United States Department of Veterans Affairs

Lebanon VA Medical Center

Eligibility

 


Click here to view a video on eligibility guidelines and instructions

 

Enrollment 

How to Apply for VA Health Care

To receive VA health care benefits, most Veterans need to enroll. You can apply at any time by completing a form called VA Form 10-10EZ. You can receive this form by:

  • Visiting or calling the nearest VA health care facility, Veterans Benefits Office, or County Veterans Service Officer
  • Calling Veterans Health Administration (national) toll free at 1-877-222- VETS (8387)
  • Visiting the Web, download the form at:  https://www.1010ez.med.va.gov/sec/vha/1010ez/

When enrolling for VA health care, you will need:

  • Completed Signed Application
  • DD214/Discharge Papers
  • Copies of Health Insurance Cards

Explanation of important and often forgotten information required to complete the application:

  • Next of Kin/Emergency Contact Information:  Page 1, #17 & #18:  Complete Address/Telephone Number and what relation they are to you;  i.e., spouse, son, daughter, friend, etc.
  • Employment Information:  Page 2, Section III:  Complete Company Name/Address/ Telephone Number
  • Dependent Information:  Page 3, Section VII:  Spouse/Children Social Security Number(s) and Dates of Birth
  • Financial Information:
    • Section VIII Gross Income:  Income can be retrieved from prior year’s tax return or appropriate source
    • Section IX Deductible Expenses:  Medical includes:  Health, Eye and Dental for Self and Dependents  (Tally all:  Insurance Premiums, Co-Pays, Medication Expenses, ANY “out of pocket” expenses, including glasses and dental expenses)
    • Section X – Previous Calendar Year Net Worth:  Market Value of Land and Buildings (does not include your primary home) and Value of Property/Assets (does not include household effects or vehicles)

Once you have completed and signed the 10-10EZ, mail or return the original application with a copy of the materials described on page 6 to the Lebanon VA Medical Center at:

Lebanon VA Medical Center
1700 South Lincoln Avenue
Lebanon, PA 17042

Once your application is received, our enrollment specialists review your military service record to determine your benefit eligibility. The results are sent to you in writing. You will be assigned to a priority group based on your specific eligibility status, income, and service information you provided on the 10-10EZ form.

Your enrollment information is reviewed each year or whenever you have a life change. Your ability to remain enrolled in VA may depend on the funding that VA receives from Congress to provide your care. You will be notified in writing if VA cannot renew your enrollment for another year.

Veterans Who Do Not Need to Enroll

There are three groups of Veterans that are not required to enroll. However, we suggest that enrollment will improve our ability to serve you better.

  1. Veterans with a service-connected disability (a disability that the military has determined was caused by or made worse in the line of duty) of 50 percent or more.
  2. Veterans who have been discharged within the past 12 months who are seeking care for a service-connected disability that has not yet been rated by VA.
  3. Veterans seeking care for a service-connected disability only.

Priority Groups

The number of Veterans who can be enrolled in the healthcare program is determined by the amount of funding Congress gives VA each year. VA prioritizes enrollment.

Once you apply for enrollment, your eligibility will be evaluated. Based on your evaluation, you will be assigned a priority group. The priority groups range from groups 1-8. Group 1 has the highest priority to be enrolled first. Some Veterans may have to agree to pay co-payments to be placed in certain groups.

You may be eligible for more than one enrollment priority group. If this happens, VA will always place you in the highest priority group for which you are eligible.

The priority groups are complicated and there may also be some financial limitations. Talk to someone in the Veterans Business Center if you are unsure of your priority group.

What is a VA Service-Connected Rating?

A service-connected rating is an official ruling by VA that your illness/condition is directly related to your active military service. Service-connected ratings are established by VA Regional Offices located throughout the country. In addition to compensation and pension ratings, VA Regional Offices are also responsible for administering educational benefits, vocational rehabilitation, and other benefit programs, including home loans. To obtain more information or to apply for any of these benefits, contact your nearest VA Regional Office at 1-800-827-1000.

Priority Group 1

  • Veterans with VA-rated service-connected disabilities of 50 percent or more
  • Veterans who VA has determined to be unemployable because of a service-connected disability

Priority Group 2

  • Veterans with VA-rated service-connected disabilities of 30-40 percent

Priority Group 3

  • Veterans who are former prisoners of war (POWs)
  • Veterans awarded a Purple Heart medal
  • Veterans whose discharge was for a disability that was caused or made worse in the line of duty
  • Veterans with VA-rated service-connected disabilities of 10-20 percent
  • Veterans who have been awarded special eligibility classification under Title 38, U.S.C, Section 1151, “benefits for individuals disabled by treatment or vocational rehabilitation”

Priority Group 4

  • Veterans who are receiving Aid and Attendance or Housebound Benefits from VA
  • Veterans who have been determined by VA to be catastrophically disabled

Priority Group 5

  • Veterans who have no service-connected disability or who are rated 0 percent disabled and are not eligible for compensation, whose annual income and net worth are below VA national income limitations
  • Veterans receiving VA pension benefits
  • Veterans eligible for Medicaid programs

Priority Group 6

  • World War I Veterans
  • Veterans exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki
  • Project 112/SHAD participants
  • Currently enrolled Veterans and new enrollees who were discharged from active duty on or after January 28, 2003, are eligible for the enhanced benefits for 5 years after discharge

Priority Group 7

  • Veterans with income and/or net worth above VA national income limits and geographic income limits who agree to pay co-payments


Priority Group 8

  • Veterans with income and/or net worth above VA national income limits and geographic income limits who agree to pay co-payments
  • Subpriority a:  0 percent service-connected Veterans who are not eligible for compensation, enrolled as of January 16, 2003, and who have remained enrolled since that date
  • Subpriority c:  Non-service-connected Veterans enrolled as of January 16, 2003, and who have remained enrolled since that date
  • Subpriority e**:  0 percent service-connected Veterans who are not eligible for compensation, applying for enrollment after January 16, 2003
  • Subpriority g**:  Non-service-connected Veterans applying for enrollment after January 16, 2003

** NOTE:  Veterans assigned to Priority Group 8e or 8g are not eligible for enrollment as a result of the restrictions which suspended enrolling new high-income Veterans who apply for care after January 16, 2003. Veterans enrolled in Priority Groups 8a or 8c will remain eligible for the full range of VA health care benefits.

Special Access to Care

Service Disabled Veterans

Veterans who are 50 percent or more disabled from service-connected conditions, unemployable due to service-connected conditions, or receiving care for a service-connected disability, will receive priority scheduling of hospital or outpatient appointments.

Combat Veterans

Veterans who served in combat locations during active military service after November 11, 1998, are eligible for free health care services for conditions possibly related to combat service for 5 years following separation from active duty.

For additional information call 1-877-222-VETS (8387).

Combat-Related Programs

 

OEF/OIF/OND (Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn)

If you are a recently discharged Veteran with service in a theater of combat operations, VA can provide you with free care for 5 years from your discharge from active duty for conditions possibly related to your service, regardless of your income status.

For information, please visit or contact:

Lebanon VA Medical Center
Building 18, Room 302,
Call 1-717-272-6621 ext. 5954
or 1-800-409-8771 ext. 5954

Check with the OEF/OIF/OND Program office at ext. 5954 for any additional combat-related programs, including services offered at the Harrisburg, PA and Lancaster, PA Vet Centers.

Vet Center Services

The Vet Center is a community-based VA program that offers a wide range of counseling services free of charge to Veterans who served in war zones and to their families. Eligibility eras range from World War II through the conflicts in Afghanistan and Iraq. Services include individual, couples, family, and group counseling for post-war adjustment issues. Counseling is also offered for victims of military sexual trauma. Bereavement counseling is available for families of a service person who died while on active duty. The Vet Center will also provide information about VA benefits and referral to other community agencies.

To contact your local Vet Center directly, call:

Harrisburg Vet Center Services
Marian Bova, Team Leader
1500 N. Second Street, Suite 2
Harrisburg, PA 17102
Voice: 1-717-782-3954
Fax: 1-717-782-3791

Lancaster Vet Center Services
Joann Thompson, Team Leader
1817 Olde Homestead Lane, Suite 207
Lancaster, PA 17601
Voice: 1-717-283-0735

Who is Eligible for Combat Veteran Services?

Veterans, including activated Reservists and members of the National Guard, are eligible if they
served on active duty in a theatre of combat operations after November 11, 1998, and have NOT been discharged under dishonorable conditions.

Documentation used to determine service in a theater of combat operations can include any of the following:

  • Military service documentation that reflects service in a combat theatre
  • Receipt of combat service medals
  • Receipt of imminent danger or hostile fire pay or tax benefits

Dental Care

Eligibility for VA dental benefits is based on very specific guidelines and differs significantly from eligibility requirements for medical care. Combat Veterans may be authorized for dental treatment as reasonably necessary for the one-time correction of dental conditions if:

  • They served on active duty and were discharged or released from active duty under conditions other than dishonorable from a period of service not less than 90 days and
  • The certificate of discharge or release does not bear a certification that the Veteran was provided, within the 90-day period immediately before the date of such discharge or release, a complete dental examination (including dental x-rays and all appropriate dental service and treatment indicated by the examination to be needed) and 
  • Application for VA dental treatment is made within 180 days of discharge or release

For more information on VA Dental Benefits, contact Office of Care Coordination at:
1-717-272-6621 or 1-800-409-8771 extension 5086.

Financial/Co-Payments

 

Income Verification

By law, VA is required to verify the gross household income (Veteran, spouse and dependents, if any) of certain Veterans to evaluate their eligibility for VA health care, co-payment requirements, and enrolled priority group assignment.

VA verifies a Veteran’s gross household income through something called a financial assessment (Means Test). This financial information is verified by matching financial records maintained by the Internal Revenue Service (IRS) and the Social Security Administration (SSA). If the Veteran’s gross household income is higher than the established VA national means limitations, the Veteran will be contacted via mail.

Financial Assessment (Means Test)

You must complete a financial assessment (Means Test) each year. This assessment is based on the previous year’s income, assets, and debts. This information is used to determine your co-payment. You can agree to make co-payments without providing any financial information. If you indicate this on your application form, you will automatically be put into a co-payment category.

If you do not complete the Means Test or do not agree to make the co-payments,
you will NOT be eligible for VA health care.

Co-Payments

Certain priority groups are required to make co-payments for their care. Generally, you will be charged only one co-payment on a single day based on the highest level of service provided that day, regardless of the number of clinical visits in that day. If you are an outpatient who has both a specialty care visit as well as a basic care visit on the same day, you will be charged for the specialty care visit since it is the more expensive level of care.

Veterans who qualify under special eligibility/special access to care are not subject to co-payment requirements for conditions potentially related to their combat service.

Services Exempt from Inpatient and Outpatient Co-Payments

  • Specialty registry examinations offered by VA to evaluate possible health risks associated with military service
  • Counseling and care for military sexual trauma
  • Compensation and pension examinations requested by the Veterans Benefits Administration (VBA)
  • Care that is part of a VA-approved research project
  • Care related to a VA-rated service-connected disability
  • Readjustment counseling and related mental health services for Post Traumatic Stress Disorder (PTSD)
  • Care for cancer of head or neck caused from nose or throat radium treatments given while in the military
  • Publicly announced VA public health initiatives (such as health fairs)
  • Care related to service for Veterans who served in combat or against a hostile force during periods of hostilities after November 11, 1998
  • Laboratory services, such as flat film radiology services and electrocardiograms
  • Preventive screenings (hypertension, hepatitis C, tobacco, alcohol, colorectal cancer, etc.)
  • Immunizations, such as influenza (flu) and pneumococcal (pneumonia)

Medication Co-Payments

As part of your VA health care, outpatient prescription medications are available. In most cases, a co-payment is required for prescriptions if they are not for treatment of a service-connected condition.

Hardship Determinations & Waivers

Requests for hardship evaluation may be made based on a change in your financial situation (loss of job, retirement, etc.). Hardship requests only apply to future charges (not to current balances for your VA care). To request consideration for hardship, a current financial Means Test should be on file. A review of your request may result in a change to your eligibility or may impact your co-payment status. Hardship considerations do not apply to prescription co-pays.

If you are financially unable to pay for care, you may request a waiver. A waiver applies only to co-payments currently owed (from the last 180 days).
 
To request a waiver, a current financial Means Test must be on file. Waivers do not apply to the following:

  • Co-pay charges related to an emergent or humanitarian visit
  • Charges related to inpatient per diem for hospital or nursing home care

For more information about Hardship Determinations or Waivers, call the Customer Service line at 1-717-272-6621 or 1-800-409-8771 ext. 4041 or ext. 4499.

 

Health Insurance

VA needs to know about your health insurance. VA encourages you to maintain any health insurance plans you currently hold. VA bills private insurance companies for all non-service-connected care you receive. VA does not bill insurance companies for treatment of service-connected conditions.

You do not have to pay any balances that are not covered by your insurance carrier. Many insurance companies apply VA health care charges toward the satisfaction of your annual deductible.

Your co-payments may be offset by the payments we receive from your insurance company. Your current insurance status (insured or uninsured) has no bearing on your VA health care benefits. You are eligible for care regardless of your current insurance status.

CAUTION:  Before cancelling coverage, enrolled Veterans should carefully consider the following risks:

  • Non-Veteran spouses and other family members generally do NOT qualify for VA health care
  • If participation in Medicare Part B is cancelled, it cannot be reinstated until January of the next year and there may be a penalty for reinstatement

Private Health Insurance Billing

VA is required to bill private health insurance providers for medical care, supplies and prescriptions provided for treatment of a Veteran’s non-service-connected conditions. Generally, VA cannot bill Medicare, but can bill Medicare supplemental health insurance for covered services.

All Veterans applying for VA medical care are required to provide information about their health insurance coverage, including coverage provided under policies of their spouses. Veterans are not responsible for paying any remaining balances on VA’s insurance claims not paid or covered by their health insurance, and any payment received by VA may be used to offset a Veteran’s VA co-payment responsibility. You will need to verify the status of your health insurance at each patient visit. Since collections received from insurance companies help supplement the funding available for providing services to Veterans, patients are asked to cooperate by disclosing all relevant health insurance information.

Dual Care

If you are a Veteran who is receiving care from both a VA provider and a non-VA provider, it is important for your health and safety that your care be coordinated into one treatment plan (co-managed care). Your VA and non-VA provider(s) should communicate about your health status, medications, treatments, and diagnostic tests.

When requesting services or medications that have been recommended by your non-VA provider, it is important that you bring along the necessary documentation to support the request.

The necessary documentation might include, but is not limited to:

  • A signed note from your non-VA provider that explains the treatment and/or testing you are requesting, and the condition that requires this treatment and/or testing.
  • A copy of your non-VA provider’s discharge note if you were recently treated in a community hospital.
  • A copy of the recent test results that explain why your non-VA provider has suggested the treatment and/or testing.
  • A list of the medications and medication dosages that your non-VA provider is currently prescribing.
  • The telephone number and address of your non-VA provider.

This information should be brought with you to your VA appointment. If you have any questions, call your VA health care provider prior to coming in for your visit to make sure you have the proper information. Please understand that it is the responsibility of your VA provider to use his/her own clinical judgment to decide what medical treatment, test(s) and medications are appropriate and necessary.