CHAMPUS has instituted similar checking policies at their fiscal intermediaries. Health benefits advisors (HBAs) and other personnel should encourage beneficiaries to review their enrollment status to prevent a claim denial.
DEERS is continuing to expand to assist military treatment facilities in accomplishing several functions. Those under consideration include:
DEERS is hereto stay. Only by assisting our beneficiaries and our beneficiaries assisting us can use of this system continue to assure that only those personnel eligible for benefits receive them.
The Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) is a medical benefits program established to cost-share charges for medically necessary civilian services and supplies required in the diagnosis and treatment of illness or injury when the required services are not available from the direct care system of Department of Defense treatment facilities or designated uniformed services treatment facilities (USTFs) (former PHS hospitals).
The information contained in this section is general. Specific guidance should be requested from the nearest HBA when dealing with CHAMPUS matters.
CHAMPUS is a health benefits program covering certain beneficiaries of all seven uniformed servicesthe Army, Navy, Air Force, Marine Corps, Coast Guard, Public Health Service, and the National Oceanic and Atmospheric Administration.
Active duty dependents, retirees and their dependents, unremarried spouses and children of deceased personnel, dependents of reservists on active duty for greater than 30 days, and unremarried former spouses meeting certain additional eligibility requirements are covered.
Active duty members, beneficiaries eligible for Medicare (Part A), and remarried widows or widowers are ineligible; and parents and parentsin-law, even though dependent upon the sponsor, are also ineligible.
In general, CHAMPUS helps pay most medical bills associated with inpatient and outpatient care. This includes most hospital bills for semiprivate rooms, meals (including special diets), diagnostic tests and treatment, and medical supplies such as prostheses. CHAMPUS will also help pay for treatment in health care centers other than hospitals such as psychiatric care facilities, drug detoxification centers, residential treatment centers for emotionally disturbed children, and marriage counseling. Some care requires prior approval from CHAMPUS, so the HBA must be consulted.
Examples of care not generally covered includes acupuncture, biofeedback, postmortem examinations, chiropractic, electrolysis, orthopedic shoes and arches, private hospital rooms, sex changes, and surgical sterilization reversals. There are many others and often some of the above treatments are permitted under extenuating circumstances. Once again, the HBA should be consulted for specifics.
Outpatient care and emergency inpatient care requires no prior approval. However, nonemergent inpatient care requires that if the beneficiary lives within certain ZIP Code defined catchment areas around a military treatment facility or uniformed services treatment facility (USTF), they must first apply at that facility. The nearest HBA should be consulted to determine if