The VA Medical Benefits Package

26 Feb The VA Medical Benefits Package

The VA Medical Benefits Package offers comprehensive health care, including preventative care, mental health, emergency care, and specialist care.  The services covered by the VA that make up the definition of the “medical benefits package” are defined by law and are listed in the federal regulations at 38 CFR 17.38.  This regulation limits VA care to services that have been determined to “promote, preserve, or restore the health of the individual and [are] in accord with generally accepted standards of medical practice.”

Promoting health: A service or treatment promotes health if it “will enhance the quality of life or daily functional level of the veteran, identify a predisposition for development of a condition or early onset of disease which can be partly or totally ameliorated by monitoring or early diagnosis and treatment, and prevent future disease.”

Preserving health: A service or treatment preserves health if it “will maintain the current quality of life or daily functional level of the veteran, prevent the progression of disease, cure disease, or extend lifespan.”

Restoring health: A service or treatment restores health if it “will restore the quality of life or daily functional level that has been lost due to illness or injury.”

 The following listed items can only be changed or added to by an act of Congress.

Basic care, which includes:

• Outpatient medical, surgical, and mental healthcare, including care for substance abuse
• Inpatient hospital, medical, surgical, and mental healthcare, including care for substance abuse
• Prescription drugs, including over-the-counter drugs and medical and surgical supplies available under the VA national formulary system
• Emergency care in VA facilities and emergency care in non-VA facilities per sharing contracts, or if authorized by law
  • Emergency care in non-VA facilities will only be covered or reimbursed if there are no VA facilities available and if the medical emergency is related to a service-connected disability
• Bereavement counseling, as authorized by law
• Comprehensive rehabilitative services other than vocational services provided by law
• Consultation, professional counseling, marriage and family counseling, training, and mental health services for the members of the immediate family or legal guardian of the veteran or the individual in whose household the veteran certifies an intention to live, as necessary and appropriate, in connection with the veteran’s treatment, as authorized by law
• Durable medical equipment and prosthetic and orthotic devices, including eyeglasses and hearing aids, as authorized by law
• Home health services, as authorized by law
• Reconstructive (plastic) surgery required as a result of disease or trauma, not including cosmetic surgery that is not medically necessary
• Hospice care, palliative care, and institutional respite care
• Non-institutional extended care services, including but not limited to non-institutional geriatric evaluation, non-institutional adult day health care, and non-institutional respite care
• Payment of beneficiary travel, as authorized by law
• Pregnancy and delivery services, to the extent authorized by law
• Newborn care, post-delivery, for a newborn child for the date of birth plus seven calendar days after the birth of the child
  • when the birth mother is a woman veteran enrolled in VA health care and receiving maternity care furnished by VA or
  • under authorization from VA and the child is delivered either in a VA facility or another facility under a VA authorization for maternity care at VA expense

Preventative care, which includes:

• Periodic medical exams
• Health education, including nutrition education
• Maintenance of drug-use profiles, drug monitoring, and drug use education
• Mental health and substance abuse preventive services
• Immunizations against infectious disease
• Prevention of musculoskeletal deformity or other gradually developing disabilities of a metabolic or degenerative nature
• Genetic counseling concerning inheritance of genetically determined diseases
• Routine vision testing and eye-care services
• Periodic reexamination of members of high-risk groups for selected diseases and functional decline of sensory organs, and the services to treat these diseases and functional declines

The following items are specifically excluded from the definition of the “VA medical benefits package”:

• Abortions and abortion counseling
• In vitro fertilization
• Drugs, biologicals, and medical devices not approved by the Food and Drug Administration, unless:
  • the treating medical facility is conducting formal clinical trials under an Investigational Device Exemption (IDE) or an Investigational New Drug (IND) application, or
  • the drugs, biologicals, or medical devices are prescribed under a compassionate use exemption
• Gender alterations
• Hospital and outpatient care for a veteran who is either a patient or inmate in an institution of another government agency, if that agency must provide care or services
  • This exclusion does not apply to veterans who are released from incarceration in a prison or jail into a temporary housing program (such as a community residential re-entry center or halfway house)
• Membership in spas and health clubs