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Requirements to Access the Imperial Valley VA Outpatient Clinic

The MEANS TEST

In order to access Health Benefit Services most veterans must complete a yearly MEANS TEST. A Means Test is simply an Application for Health Benefits VA Form 1010-EZ or, in the case of veterans who are renewing, a 1010-EZR. This is required even if a veteran is enrolled in the VA Health System elsewhere in the State or Nation. Unfortunately, neither the clinic nor this office has access to VA ELIGIBILITY Medical Records to determine eligibility or previous year income.

The reason for the yearly application (Means Test) is that Health Benefits are based on Priority Rating 1 through 8 and/or the veteran’s household income. Some veterans qualify year-to-year based only on household income. Those veterans MUST assure to submit a yearly Means Test as early in the year as possible to prevent cancellation of appointments or retroactive billings.

Read on to learn more.

FIRST TIME REGISTRANTS

To enroll locally a veteran will need to complete a VA Form 1010-EZ Application for Health Benefits. In order to properly complete the form this office will need the veteran to provide:

  1. DD214
  2. Some form of Identification
  3. Dependent information
    1. Spouse
    2. Children
  4. Family Health Insurance Information to include:
    1. Private Insurance Policy
    2. Medical cards
    3. Medicare
  5. You will be asked to provide family household income and financial information
    1. Income (earned or other)
    2. Financial Information
      • Income
      • Savings
      • Holdings
      • Real Estate (Excluding Primary Home)

A veteran can refuse to provide financial information. Refusing to do so may delay the eligibility date for services. Typical time frames for confirmation of eligibility are between 10 to 30 days.

YEARLY RENEWALS

Veterans who are registered with this office and have been enrolled into Health Benefits, need only provide information related to changes in:

  1. Personal Status
  2. Dependent (family member) status
  3. Insurance coverage (Private or Public)
  4. Income or net worth as noted for new registrants

ARLY ELIGIBILITY ANNIVERSARY

Eligibility must by confirmed at the start of each new calendar year (January to December). This requires that a Means Test be submitted before your eligibility anniversary (the day you were initially deemed eligible). We, however, recommend that you submit your Means Test as early in the year as possible to prevent RETORACTIVE CHARGES for medical services.

RETORACTIVE CHARGES

An important aspect of receiving medical benefits or services based on income is to assure a veteran does not incur charges for these benefits or services if the veteran’s previous year’s income increased beyond the ALLOWABLE INCOME THRESHOLD. Let us explain. As an example we will use the year 2011 as the year to establish eligibility for services in 2012. In 2011 a veteran was unemployed and had no income. The veteran applied for Health Benefits (late in the year) in October of 2012 and was found eligible due to Zero (0) income. In this case his anniversary will be October 2013. During 2012, however, the veteran became employed and earned enough income that elevated the household income beyond the allowable threshold. In early 2013 the veteran attends some medical appointments, has lab work done and buys medication through the VA health system. The veteran now dutifully submits the Means Test in September 2013. The veteran then receives a letter form the VA indicating ineligibility for services at no cost or reduced rates because the 2102 income exceeded the allowable income threshold. The veteran must now pay for any co-pays or other billable amounts the veteran incurred early in the year. Remember: The current income eligibility is based on the previous calendar year income. Not from the veteran's anniversary date. In order to prevent these surprise charges it is best to provide a means test as early in the year as possible.

REMEDIES

The VA understands that, in some instances, these charges will impose a hardship on the veteran. In these cases a veteran can request to be set on a payment plan to pay back the charges or request a waiver of the charges. Each case is reviewed on its merits. The veteran must submit an explanation on a VA Form 21-4138 - Statement of The Case and complete VA Form 5655 - Financial Status Report indicating how the charges will impose a hardship.

CONTACT US FOR ASSISTANCE

Feel free to contact this office you have any questions or need assistance for any veteran related matter. We are here to assure you receive all the benefits you rightfully deserve.

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