Attachment 5 - IB10-441_enrollment_priority_groups.pdf

IB 10-441

Apr 2018

Enrollment Priority Groups Today’s Veterans have a comprehensive medical benefits package, which VA administers through an annual patient enrollment system. The enrollment system is based on priority groups to ensure health care benefits are readily available to all enrolled Veterans.

Complementing the expansion of benefits and improved access is our ongoing commitment to providing the very best in quality health care service to our patients when they are needed during that enrollment period, regardless of the treatment program or the location.

Priority Group Definition

• Veterans with VA-rated service-connected disabilities 50% or more disabling

• Veterans determined by VA to be unemployable due to service-connected conditions

• Veterans awarded the Medal Of Honor (MOH)

2 • Veterans with VA-rated service-connected disabilities 30% or 40% disabling

• Veterans who are Former Prisoners of War (POWs)

• Veterans awarded a Purple Heart medal

• Veterans whose discharge was for a disability that was incurred or aggravated in the line of duty

• Veterans with VA-rated service-connected disabilities 10% or 20% disabling

• Veterans awarded special eligibility classification under Title 38, U.S.C., § 1151, “benefits for individuals disabled by treatment or vocational rehabilitation”

• Veterans who are receiving aid and attendance or housebound benefits from VA

• Veterans who have been determined by VA to be catastrophically disabled

• Nonservice-connected Veterans and noncompensable service-connected Veterans rated 0% disabled by VA with annual income below the VA’s and geographically (based on your resident zip code) adjusted income limits

• Veterans receiving VA pension benefits

• Veterans eligible for Medicaid programs

Page 1 of 2IB 10-441

Priority Group Definition

• Compensable 0% service-connected Veterans.

• Veterans exposed to ionizing radiation during atmospheric testing or during the occupation of Hiroshima and Nagasaki.

• Project 112/SHAD participants.

• Veterans who served in the Republic of Vietnam between January 9, 1962, and May 7, 1975.

• Veterans of the Persian Gulf War who served between August 2, 1990, and November 11, 1998.

• Veterans who served on active duty at Camp Lejeune for at least 30 days between August 1, 1953, and December 31, 1987.

• Currently enrolled Veterans and new enrollees who served in a theater of combat operations after November 11, 1998 and those who were discharged from active duty on or after January 28, 2003, are eligible for the enhanced benefits for five years post discharge

Note: At the end of this enhanced enrollment priority group placement time period, Veterans will be assigned to the highest PG their eligibility status at that time qualifies for.

• Veterans with gross household income below the geographically-adjusted income limits for their resident location and who agree to pay copays

• Veterans with gross household income above the VA and the geographically- adjusted income limit for their resident location, and who agrees to pay copays

Veterans eligible for enrollment:

Noncompensable 0% service-connected and:

þ Subpriority a: Enrolled as of January 16, 2003, and who have remained enrolled since that date and/or placed in this sub priority due to changed eligibility status þ Subpriority b: Enrolled on or after June 15, 2009 whose income exceeds the current VA or geographic income limits by 10% or less

Nonservice-connected and:

þ Subpriority c: Enrolled as of January 16, 2003, and who have remained enrolled since that date and/or placed in this sub priority due to changed eligibility status þ Subpriority d: Enrolled on or after June 15, 2009, whose income exceeds the current VA or geographic income limits by 10% or less

Veterans not eligible for enrollment: Veterans not meeting the criteria above:

þ Subpriority e: Noncompensable 0% service-connected (eligible for care of their SC condition only) þ Subpriority g: Nonservice-connected

IB 10-441

Rev. April 2018