Why is CHAMPVA the secondary payer when beneficiaries have other health insurance (OHI)?
• Fact Sheet – CHAMPVA-OHI (01-23) To answer this question, a look at CHAMPVA’s origin and the congressional intent behind its legislation may help. From the start, CHAMPVA was intended to serve as a safety net in the event other coverage was not available – rather than being the primary carrier. While families with OHI are not disqualified from CHAMPVA benefits, CHAMPVA’s safety net protection becomes available after the OHI has paid. This includes benefits available from the enrollment in a health maintenance organization (HMO), preferred provider organization (PPO), Medicare or other health insurance. Exceptions to CHAMPVA’s secondary payer status are supplemental CHAMPVA policies, Medicaid, and State Victims Compensation Programs – CHAMPVA becomes the primary payer in these cases.
