VETERAN FULL MED BENEFITS TX GMT COPAY REQ AND RX COPAY REQ (61)    HEALTH BENEFIT PLAN (25.11)

Name Value
NAME VETERAN FULL MED BENEFITS TX GMT COPAY REQ AND RX COPAY REQ
PLAN CODE 221
SHORT DESCRIPTION
FM TxCoG RxCo
LONG DESCRIPTION
All enrolled Veterans have a comprehensive medical benefits package, which 
status is Non-Exempt. These Veterans are subject to copays for inpatient 
services at a reduced rate, copays for outpatient services at the full 
copay rate, and copays for 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), 
Shipboard Hazard and Defense (SHAD), Combat Veteran (CV), Camp Lejeune 
(CL), Military Sexual Trauma (MST), Toxic Exposure Risk Activity (TERA).
VA administers through an annual patient enrollment system. Veterans who 
 
Veterans assigned this VHAP meet one of the following conditions:
   .  0% SC, Non-Compensable
   .  Non-Service Connected
   .  Priority Group 7 (i.e., SC 0% Non-Compensable or NSC)
 
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. 
meet Veteran status for VA healthcare benefits and must complete a Means 
Eligible individuals are Veterans who served in the active military 
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.
Test to determine their copay status for their inpatient, outpatient 
services and medications.
 
Veterans with gross household income below the geographically adjusted 
income limits for their resident location and who agree to pay copays. The 
Means Test outcome of GMT Copay Required and outcome of their Rx Exemption 
COVERAGE CODE FB01006