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Gain insight into VA enrollment eligibility, from basic qualifications to income means testing, co-pay thresholds, and necessary documentation. Learn about exceptions, hardships, disability discharges, and vision and dental care standards. Discover how to enroll and access benefits.
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Boise VA Medical Center Veteran Service Organization ‘Officers Day’ December 3, 2010 Enrollment Eligibility
Overview • Basic qualifications • Information needed to complete a registration • Vision • Dental • Changes
Veterans Period of Service • Prior to November 7, 1980 • After November 7, 1980
Exceptions to 24 month rule • Early Outs • Hardships • Disability
Discharges • Meets Qualifications • Honorable • Under Honorable Conditions • General • Does-Not Meet Qualifications • Other Than Honorable • Dishonorable • Uncharacterized
Has the veteran used VA health care? • Enrolled prior to January 16, 2003 with continual use • Enrolled prior to 1996 and not used • Enrolled after January 16, 2003
Income Qualification after 03’ • Means/income test • Two different income thresholds • Means Threshold (MT) • Geographical Means Threshold (GMT) • 10% above MT/GMT allowed • MT/GMT determines qualification • Above MT/GMT not qualified • Below MT/GMT qualified
Means Test Formula • Gross household income • Minus non-reimbursed medical expenses • Minus pre-paid funeral/burial expenses • Minus educational expenses • Equals allowable amount for MT/GMT
Means tests MT/GMT determines… • Qualifications for health care • Priority Group placement (5, 7 and 8) • Co-Pay thresholds • Visits • Medications
Veterans not subject to 2003 guidelines: • Purple Heart recipients • Prisoners of War • OEF/OIF (for 5 years post discharge) • Service Connected Veterans with 10% or higher disability
Veterans not subject to 2003 guidelines: • Service Connected veterans 0% • Enrolled prior to 16 January 2003 with continual use • Enrolled prior to 1996 and not used • Enrolled after 16 January 2003 • Vietnam Veterans • Boots on ground • Brown Water • Blue water
Needed Items to Enroll/Register • 10-10EZ- Application For Health Care Benefits • DD-214/Discharge Papers (WWII) • http://www.archives.gov/veterans/evetrecs/ • Knowledge of Gross Annual Incomes • Knowledge of Non-reimbursed medical expenses • Knowledge of Assets • Insurance Card(s)
How to Enroll/Register • In person • By Mail • Internet • https://www.1010ez.med.va.gov/sec/vha/1010ez/ • By phone • Previously enrolled veterans • Transfers • 10% or higher Service Connected
Priority Groups: • 1 • 2 • 3 • 4 • 5 • 6 • 7 • 8a, 8b, 8c, 8d, 8e, and 8g
Hardships • Case by Case basis • Bridge a Gap • Catastrophic • Qualified Otherwise
Dental Qualifications • 60-100%-Unemployable • 100% Permanent and Total • Emergency/Humanitarian • Dental Trauma • Veterans released from Active Duty/Activation • Service of 90 days • Register within 180 days • DD214 annotates no dental
Dental Qualifications • POW’s • Chapter 31 • Medical • Inpatient • Homeless
Vision and Hearing • Categories 1-5 • Categories 6-8
Important Things to Remember • Veterans • Laws