Retired Association for the Uniformed Service

RAUS
RETIRED ASSOCIATION FOR THE UNIFORMED SERVICES, INC.

 Membership
 Member Benefits
 RAUS Purpose
 Communications
 Discounts
 Health
 Partnering
 Resources
 Finance
 Education
 Newsletter
 Contact Us
 Merchandise

 

The RAUS CHAMPVA Supplement Plan
(Civilian Health and Medical Program of the Department of Veteran Affairs)

CHAMPVA is a federal health benefit program administered by the Department of Veterans Affairs. CHAMPVA like TRICARE is a fee for service indemnity type plan.

CHAMPVA Supplement Plan provides reimbursement for most healthcare services that are medically necessary (this includes inpatient, outpatient, mental health, prescription medication, skilled nursing care and durable medical equipment).

CHAMPVA Supplement Plan, when combined with your CHAMPVA benefits, is designed to help provide you with the protection you need when you need it.

Eligibility

  • To be eligible for CHAMPVA you cannot be eligible for TRICARE and you must be in one of the following categories: The spouse or child of a veteran who has been rated 100% permanently and totally disabled from a service connected disability by a VA regional office, or

  • The surviving spouse or child of a veteran who died from a VA-rated service connected disability, or who, at the time of death, was rated 100% permanently and totally disabled, or

  • The surviving spouse or child of a veteran who died in the line of duty, not due to misconduct (in most cases, these family members are eligible for TRICARE, not CHAMPVA).

Under CHAMPVA eligibility for an unmarried dependent child ends at age 18 or 23, if a full-time student. Eligibility continues for an unmarried dependent child who prior to age 18 became permanently incapable of self-support as rated by a VA regional office. Eligibility for spouse ends at age 65. At age 65 the spouse becomes eligible for Medicare and CHAMPVA for Life.

Definitions
Skilled Nursing Facility does not mean: a) a hospital; or b) a place for rest, custodial care, or the aged; or c) a place for the treatment of mental disease, drug addicts or alcoholics.

Termination
A Covered Person's coverage under the Policy will cease on the first to occur of:

     a) the date the Policy terminates, or the date the AMRA ceases to be a Participating Organization of the Policyholder;
     b) the date the required premium is not paid, subject to the Grace Period provision;
     c) the date you or your widow(er) terminates membership in the Participating Organization;
     d) the first premium due date on or next following the date a dependent ceases to be an Eligible Spouse or an Eligible Child;
     e) the date we or the group cancel coverage for a class of Eligible Person to which he or she belongs;
     f) the first premium due date on or next following the date he or she ceases to be covered by CHAMPVA;
     g) the date he or she becomes eligible for Medicare;
     h) if a spouse, the date he or she attains age 65;
     i) if a child, the date he or she attains age 18, or age 23 if enrolled full-time in a school of higher learning. Termination of insurance will not prejudice any claim which occurred before the effective date of termination.

Exclusions
The Policy does not cover:

1. treatment or confinement not ordered by a physician or necessary for medical care;
2. intentionally self-inflicted injury;
3. suicide or attempted suicide, whether sane or insane;
4. sickness or injury resulting from acts of war, whether declared or undeclared;
5. routine physical exams, eye exams, hearing exams and immunizations, except when considered Well Baby Care covered by CHAMPVA;
6. eye refractions;
7. custodial care, care received in a retirement home, rest home or halfway house, or domiciliary care;
8. rest cures;
9. hearing aids;
10. orthopedic footwear;
11. eyeglasses or contact lenses;
12. cosmetic procedures except those resulting from sickness or injury occurring while a Covered Person under the Policy;
13. drugs (other than insulin and other diabetic supplies) which do not require a prescription;
14. any confinement, service or supply not covered by CHAMPVA as contained in Regulations 38 CFR17.272;
15. expenses paid in full by CHAMPVA;
16. expenses in excess of the CHAMPVA Allowed Amount;
17. expenses in excess of the CHAMPVA Cap;
18. care for the mentally or physically incapacitated if the care is required because of the mental or physical incapacitation;
19. any part of a covered expense which the Covered Person is not legally obligated to pay;
20. care received as part of a grant, study or research program;
21. care considered experimental or investigational.
 

Non-Duplication of Coverage under Employer Health Program
If a claim payable under the Policy is also payable under an Employer Health Program with TRICARE as the secondary payor, we will limit our payment to an amount which, when added to the amounts paid by the Employer Health Program and TRICARE, will not exceed 100% of TRICARE Covered Expenses.

Monumental Life Insurance Company Cedar Rapids, IA (Transamerica Financial Life Insurance Company, Harrison, NY for New York residents) AEGON companies.

All benefits are subject to the terms and conditions of the policy. Policies underwritten by Monumental Life Insurance Company (Transamerica Financial Life Insurance Company for New York residents) detail exclusions, limitations, reduction of benefits and terms under which the policies may be continued in force or discontinued.


Click below to download and print the RAUS Membership Application and insurance enrollment forms including rates.

RAUS CHAMPVA Supplement Plan Enrollment Form - For residents of CO and SD only.

Mail membership application and enrollment forms with your payment for dues and premium to:

RAUS
504 Autumn Springs Court, Suite 8
Franklin, TN  37067-8278
1-800-321-RAUS (7287)

If you do not have the current Acrobat Reader software, obtain it FREE from Adobe's web site. Click here.

View RAUS CHAMPVA Plan Profile
View RAUS CHAMPVA Supplement Plan Brochure
View CHAMPVA Supplement Sample Certificate
View CHAMPVA Supplement Sample Certificate (NY Residents)

For more about CHAMPVA Supplement Plan, select:

 

To top of page

This plan is sponsored by:
Retired Association for the Uniformed Services
504 Autumn Springs Court, Suite 8
Franklin, TN 37067-8278

RAUS
Administered by:
Selman & Company
6110 Parkland Boulevard
Cleveland, OH 44124-4187
Phone: 800.735.6262
Fax: 440.646.9339

Underwritten by:
Monumental Life Insurance Company, Cedar Rapids, IA

Transamerica Financial Life Insurance Company, Harrison, NY (NY residents only)
AEGON companies

(# 19837953)
 

Copyright (c) 1997-2014 Retired Association for the Uniformed Services, Inc.
Revised: April 11, 2016