|
COVERED CARE REQUIRED |
CHAMPVA PAYS |
YOUR
CHAMPVA SUPPLEMENT
PAYS |
|
Inpatient Services
Confinement in civilian hospital or skilled nursing facility |
DRG* rate, less the
beneficiary share |
The lesser of
(1)
$535/day times the number of inpatient days (2)
25% of billed amount, or (3) the DRG* rate. |
|
Inpatient Services
Non-DRG* based |
75% of the
Allowable Amount |
25% of the Allowable Amount |
|
Inpatient Physician
Services
Visits, surgeons, anesthesiologist, etc. |
75% of the
Allowable Amount |
25% of the Allowable Amount |
|
Outpatient Services
Office visits, clinics, laboratory and pharmacy services, durable
medical equipment (non-VA source) |
75% of the
Allowable Amount2,
the CHAMPVA Annual Ourpatient Deductible |
25% of the Allowable Amount |
| We
will pay the Inpatient and Outpatient covered medical expenses once the
Calendar Year plan deductible of $250 per person and $500 family maximum
has been satisfied. Expenses incurred to satisfy the CHAMPVA Calendar
Year Outpatient deductible cannot be used to satisfy the CHAMPVA
Supplement Plan deductible. |
