Eligibility

• To be eligible for CHAMPVA you cannot be eligible for TRICARE and you must be in one of the following categories: The spouse or child of a veteran who has been rated 100% permanently and totally disabled from a service connected disability by a VA regional office, or

• The surviving spouse or child of a veteran who died from a VA-rated service connected disability, or who, at the time of death, was rated 100% permanently and totally disabled, or

• The surviving spouse or child of a veteran who died in the line of duty, not due to misconduct (in most cases, these family members are eligible for TRICARE, not CHAMPVA).

Under CHAMPVA eligibility for an unmarried dependent child ends at age 18 or 23, if a full-time student. Eligibility continues for an unmarried dependent child who prior to age 18 became permanently incapable of self-support as rated by a VA regional office. Eligibility for spouse ends at age 65. At age 65 the spouse becomes eligible for Medicare and CHAMPVA for Life.

     a) the date the Policy terminates, or the date the AMRA ceases to be a Participating Organization of the Policyholder;
     b) the date the required premium is not paid, subject to the Grace Period provision;
     c) the date you or your widow(er) terminates membership in the Participating Organization;
     d) the first premium due date on or next following the date a dependent ceases to be an Eligible Spouse or an Eligible Child;
     e) the date we or the group cancel coverage for a class of Eligible Person to which he or she belongs;
     f) the first premium due date on or next following the date he or she ceases to be covered by CHAMPVA;
     g) the date he or she becomes eligible for Medicare;
     h) if a spouse, the date he or she attains age 65;
     i) if a child, the date he or she attains age 18, or age 23 if enrolled full-time in a school of higher learning. Termination of insurance will not prejudice any claim which occurred before the effective date of termination.

1. treatment or confinement not ordered by a physician or necessary for medical care;
2. intentionally self-inflicted injury;
3. suicide or attempted suicide, whether sane or insane;
4. sickness or injury resulting from acts of war, whether declared or undeclared;
5. routine physical exams, eye exams, hearing exams and immunizations, except when considered Well Baby Care covered by CHAMPVA;
6. eye refractions;
7. custodial care, care received in a retirement home, rest home or halfway house, or domiciliary care;
8. rest cures;
9. hearing aids;
10. orthopedic footwear;
11. eyeglasses or contact lenses;
12. cosmetic procedures except those resulting from sickness or injury occurring while a Covered Person under the Policy;
13. drugs (other than insulin and other diabetic supplies) which do not require a prescription;
14. any confinement, service or supply not covered by CHAMPVA as contained in Regulations 38 CFR17.272;
15. expenses paid in full by CHAMPVA;
16. expenses in excess of the CHAMPVA Allowed Amount;
17. expenses in excess of the CHAMPVA Cap;
18. care for the mentally or physically incapacitated if the care is required because of the mental or physical incapacitation;
19. any part of a covered expense which the Covered Person is not legally obligated to pay;
20. care received as part of a grant, study or research program;
21. care considered experimental or investigational.
 

Transamerica Financial Life Insurance Company, Harrison, NY (NY residents only)
AEGON companies
(# 19837953)