VETERAN FULL MED BENEFITS TX COPAY REQ AND RX COPAY EXMT 6 (55)    HEALTH BENEFIT PLAN (25.11)

Name Value
NAME VETERAN FULL MED BENEFITS TX COPAY REQ AND RX COPAY EXMT 6
PLAN CODE 215
SHORT DESCRIPTION
FM TxCo 6
LONG DESCRIPTION
All enrolled Veterans have a comprehensive medical benefits package, which 
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), 
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:
   .  0% SC, non-compensable *
   .  Non-Service Connected (NSC)
VA administers through an annual patient enrollment system. Veterans who 
   .  MT Status in MT Copay Required
   .  Priority Group 6 (i.e., AO, SWA, IR, EC, SHAD, CV, CL)
* They are subject to copays for their inpatient, outpatient services and 
are exempt from copay for their medications.
 
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 
meet Veteran status for VA healthcare benefits and current Means Test is 
service, and meet the minimum duty service requirement according to 38 
USC 5303A.
 
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.
based on Net Worth Adjudication. Their income plus net worth is above the 
National Threshold, but income alone is below the VA Pension Threshold.
 
 They are subject to copays for their inpatient, outpatient services and 
not subject to copay for their medications. 
 
COVERAGE CODE FB01003