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In October 1996, Congress passed Public Law 104-262, the Veterans' Health Care Eligibility Reform Act of 1996. This legislation paved the way for the creation of a Medical Benefits Package - a standard enhanced health benefits plan generally available to all enrolled veterans. Like other standard health care plans, the Medical Benefits Package emphasizes preventive and primary care, offering a full range of outpatient and inpatient services.
VA places a priority on improved veteran satisfaction maintains that their goal is to ensure the quality of care and service that veterans receive is consistently excellent, in every location, in every program.
What does it cover?
The Medical Benefits Package will generally be provided to all enrolled veterans regardless of your priority group.
Public Law 104-262 calls for VA to provide you hospital care and outpatient care services that are defined as "needed". VA defines "needed" as care or service that will promote, preserve, and restore health. This includes treatment, procedures, supplies, or services. This decision of need will be based on the judgment of your health care provider and in accordance with generally accepted standards of clinical practice.
The following three categories contain a list of health care services that are provided under the Medical Benefits Package, a list of some that are not covered by VA, and a list of other services that are provided under special authority.
Services Covered Under the Medical Benefits Package
Basic Care
- Outpatient medical, surgical, and mental health care, including care for substance abuse.
- Inpatient hospital, medical, surgical, and mental health care, including care for substance abuse.
- Prescription drugs, including over-the-counter drugs and medical and surgical supplies available under the VA national formulary system.
- Emergency care in VA facilities.
- Emergency care in non-VA facilities in certain conditions: This benefit is a safety net for veterans requiring emergency care for a service connected disability or enrolled veterans who have no other means of paying a private facility emergency bill. If another health insurance provider pays all or part of a bill, VA cannot provide any reimbursement. To qualify for payment or reimbursement for non-VA emergency care service for a service-connected disability, you must meet all of the following criteria:
- It must be for a Medical Emergency.
- Department of Veterans Affairs or other Federal facilities are not feasibly available at time of emergency event.
- The emergency was for a service-connected disability.
To qualify for payment or reimbursement for non-VA emergency care services for a non service-connected condition, you must meet all of the following criteria:
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- You are enrolled in the VA Health Care System.
- You have been provided care by a VA clinician or provider within the last 24 months.
- You were provided care in a hospital emergency department or similar facility providing emergency care.
- You have no other form of health insurance.
- You do not have coverage under Medicare, Medicaid, or a state program.
- You do not have coverage under any other VA programs.
- Department of Veterans Affairs or other Federal facilities are not feasibly available at time of emergency event.
- A reasonable layperson would judge that any delay in medical attention would endanger your health or life.
- You are financially liable to the provider of the emergency treatment for that treatment.
- You have no other contractual or legal recourse against a third party that will pay all or part of the bill.
- Bereavement counseling.
- Comprehensive rehabilitative services other than vocational services.
- Consultation, professional counseling, training, and mental health services for the members of the immediate family or legal guardian of the veteran.
- Durable medical equipment and prosthetic and orthotic devices, including eyeglasses and hearing aids.
- Home health services.
- Reconstructive (plastic) surgery required as a result of a disease or trauma but not including cosmetic surgery that is not medically necessary.
- Respite, hospice, and palliative care.
- Payment of travel and travel expenses for eligible veterans.
- Pregnancy and delivery service, to the extent authorized by law.
- Completion of forms.
Preventative Care
- Periodic medical exams.
- Health education, including nutrition education.
- Maintenance of drug-use profiles, drug monitoring, and drug use education.
- Mental health and substance abuse preventive services.
Services Not Covered Under the Medical Benefits Package
- Abortions and abortion counseling.
- In vitro fertilization.
- Drugs, biologicals, and medical devices not approved by the Food and Drug Administration unless the treating medical facility is conducting formal clinical trials under an Investigational Device Exemption (IDE) or an Investigational New Drug (IND) application, or the drugs, biologicals, or medical devices are prescribed under a compassionate use exemption.
- Gender alterations.
- Hospital and outpatient care for a veteran who is either a patient or inmate in an institution of another government agency if that agency has a duty to give the care or services.
- Membership in spas and health clubs.
Services With Limited Coverage
- Commonwealth Army veterans and new Philippine Scouts may receive hospital and outpatient care provided for in the Medical Benefits Package.
- A veteran may receive certain types of VA hospital and outpatient care not included in the Medical Benefits Package such as humanitarian emergency care for which the individual will be billed, compensation and pension examinations, dental care, readjustment counseling, care as part of a VA-approved research project, seeing-eye or guide dogs, sexual trauma counseling and treatment, special registry examinations.
- A veteran may receive an examination to determine whether the veteran is catastrophically disabled and therefore eligible for inclusion in priority category 4.
- Non-enrolled veterans
- A veteran rated for service-connected disabilities at 50 percent or greater will receive VA hospital and outpatient care.
- A veteran who has a service-connected disability will receive VA hospital care for that service-connected disability.
- A veteran who was discharged or released from active military service for a disability incurred or aggravated in the line of duty will receive VA hospital and outpatient care for that disability for the 12-month period following discharge or release.
- When there is a compelling medical need to complete a course of VA treatment started when the veteran was enrolled in the VA health care system, a veteran will receive that treatment.
- A veteran participating in VA's vocational rehabilitation will receive VA hospital and outpatient care.
- A veteran may receive VA hospital and outpatient care based on factors other than veteran status e.g., a veteran who is a private-hospital patient and is referred to VA for a diagnostic test by that hospital under a sharing contract; a veteran who is a VA employee and is examined to determine physical or mental fitness to perform official duties; A Department of Defense retiree under a sharing agreement.
- A veteran may receive VA hospital and outpatient care outside the United States, without regard to the veteran's citizenship, if necessary for treatment of a service-connected disability, or any disability associated with and held to be aggravating a service-connected disability or if the care is furnished to a veteran participating in a VA rehabilitation program.
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Benefits 
