VETERAN FULL MED BENEFITS TX COPAY EXMT AND RX COPAY REQ (54)    HEALTH BENEFIT PLAN (25.11)

Name Value
NAME VETERAN FULL MED BENEFITS TX COPAY EXMT AND RX COPAY REQ
PLAN CODE 214
SHORT DESCRIPTION
FM RxCo
LONG DESCRIPTION
All enrolled Veterans have a comprehensive medical benefits package, which 
Shipboard Hazard and Defense (SHAD), Combat Veteran (CV), Camp Lejeune 
(CL), Military Sexual Trauma (MST), Toxic Exposure Risk Activity (TERA).  
Veterans assigned this VHAP meet one of the following conditions:
   .  Determined to be 10% to 40% Compensable SC*
   .  Received a Purple Heart (PH)**
   .  Discharge Due to Disability**
   .  Military Disability Retirement **
   .  Granted a Financial Hardship based on the evidence provided*** 
   .  Receive Medicaid**
   .  Non-Service Connected (NSC)****
VA administers through an annual patient enrollment system. Veterans who 
*They are exempt from copay for medications related to their SC rated 
condition, but they must complete a Pharmacy Copay Exemption Test and the 
outcome is Non-Exempt. They must pay copay for their NSC medication copays.
**They must complete a Pharmacy Copay Exemption Test and the outcome is 
Non-Exempt.  They must pay copay for their NSC medication.
***The Hardship assigns Means Test (MT) Status outcome of MT Copay Required 
for Medical Benefits Treatments. The Hardship does not affect Pharmacy 
Copay Exemption Test outcome. If the Pharmacy Copay Exemption Test outcome 
is Non-Exempt, they are subject to NSC medication copays.  
****NSC Veterans who are subject to Means Testing; the outcome of the Means 
meet Veteran status for VA healthcare benefits and are not subject to copay 
Test is MT Copay Exempt and Rx Exemption status is Non-Exempt.
 
For eligible individuals, under Veterans Comprehensive Prevention, Access 
to Care, and Treatment Act of 2020 (COMPACT), Section 201, VA will 
furnish, reimburse, pay for emergent suicide care, make referrals, as 
appropriate, for care following the period of emergent suicide care. 
Eligible individuals are Veterans who served in the active military 
service, and meet the minimum duty service requirement according to 38 
USC 5303A.
 
for their inpatient, outpatient services but are subject to copay for their 
For eligible individuals, under Dr. Kate Hendricks Thomas Supporting 
Expanded Review for Veterans in Combat Environments (SERVICE) Act, VA 
will furnish clinically appropriate breast cancer risk assessment for 
care. Eligible individuals are Veterans who served in the active military 
service, and meet the minimum duty service requirement according to 38 USC
5303A.
medications.
 Veterans are exempt from copayments for inpatient, outpatient services and 
medications related to their Service Connected (SC) related disability and 
special authority factor(s) - Agent Orange Exposure (AO), Southwest Asia 
Conditions (SWA), Ionizing Radiation (IR), Nose Throat Radium (NTR), 
COVERAGE CODE FB01002