It
is up to you to make the decision on who you choose to rely on for emotional
support or involvement in your care.
Can my family take an active role in my treatment decisions?
Yes. Family members can help you prepare for your appointments and help
you think of questions you need to ask. If you wish, a family member can
accompany you to your medical appointments. Having another person
there to hear explanations, receive instructions, and ask questions can be
reassuring.
At home, they can remind you to follow the treatment plan. We encourage
you to give permission to your providers to discuss aspects of your health
problems or health care with your family. When you are able to make your
own treatment decisions, your family can help you as much or as little as you
choose. You’re in charge.
How can my family members share their concerns or complaints about my
care?
Your family members can seek help from your treatment team or a Patient
Advocate if they have concerns or complaints about your care.  They may
complain verbally or in writing through the Patient Advocate.

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Chapter 8: Your Patient Rights and Responsibilities | Advance Directives: What Are They and Why Are They Important?

What if I am an Inpatient or a Community Living Center Resident?
◙◙ If you are an inpatient or Community Living Center resident, you have
the right to communicate freely and privately. You may receive or
refuse visitors, and you will have access to public telephones.
◙◙ You have the right to social interaction and regular exercise. If you
choose, you will have the opportunity to worship in accordance with
your beliefs and to request spiritual support.
◙◙ You may participate in civic activities, such as exercising your right to
free speech or to vote in elections.
◙◙ You can organize and take part in resident groups in the facility, and
your family can meet with the families of other residents.
◙◙ You are to avoid unsafe acts that may place you or others at risk
for accidents or injuries. You may wear your own clothes and keep
personal items, as appropriate, depending on your medical condition.
◙◙ You or someone you choose has the right to keep and spend your
money. You will receive an accounting of any funds VA holds for you.
◙◙ While providing treatment, we will respect your personal freedoms. In
rare cases, medication or physical restraints may be used, if all other
efforts to keep you or others free from harm have not worked.
Feel free to talk with your treatment team or a Patient Advocate if you have
any questions.

Advance Directives: What Are They and Why Are They
Important?
If you are not able to make your own treatment decisions, then someone must
stand in for you and make decisions on your behalf. The best way to make sure
that your wishes are followed is to set up directives in advance, while you are able
to make your wishes known.
An Advance Directive is a written statement regarding your preferences about
future health care decisions if you are unable to make them yourself. This helps
your VA providers and family understand your wishes about your health care. And
it can help them decide about treatments if you are too ill to decide for yourself.

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There are two types of Advance Directives:
◙◙ Durable Power of Attorney for Health Care
◙◙ Living Will

What is a Durable Power of Attorney for Health Care?
A Durable Power of Attorney for Health Care lets you name a person you trust
to act as your health care agent — to make health care decisions for you if you
cannot make them yourself. That person should be someone who knows you
well and is willing to serve as your health care agent. If you do not choose
a health care agent, your doctor will select the appropriate person to make
decisions for you, based on an established order as follows:
◙◙ Health Care Agent
◙◙ Legal guardian or special guardian
◙◙ Next-of-kin (a close relative, 18 years of age or older, in the following
order of priority: spouse; child; parent; sibling; grandparent;
grandchild); close friend.

What Is a Living Will?
A living will is a type of advance directive in which you indicate your personal
preferences regarding future treatment options. A living will typically includes
your preferences about life-sustaining treatment, but it may also include
preferences about other types of health care.
Should I have an Advance Directive?
It’s up to you to decide if you want an advance directive. An Advance Directive
helps protect your right to make your own choices — to make sure your values
and wishes are respected if you can’t speak for yourself. Some people name
a health care agent and also complete a living will. You can decide how
general or specific you want your instructions to be.
What should I do with my Advance Directive?
Give a copy of your Advance Directive to your health care agent and your
health care providers so that it can be placed in your medical record. You
should also keep a copy for yourself — along with your other important papers
— in a safe place.

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Chapter 8: Your Patient Rights and Responsibilities | Advance Directives: What Are They and Why Are They Important?

Can my Advance Directive be
changed?
Yes, but only by you. You may
change or revoke it at any time. If
you make changes, give the new
version to the people listed above.
Where can I get the Advance
Directive form?
You can download the form (VA Form
10-0137, VA Advance Directive) from
the VA website: http://www.va.gov/
vaforms/medical/pdf/vha-10-0137fill.pdf or at the My HealtheVet
website: http://www.myhealth.
va.gov.
If you would like more information
about Advance Directives or need help
filling out the form, contact your Primary
Care team.

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Notes

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Chapter 9

VA Copayments and Insurance

Overview of VA Billing
Federal law requires VA to bill your private health insurance provider for medical
care, supplies, and prescriptions for any non-service-connected condition. You
are required to provide information on your health insurance coverage, including
coverage provided under policies of your spouse. You are not responsible for
paying any remaining balance of VA’s insurance claim that is not paid or covered
by your health insurance. As applicable, any payment received by VA may be used
to offset “dollar for dollar” your VA copay responsibility.
Does VA Bill for Service-Connected Conditions?
No. VA will not bill your private health insurance carrier for treatment or services
for any service-connected condition. However, VA does bill for treatment of your
nonservice-connected conditions.
Does VA Bill Medicare?
No. While VA does not bill Medicare, your Medicare supplemental health
insurance may be billed for treatment of a nonservice-connected condition.

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Retroactive Award of Service-Connection or VA
Pension Benefit
If you have recently received an award of a service-connected condition, an
increase in percentage of your service-connected rating, or a VA pension benefit,
you may be eligible for reimbursement for copays you have already paid.
For information, contact your local Revenue Office or call VA at
1-877- 222-VETS (8387).
You may also be eligible for beneficiary travel payments back to the effective date
of your award. You must apply within 30 days of the date you became eligible for
travel benefits. For more information, contact your local Enrollment Coordinator
or call VA at 1 877-222-VETS (8387).

Notes

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Chapter 10

Care Outside the VA System:
What VA Covers

VA may refer you to a non-VA provider in your community for a portion of your care
under certain limited circumstances.

Pre-authorized non-VA Care
Non-emergency health care provided in non-VA facilities at VA expense (such as
Fee Basis care) must always be pre-authorized. That is, VA must authorize in
advance the services being furnished. We may pre-authorize health care at a nonVA facility, or other Federal facility with which VA has an agreement.
We may authorize non-VA emergency care — even though it was not authorized
in advance by VA — when (a) the nearest VA medical facility is notified within 72
hours of admission; (b) the care rendered is for a medical emergency; (c) VA
or other Federal facilities are not feasibly available; (d) you meet the eligibility
requirements below.

If you require inpatient hospital care…
Your non-VA care may be pre-authorized when treatment is needed for any
condition.

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If you require outpatient care…
Your non-VA care may be pre-authorized when treatment is needed for:
◙◙ Any condition.
◙◙ Any dental services and treatments.

Emergency Care
A medical emergency is generally defined as a condition of such a nature that
a prudent layperson would reasonably expect that delay in seeking immediate
medical attention would be hazardous to life or health.
You may receive emergency care at a non-VA health care facility at VA expense
when a VA facility (or other Federal health care facility with which VA has an
agreement):
◙◙ Cannot furnish economical care due to your distance from the facility; or
◙◙ When VA is unable to furnish the needed emergency services.

VA Payment for Emergency Care of your Service-connected
conditions without prior authorization
Since payment may be limited to the point when your condition is stable
enough for you to travel to a VA facility, you need to contact the nearest VA
medical facility as soon as possible. An emergency is deemed to have ended
at the point when a VA provider has determined that, based on sound medical
judgment, you should be transferred from the non-VA facility to a VA medical
center.
VA may pay for your non-VA emergency care for any condition.
What if I am Living or Traveling in a Foreign Country
VA will pay for medical services for treating your service-connected disabilities,
or any disability that is associated with and aggravates a service-connected
disability if you live or travel outside the United States. This program will
also reimburse you for certain treatment of medical services while you are
outside the United States, if needed as part of your VA-approved vocational
rehabilitation program.

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Chapter 10: Care Outside the VA System: What VA Covers | Emergency Care

If you are living or planning to travel outside the U.S. (other than in the
Philippines), you need to register with the VA’s Foreign Medical Program office,
Denver Foreign Medical Program office
P.O. Box 469061
Denver, CO 80246-9061, USA
Telephone: (US country code) 303-331-7590.
For information, visit: http://www.va.gov/hac/forbeneficiaries/fmp/fmp.asp.
Veterans living in the Philippines should register with the U.S. Veterans Affairs
office in Pasay City. Call 011-632-838-4566.
If you are traveling or living overseas in one of the following countries, you can
telephone the Foreign Medical Program toll free:
Foreign Country

Telephone
Germany

0800-1800-011

Australia

1 800-354-965

Italy

1 800-782-655

United Kingdom (England and Scotland)

0800-032-7425

Mexico

001-877-345-8179

Japan

00531-13-0871

Costa Rica

0800-013-0759

Spain

900-981-776

(NOTE: Veterans in Mexico or Costa Rica must first dial the United States
country code.)

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Notes

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Chapter 11

Appeals

Administrative Appeals
An appeal is a request for VA’s Board of Veterans’ Appeals to review a decision
about your health care benefits. You may file an appeal if you do not agree or are
not satisfied with a VA decision. Specific information about the appeals process
is available on VA Form 4107VHA “Your Rights to Appeal our Decision” which is
available at http://www1.va.gov/opa/publications.

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Can I appeal an administrative determination that denies me a health care
benefit?
Yes. If you believe you have been denied a health care benefit for which you
are eligible, you may write VA a letter telling us why you disagree with that
decision. Within one year of the date of the initial decision, send the letter — called
a Notice of Disagreement — to the VA health care facility where the decision
was made.
Can I appeal a decision about payment for non-VA care?
Yes. As described in Chapter 10, VA may pay for certain care you receive
outside of the VA health care system. But VA may deny payment if you do
not meet the conditions described in that section. If you believe VA should
make a payment that was denied, you may write a letter to the health care
facility where the decision was made within one year of the date of the initial
decision. Send this letter — called a Notice of Disagreement — to the Fee
Office located at the VA health care facility.

Can I request reconsideration of a VA decision?
As part of the Appeal process, you may ask VA to reconsider a decision. Within
one year of the date of the initial decision, you may submit a “reconsideration”
request in writing to the health care facility where the decision was made. A
reconsideration decision will be made by the immediate supervisor of the
initial VA decision-maker.
You may also request a meeting with the immediate supervisor of the initial
VA decision-maker. This is not a formal hearing, but it provides an opportunity
for you (and your representative, if desired) to discuss the issues. You
can request that the meeting be taped and transcribed, and a copy of the
transcript will be provided to you. After reviewing all the information, the
immediate supervisor of the initial VA decision-maker will issue a written
decision that either upholds, reverses, or modifies the initial decision. If the
decision to deny is upheld, you may still proceed with your appeal.

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Chapter 11: Appeals | Health Care Ethics Consultation

Clinical Appeals
If you have problems or complaints
about your medical treatment, we
encourage you to seek help from your
treatment team or a Patient Advocate. 
You will be given instructions (in plain
English) about the complaint process,
and the steps you must follow to
complete it.

Health Care Ethics
Consultation
Sometimes health care decisions are
very difficult and create uncertainty or
conflict about the right thing to do. If
this happens to you, we encourage you
to seek help from your treatment team
or a Patient Advocate. If the concern is
not resolved by them, VA offers a service called health care ethics consultation
to help with these difficult situations. Health care ethics consultants can meet
with you, your family, and your treatment team to help you decide what is right
for you, or what you think should be done, and why. You always have the option
to request an ethics consultation when something just doesn’t seem right to you
or you and your health care team are having trouble agreeing on the best choice.
You can request a health care ethics consultation through your Patient Advocate.

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Notes

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Chapter 12

Vet Centers

Introduction to Vet Centers
The Vet Center Program was established by Congress in 1979 in response to the
readjustment problems that a significant number of Vietnam-era Veterans were
continuing to experience after their return from combat. In subsequent years,
Congress extended eligibility to WW II and Korean Combat Veterans, and to
Veterans who served in conflicts after Vietnam: Lebanon, Grenada, Panama, the
Persian Gulf, Somalia, Kosovo/Bosnia, Operation Enduring Freedom, Operation
Iraqi Freedom, and other operations within the Global War on Terrorism.
What Services Do Vet Centers Provide?
If you served in any combat zone (Vietnam, Southwest Asia, Operation
Enduring Freedom, Operation Iraqi Freedom, etc.), you are eligible for Vet
Center services. Our community-based Vet Centers provide a broad range of
counseling, outreach, and referral services to help Veterans make a satisfying
post-war readjustment to civilian life:
◙◙ Individual counseling
◙◙ Group counseling
◙◙ Post-traumatic stress disorder (PTSD) counseling
◙◙ Marital and family counseling
◙◙ Bereavement counseling

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◙◙ Medical referrals
◙◙ Assistance in applying for VA benefits
◙◙ Employment counseling
◙◙ Guidance and referral
◙◙ Alcohol/drug assessments
◙◙ Information and referral to community resources
◙◙ Military sexual trauma counseling & referral
◙◙ Outreach and community education

Vet Center services are provided at no cost to
Veterans or their families.
How Do I Gain Access to Vet Center Services?
VA’s readjustment counseling is provided at community-based
Vet Centers located near Veterans and their families. Vet Center
staff are also available toll free during normal business hours
at 1-800-905-4675 (Eastern) and 1-866-496-8838 (Pacific). For
more information or to find locate the Vet Center nearest you, go to
http://www.vetcenter.va.gov/.

Notes

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Chapter 13

VA Health Care and Medicare

You may also be eligible to enroll in Medicare. Because each Veteran’s situation
is unique, VA cannot provide a single answer to the question of whether you
should enroll in Medicare, but we offer the following information to assist you in
weighing your options.

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Here are some key points about the two programs:
◙◙ Remember, your VA health care benefits are separate from Medicare. You
may be enrolled in both programs, but the enrollment process (and the
eligibility criteria) is different for each.
◙◙ Medicare offers three types of coverage:
◙◙ Inpatient (“Part A”),
◙◙ Outpatient (“Part B”), and
◙◙ Prescription drug (“Part D”).
You can decide whether to participate in one “part” or all three.
◙◙ VA does not recommend that you cancel or decline coverage in Medicare
(or other health care or insurance programs) solely because you are
enrolled in VA health care. There is no guarantee that in the years to
come, Congress will appropriate sufficient funds for VA to provide care
for all enrollment priority groups. If you are enrolled in one of the lower
priority groups, this could leave you with no access to VA health care
coverage. For this reason, signing up for Medicare as a secondary source
of coverage may be in your best interest.
◙◙ Enrolling in both VA and Medicare gives you greater flexibility. For example,
if you are enrolled in both programs, you will have access to non-VA
physicians (under Parts A and B); or you may obtain prescription drugs
(under Medicare Part D) — prescribed by your non-VA physicians and filled
at your local retail pharmacies — that are not on the VA formulary.
◙◙ Medicare allows enrollment (typically at age 62) during a yearly enrollment
period. You may be subject to a penalty if you don’t enroll when you first
become eligible for some Medicare programs. You can delay enrollment
in Part D (prescription drugs) without penalty if you are enrolled in a
prescription drug plan (like VA’s) that is considered “creditable coverage” —
that is, prescription drug coverage that provides a benefit at least as good
as Medicare’s. However, “creditable coverage” for Part B (outpatient/
doctor coverage) can only be received through an employer; so you
cannot claim VA enrollment as “creditable coverage” for the outpatient
Medicare program.

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◙◙ Take time to understand your options under the Medicare program,
and read all information received from Medicare or the Social Security
Administration carefully. Action on your part may be required.
For example, you are required to sign and return a card if you choose
not to enroll in Medicare Part B. Failure to return the card could result
in automatic enrollment and deduction of the Part B premium from your
Social Security check.

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Notes

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Privacy

Department of Veterans Affairs
Veterans Health Administration

Notice of Privacy Practices

Effective Date April 14, 2009
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED
OR DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
The Department of Veterans Affairs (VA) Veterans Health Administration (VHA) is
required by law to maintain the privacy of your protected health information and
to provide you with notice of its legal duties and privacy practices. VHA is also
required to abide by the terms of this notice and its privacy policies.

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How VHA May Use or Disclose Your Health Information
Federal law allows us to use or disclose your health information without your
permission for the following purposes:
◙◙ Treatment
(e.g., giving information to VHA and other doctors and nurses caring for
you)
◙◙ Eligibility and Enrollment for VA Benefits
(e.g., giving information to officials who decide benefits)
◙◙ Public Health Activities
(e.g., giving information about certain diseases to government agencies)
◙◙ Research Activities
(e.g., giving information to a researcher to prepare a research protocol)
◙◙ Abuse Reporting
(e.g., giving information about suspected abuse of elders or children to
government agencies)
◙◙ Assisting Family Members or Designated Individuals Involved in your Care
◙◙ Payment
(e.g., giving information to non-VHA facilities that provide care or services)
◙◙ Patient Directories
(e.g., publishing basic information about patients)
◙◙ Law Enforcement
◙◙ Judicial or Administrative Proceedings
◙◙ National Security Matters
◙◙ Correctional Facilities and/or Parole Officers
◙◙ Workers’ Compensation Cases
(e.g., giving information to officials who decide payments for
workplace injuries)
◙◙ Services
(e.g., giving information to contractors or business associates performing
services for VHA)
◙◙ Health Care Operations
(e.g., giving information to individuals conducting Quality of Care reviews)

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◙◙ Coroner or Funeral Activities
◙◙ When Required by Law
◙◙ Health Care Oversight
(e.g., giving information to the Office of Inspector General or a
Congressional Committee)
◙◙ Health or Safety Activities
◙◙ Military Activities
(e.g., giving information to the Department of Defense)
◙◙ Academic Affiliates
(e.g., giving information to assist in training medical students)
◙◙ Responding to Court Orders
NOTE: VHA will make no other uses or disclosures of your health information
without your prior written authorization. In addition, you may revoke that
authorization, in writing, at any time.

Your Privacy Rights
You have the right to:
◙◙ Review your health information
◙◙ Obtain a copy of your health information
◙◙ Request your health information be amended or corrected
◙◙ Request that we not use or disclose your health information
◙◙ Request that we provide your health information to you in an alternative
way or at an alternative location in a confidential manner
◙◙ Receive an accounting or list of disclosures of your health information; and
◙◙ Receive a paper copy of VHA’s Notice of Privacy
◙◙ Practices upon request

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Complaints
If you are concerned that your privacy rights have been violated, you may file a
complaint with:
◙◙ The VHA health care facility’s Privacy Officer, where you are receiving care.
Visit this Website for VHA facility telephone numbers
http://www1.va.gov/directory/guide/division_flsh.asp?dnum=1.
◙◙ VA via the Internet through “Contact the VA” at http://www.va.gov;
by dialing 1-800-983-0936 or by contacting the VHA Privacy Office (19F2)
at 810 Vermont Avenue, NW, Washington, DC 20420.
◙◙ The U.S. Department of Health and Human Services, Office for Civil Rights
or the Office of Inspector General.
◙◙ Complaints do not have to be in writing, though it is recommended.

Changes
We reserve the right to change this VHA Notice of Privacy Practices. The revised
privacy practices will pertain to all health information we already have about you,
as well as, health information we receive in the future. We will send and make
available to you a copy of the revised Notice within 60 days of any change.

Contact Information
You may contact your VHA health care facility’s Privacy Officer if you have
questions regarding the privacy of your health information or would like further
explanation of this Notice. The VHA Privacy Office may be reached by mail at:
VHA Privacy Office
Office of Information (19F2)
810 Vermont Avenue, NW
Washington, DC 20420
or via telephone at
1-877-461-5038.
NOTE: A large print version of this Notice is available upon request from the
facility where you are receiving care.

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Privacy: Notice of Privacy Practices | When We May Use or Disclose Your Health Information

When We May Use or Disclose Your Health Information
Treatment.
We may use and disclose your health information for treatment or to provide
health care services. Treatment may include:
◙◙ Emergency and routine health care or services, including but not
limited to, labs and x-rays; clinic visits; inpatient admissions
◙◙ Contacting you to provide appointment…
• reminders or information about treatment
• alternatives
◙◙ Prescriptions for medications, supplies, and equipment
◙◙ Coordination of care, including care from non-VHA providers
◙◙ Coordination of care with the Department of Defense (DoD), including
electronic information exchange
NOTE: If you are an active duty service member, Reservist or National Guard
member, your health information is available to DoD providers with whom you
have a treatment relationship through an electronic database that is shared
between VHA and DoD. VHA does not have the ability to restrict DoD’s access
to your information in this database, even if you ask us to do so.
Examples:
1. A Veteran sees a VHA doctor who prescribes medication based on
the Veteran’s health information. The VHA pharmacy uses this
information to fill the prescription.
2. A Veteran is taken to a community hospital emergency room. Upon
request from the emergency room, VHA discloses health information
to the non-VHA hospital that needs the information to treat
this Veteran.
3. A National Guard member seeks mental health care from VHA.
VHA discloses this information to DoD by entering the information
into a database that may be accessed by DoD providers at some
future date.

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Payment.
We may use and disclose your health information for payment purposes or to
receive reimbursement for care provided, including:
◙◙ Determining eligibility for health care services
◙◙ Paying for non-VHA care and services, including but not limited to,
CHAMPVA and fee basis
◙◙ Coordinating benefits with other insurance payers
◙◙ Finding or verifying coverage under a health insurance plan or policy
◙◙ Pre-certifying benefits
◙◙ Billing and collecting for health care services provided
◙◙ Providing personal information to consumer reporting agencies
regarding delinquent debt owed to VHA
Examples:
1. A Veteran is seeking care at a VHA health care facility. VA uses
the Veteran’s health information to determine eligibility for health
care services.
2. The VHA health care facility discloses a Veteran’s health information
to a private health insurance company to seek and receive payment
for the care and services provided to the Veteran.

Health Care Operations.
We may use or disclose your health information to support the activities
related to health care, including:
◙◙ Improving quality of care or services
◙◙ Conducting Veteran and beneficiary satisfaction surveys
◙◙ Reviewing competence or qualifications of health care professionals
◙◙ Providing information about treatment alternatives or other
health‑related benefits and services
◙◙ Conducting health care training programs

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◙◙ Managing, budgeting and planning activities and reports
◙◙ Improving health care processes, reducing health care costs and
assessing organizational performance
◙◙ Developing, maintaining and supporting computer systems
◙◙ Legal services
◙◙ Conducting accreditation activities
◙◙ Certifying, licensing, or credentialing of health care professionals
◙◙ Conducting audits and compliance programs, including fraud, waste
and abuse investigations
Examples:
1. Medical Service, within a VHA health care facility, uses the health
information of diabetic Veterans as part of a quality of care review
process to determine if the care was provided in accordance with the
established best clinical practices.
2. A VHA health care facility discloses a Veteran’s health information to
the Department of Justice (DOJ) attorneys assigned to VA for defense
of VHA in litigation.

Eligibility and Enrollment for Federal Benefits.
We may use or disclose your health information to other programs within
VA or other Federal agencies, such as the Veterans Benefits Administration
and Social Security Administration, to determine your eligibility for
Federal benefits.

Abuse Reporting.
We may use or disclose your health information to report
◙◙ suspected child or elder abuse or neglect; or
◙◙ domestic violence
to appropriate Federal, State, local, or tribal authorities. This reporting is for
the health and safety of the suspected victim.

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Health and Safety Activities.
We may use or disclose your health information when necessary to prevent
or lessen a serious threat to the health and safety of the public, yourself,
or another person. Any disclosure would only be to someone able to help
prevent or lessen the harm, such as a law enforcement agency or the person
threatened. You will be notified in writing if any such disclosure has been
made by a VHA health care facility.

Public Health Activities.
We may disclose your health information to public health and regulatory
authorities, including the Food and Drug Administration (FDA) and Centers for
Disease Control (CDC), for public health activities.
Public health activities may include:
◙◙ Controlling and preventing disease, injury, or disability
◙◙ Reporting vital events such as births and deaths
◙◙ Reporting communicable diseases such as hepatitis, tuberculosis,
sexually transmitted diseases &HIV
◙◙ Tracking FDA-regulated products
◙◙ Reporting adverse events and product defects or problems
◙◙ Enabling product recalls, repairs or replacements

Judicial or Administrative Proceedings.
We may disclose your health information for judicial or
administrative proceedings:
◙◙ We receive an order of a court, such as a subpoena signed by a
judge, or administrative tribunal, requiring the disclosure
◙◙ To defend VA in judicial and administrative proceedings

Law Enforcement.
We may disclose your health information to law enforcement agencies for law
enforcement purposes when applicable legal requirements are met. These
law enforcement purposes may include:
◙◙ Responding to a court order

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Privacy: Notice of Privacy Practices | When We May Use or Disclose Your Health Information

◙◙ Responding to a specific request when in pursuit of a focused civil or
criminal law enforcement investigation
◙◙ Reporting crimes occurring at a VHA site
◙◙ Identifying or apprehending an individual who has admitted to
participating in a violent crime
◙◙ Reporting a death where there is a suspicion that death has occurred
as a result of a crime
◙◙ Reporting Fugitive Felons
◙◙ Routine reporting to law enforcement agencies, such as
gunshot wounds
◙◙ Providing certain information to identify or locate a suspect, fugitive,
material witness, or missing person

Health Care Oversight.
We may disclose your health information to a governmental health care
oversight agency (e.g., Inspector General (IG); House Veterans Affairs
Committee) for activities authorized by law, such as audits, investigations, and
inspections. Health care oversight agencies include government agencies
that oversee the health care system, government benefit programs, other
government regulatory programs, and agencies that enforce civil rights laws.

Cadaveric Organ, Eye, or Tissue Donation.
When you are an organ donor and death is imminent, we may use or disclose
your relevant health information to an Organ Procurement Organization
(OPO), or other entity designated by the OPO, for the purpose of determining
suitability of your organs or tissues for organ donation. If you have not
specified your donation preferences and can no longer do so, your family may
make the determination regarding organ donation on your behalf.

Coroner or Funeral Services.
Upon your death, we may disclose your health information to a funeral director
for burial purposes, as authorized by law. We may also disclose your health
information to a coroner or medical examiner for identification purposes,
determining cause of death, or performing other duties authorized by law.

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Services.
We may provide your health information to individuals, companies and others
who need to see the information to perform a function or service for or on
behalf of VHA. An appropriately executed contract and business associate
agreement must be in place.

National Security Matters.
We may use and disclose your health information to authorized Federal
officials for the purpose of conducting national security and intelligence
activities. These activities may include protective services for the President
and others.

Workers’ Compensation.
We may use or disclose your health information to comply with workers’
compensation laws and other similar programs.

Correctional Facilities.
We may disclose your health information to a correctional facility if you are an
inmate and disclosure is necessary to provide you with health care; to protect
the health and safety of you or others; or for the safety of the facility.

Required by Law.
We may use or disclose your health information for other purposes to
the extent required or mandated by Federal law (e.g., to comply with the
Americans with Disabilities Act; to comply with a Health Insurance Portability
and Accountability Act (HIPAA) privacy or security rule complaint investigation
or review by the Department of Health and Human Services).

Research Activities.
Before we may use health information for research, all research projects
must go through a special VHA approval process. This process requires the
Institutional Review Board (IRB) to evaluate the project and its use of health
information based on, among other things, the level of risk to you and to your
privacy. If you will be seen or provided care as part of the research project,
you will be asked to sign a consent form to participate in the project that
includes an authorization for use and possibly disclosure of your information.

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Privacy:NoticeofPrivacyPractices|WhenWeOfferYoutheOpportunitytoDeclineUseorDisclosureofYourHealthInformation:PatientDirectories.

However, there are times when we may use your health information without an
authorization, such as, when:
◙◙ A researcher is preparing a plan for a research project.
For example, a researcher needs to examine patient medical records
to identify patients with specific medical needs. The researcher must
agree to use this information only to prepare a plan for a research
study; the researcher may not use it to contact you or actually
conduct the study. The researcher also must agree not to remove
that information from the VHA health care facility. These activities
are considered preparatory to research.
◙◙ A researcher conducts an IRB approved project reviewing health
information without personally seeing or contacting you.

Military Activities.
We may use or disclose your health information if you are a member of
the Armed Forces, for activities deemed necessary by appropriate military
command authorities to assure the proper execution of the military mission,
when applicable legal requirements are met. Members of the Armed
Forces include Active Duty Service members and in some cases Reservist
and National Guard members. An example of a military activity includes
the disclosure of your health information to determine fitness for duty or
deployment to your Base Commander.

When We Offer You the Opportunity to Decline Use or
Disclosure of Your Health Information: Patient Directories.
Unless you object, when you are a patient at a VHA health care facility, we may
list in the VHA Medical Center Patient Directory your general condition, religious
affiliation and the location where you are receiving care. This information may be
disclosed to people who ask for you by name. Your religious affiliation will only be
disclosed to members of the clergy who ask for you by name.
If you do object to being listed in the Patient Directory, no information will be
given out about you unless there is other legal authority.
◙◙ This means your family and friends will not be able to find what room you
are in while you are in the hospital.
◙◙ It also means you will not be able to receive flowers or mail, including
Federal benefits checks, while you are an inpatient in the hospital or
nursing home. All flowers and mail will be returned to the sender.

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Family Members or Others Involved in Your Care
General Information Disclosures.
We may disclose general information about you to your family and friends.
These disclosures will be made only as necessary and on a need-to-know
basis consistent with good medical and ethical practices. General information
is limited to:
◙◙ Verification of identity
◙◙ Your condition described in general terms
(e.g., critical, stable, good, prognosis poor)
◙◙ Your location in a VHA health care facility
(e.g., building, floor, or room number)

Disclosures to others while you are present.
When you are present, or otherwise available, we may disclose your health
information to your next-of-kin, family or other individuals that you identify.
For example, your doctor may talk to your spouse about your condition while at
your bedside. Before we make such a disclosure, we will ask you if you object.
We will not make the disclosure if you object.

Disclosures to others when you are not present.
When you are not present, or are unavailable, we may disclose your
health information to your next-of-kin, family, and others with a significant
relationship to you without your authorization if, in the exercise of professional
judgment, we determine the disclosure is in your best interests. We will
limit the disclosure to information directly relevant to the other person’s
involvement with your health care or payment for your health care.
Examples of this type of disclosure may include questions or
discussions concerning:
◙◙ Medical care
◙◙ Medical supplies (e.g., wheelchair) and filled prescriptions
◙◙ Home-based care
NOTE: We may provide a copy of your medical records to family, next-of-kin,
or other individuals involved in your care only if we have your signed, written
authorization or if the individual has your power of attorney.

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Other Uses and Disclosures with Your Authorization.
We may use or disclose your health information for any purpose based on
a written authorization you provide us. We will review the authorization to
determine it is valid, and then disclose your health information as requested
by you in the authorization.

Revocation of Authorization.
If you provide us a written authorization or permission to use or disclose your
health information, you may revoke that permission, in writing, at any time. If
you revoke your authorization, we will no longer use or disclose your health
information for the reasons covered by your written authorization. Please
understand that we are unable to take back any uses or disclosures we have
already made based on your authorization.

Your Privacy Rights
Right to Request Restriction.
You may request that we not use or disclose all or part of your health
information, including use or disclosure for a particular purpose or to a
particular person. However, we are not required to agree to such restriction.
To request a restriction, you must submit a written request that identifies the
information you want restricted, when you want it to be restricted, and the
extent of the restrictions. All requests to restrict use or disclosure should
be submitted to the facility Privacy Officer at the VHA health care facility that
provided or paid for your care. If we agree to your request, we will honor
the restriction until you no longer make the restriction request valid or you
revoke it.
NOTE: We are not able to honor requests to remove all or part of your health
information from the electronic database of health information that is shared
between VHA and DoD, or to restrict access to your health information by DoD
providers with whom you have a treatment relationship.

Right to Review and Obtain a Copy of Health Information.
You have the right to review and obtain a copy of your health information in
our records. You must submit a written request to the facility Privacy Officer
at the VHA health care facility that provided or paid for your care. Under very
limited situations, you may not be allowed to review or obtain a copy of parts

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of your health information. If your request is denied, you will be notified of
this decision in writing and you may appeal this decision to the VA Office of
General Counsel.

Right to Request Amendment of Health Information.
You have the right to request an amendment (correction) to your health
information in our records if you believe it is incomplete, inaccurate, untimely,
or unrelated to your care. You must submit your request in writing, specify
the information that you want corrected, and provide a reason to support your
request for amendment. All amendment requests should be submitted to
the facility Privacy Officer at the VHA health care facility that maintains your
information. If your request for amendment is denied, you will be notified of
this decision in writing and provided appeal rights. In response, you may do
any of the following:
◙◙ File an appeal
◙◙ File a “Statement of Disagreement”
◙◙ Ask that your initial request for amendment accompany all future
disclosures of the disputed health information

Right to Request Receipt of Communications in a
Confidential Manner.
You have the right to request that we provide your health information to you
by alternative means or at an alternative location. We will accommodate
reasonable requests, as determined by VA/VHA policy, from you to receive
communications containing your health information:
◙◙ At a mailing address (i.e., confidential communications address) other
than your permanent address
◙◙ In person, under certain circumstances

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Right to Receive an Accounting of Disclosures.
You have the right to know and request a copy of what disclosures of your
health information have been made to you and to other individuals outside
of VHA. To exercise this right, you must submit a written request to the
facility Privacy Officer at the VHA health care facility that maintains your
health information.

Right to a Printed Copy of the Privacy Notice.
You have the right to obtain an additional paper copy of this Notice from your
VHA health care facility.
◙◙ You can obtain this Notice from the facility Privacy Officer at your local
VHA health care facility.
◙◙ You may also obtain a copy of this Notice at our website, http://
www1.va.gov/vhapublications/viewpublication.asp?pub_id=1089.

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Notes

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Glossary

Commonly Used Terms A-Z

Adjudication – Refers to the process of obtaining and reviewing the facts in a
particular claim to make a decision whether to grant benefits in view of the
laws governing these benefits.
Aid and Attendance – The increased compensation and pension paid to Veterans,
their spouses, surviving spouses, and parents. A&A may be provided if the
Veteran needs the regular aid and attendance of another person.
Appeal – A person’s disagreement with a determination by VA to deny a benefit,
request for reconsideration of the determination, or direct appeal to a higher
level, such as the Board of Veterans Appeals (BVA).
Applicant – A person who has submitted a written request for VA health care
benefits and/or for enrollment in the VA Health Care System.
Automobile Adaptive Equipment – Items and/or devices necessary to permit
safe operation of, or permit access to and egress from an automobile or other
conveyance.
Beneficiary – A person determined eligible for VHA benefits.
Carrier – The insurance company; the insurer.
Catastrophically Disabled – A permanent, severely disabling injury, disorder, or
disease that compromises the ability to carry out the activities of daily living to
such a degree that the individual requires personal or mechanical assistance
to leave home or bed, or requires constant supervision to avoid physical harm
to self or others.

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Claimant – A Veteran who received services (or his/her guardian) or the hospital,
clinic, or community resource that provided the services, or the person other
than the Veteran who paid for the services.
Clinician – A Physician, Physician Assistant (PA), Nurse Practitioner (NP),
Psychologist, or other independent licensed practitioner.
Combat Veteran – A Veteran whose service includes receipt of an expeditionary
medal or other Department of Defense (DOD) authorized combat-related
medal, service in a location designated by an Executive Order as a combat
zone, service in a qualified hazardous duty area as defined by Federal
Statute that deems such service by a member of the Armed Forces to be the
equivalent if service in a combat zone for pay or a tax-related purpose, receipt
of DOD Hostile Fire or Imminent Danger pay for serving in the area subject to
hostilities, or other factor(s) as may be defined in policy and regulation by the
Secretary of Veteran Affairs.
Community Living Center – formerly known as VA Nursing Home
Compensable – A VA determination that a service-connected disability is severe
enough to warrant monetary compensation.
Copayment – Copayment is a specific monetary charge for either medical
services or medications provided by VA to Veterans.
Coverage – The extent of benefits provided under a health care policy.
Domiciliary – VA facilities that provide care on an ambulatory self-care basis
for Veterans disabled by age or disease who are not in need of acute
hospitalization and who do not need the skilled nursing services provided in a
nursing home.
Emergency Department (ED) – A unit that is dedicated to providing resuscitative
therapy and stabilization in life threatening situations. It is staffed and
equipped to provide initial evaluation, treatment, and disposition for a broad
spectrum of illnesses, injuries, and psychiatric disorders, regardless of the
level of severity. Care is provided in a clearly defined area dedicated to the ED
and operates 24 hours a day, 7 days a week (24/7).
Emergency Treatment – Treatment for a condition of such a nature that a prudent
layperson would have reasonably expected that delay in seeking immediate
medical attention would have been hazardous to life or health (this standard
would be met if there were an emergency medical condition manifesting itself
by acute symptoms of sufficient severity (including severe pain) that a prudent
layperson who possesses an average knowledge of health and medicine could
reasonably expect the absence of immediate medical attention to result in

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placing the health of the individual in serious jeopardy, serious impairment to
bodily functions, or serious dysfunction of any bodily organ or part).
Enrollment – The process established for managing categories of Veterans for
whom VA will provide services.
Financial Assessment – Financial assessment is the process used by VA to
assess a Veteran’s attributable income and assets. The financial assessment
determines Veterans’ copay responsibilities and helps to determine
enrollment priority and eligibility for beneficiary travel.
Geographic Means Test (GMT) – The financial assessment used to determine if a
Veteran may be enrolled in priority group 7.
Hardship – Refers to a temporary decrease in a Veteran’s household income
justifying enrolling a Veteran in a higher priority group than would otherwise
be the case, and resulting in exemption from current and future copays from
date of approval until a new means test is required.
Health Care – The performance of diagnostic, therapeutic, and preventive
services and procedures by health care providers to persons who are sick,
injured, or concerned about their health status.
Health Insurance – A contract between the policyholder and an insurance carrier
or government program to reimburse the policyholder for all or a portion of the
cost of medically necessary treatment or preventive care rendered by health
care professionals.
Insurance Carrier – The insurance company (insurer) that sells the policies and
administers the contract.
Means Test – The financial assessment process used by VA to assess a
Veteran’s attributable income and assets. The MT determines Veterans’ copayment responsibilities and assists in determining enrollment priority group
assignments. VA uses the appropriate MT threshold for the current calendar
year to determine whether the Veteran is considered unable to defray the
expenses of necessary care.
Medical Benefits Package – The health care that is available to enrolled
Veterans.
Medical Need – Medical need is a treatment, procedure, supply, or service
considered medically necessary when, in the judgment of an appropriate
clinical care provider, and in accordance with generally-accepted standards of
clinical practice, the treatment, procedure, supply, or service:
(1) Promotes health by:

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(a) Enhancing quality of life or daily functional level,
(b) Identifying a predisposition for development of a condition or early
onset of disease, which can be partly or totally improved by monitoring or
early diagnosis and treatment, and
(c) Preventing development of future disease.
(2) Preserves health by:
(a) Maintaining the current quality of life or daily functional level;
(b) Preventing progression of disease;
(c) Curing disease; and
(d) Extending life span.
(3) Restores health by restoring the quality of life or the daily functional level
that has been lost due to illness or injury.
Nearest VA Medical Facility – The closest VA facility properly equipped and
staffed to provide the care and treatment medically indicated by the
patient’s condition.
Non-compensable Disability – A VA determination that a service-connected
disability is not sever enough to warrant monetary compensation.
Nonservice-Connected (NSC) Pension – The NSC pension is a monetary benefit
awarded to permanently and totally disabled, low-income veterans with
90 days or more of active military service, of which, at least 1 day was
during wartime.
Nonservice-Connected (NSC) Veteran – A Veteran who does not have a VA
determined service-related condition.
Plan – A term that refers to the types of coverage offered by an
insurance company.
Policy – The legal document issued by a company to the policyholder that
outlines the conditions and terms of the insurance, also called a policy
contract or contract.
Primary Care Provider – Physicians, nurse practitioners, and physician assistants
who provide ongoing and comprehensive primary care as defined by their
privileges or scope of practice and licensure to a panel of assigned patients.
Service-Connected (SC) – A VA determination than illness or injury was incurred
or aggravated in the line of duty, in the active military, naval or air service.
Specialized Transportation – Ambulance, ambulette, air ambulance, wheelchair
van, or other mode of transportation specially designed to transport disabled

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persons (this would not include a mode of transportation not specifically
designed to transport disabled persons, such as a bus, subway, taxi, train,
or airplane). A modified, privately-owned vehicle, with special adaptive
equipment and/or capable of transporting disabled persons is not a special
mode of transportation).
United States – The states, territories, and possessions of the United States, the
District of Columbia, and the Commonwealth of Puerto Rico. Urgent Care Care that does not require immediate admission, but one for which there is a
pressing need for medical attention to prevent:
VA – Department of Veterans Affairs
VA Facility – A VA Medical Center (VAMC), VA Outpatient Clinic (OPC), or VA
Community Based Outpatient Clinic (CBOC).
VA Form 10-10EZ (Application for Health Benefits) – This form must be
completed by a Veteran in order to apply for VA health care benefits or
enrollment in the VA Health Care System.
VA Form 10-10EZR (Health Benefits Renewal Form) – The form that Veterans
may use to update their personal, insurance, and financial information.
Veteran – A person who served in active military, naval or air service
and was discharged or released from service under conditions “other
than dishonorable”.
Veteran Identification Card (VIC) – An identification card issued to a verified
eligible Veteran for the specific purpose of identifying the Veteran when
seeking VA health care benefits and assisting VHA staff with administrative
processing. The VIC is for VA official business only and is only issued to a
Veteran after the Veteran’s eligibility has been verified.
VHA – Veterans Health Administration, a principal unit within VA.

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Notes

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