CHAMPVA Supplement
Insurance Plan

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About Our Plan

How the CHAMPVA Supplement Works


Rate Schedule

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How the CHAMPVA Supplement
Insurance Plan Works

Covered Care Required
TRICARE CHAMPVA Supplement Plan Pays
Inpatient Services
Confinement(1) in civilian hospital or skilled nursing facility
DRG(2) rate, less the beneficiary cost share. The lesser of
1. $535 per day, times number of inpatient days
2. 25% of billed amount, or
3. the DRG rate
Inpatient Services
Non-DRG (2) based
75% of the Allowable Amount 25% of the Allowable Amount
Inpatient Physicians Services
Visits,surgeons,anesthesiologist, etc.
75% of the Allowable Amount 25% of the Allowable Amount
Outpatient Services
Offic visits, clinics, laboratory and pharmacy services, durable medical equipment (non-VA source)
75% of the Allowable Amount after the
CHAMPVA Annual Outpatient 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.

(1) Confinement or confined means being an inpatient in a hospital (or skilled nursing facility) due to sickness or injury. And skilled nursing facility does not mean: a) a hospital; or b) a place for rest, custodial care, or the aged; or c) a place for the treatment of mental disease, drug addicts or alcoholics.

(2) Diagnosis-Related Groups (DRG): An agreement between most hospitals and CHAMPVA to accept a fixed rate for inpatient care regardless of the billed amount.

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About Our Plan |How the CHAMPVA Supplement Works
Termination/Exclusions |Rate Schedule |How to Enroll |Return to Index