VA Benefits - Eligibility

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 Uniform Benefits Package - a standard enhanced health benefits plan available to all enrolled veterans. The Law also simplified the process by which veterans can receive services.

Public Law 104-262 was enacted to simplify the rules for providing health care to veterans and to introduce improvements in the quality and timeliness of the care you receive. Like other standard health care plans, the Uniform Benefits Package emphasizes preventive and primary care, offering a full range of outpatient and inpatient services.

VA has also placed a priority on improved veteran satisfaction. Our goal is to ensure the quality of care and service you receive is consistently excellent, in every location, in every program. Under the new Uniform Benefits Package, VA offers you, the veteran, a comprehensive health care plan that provides the care you need, when you need it.

What are the Priority Groups?

Once you apply for enrollment, your application eligibility will be verified. Based on your specific eligibility status, you will be assigned a priority group.

The priority groups are as follows, ranging from 1-7 with 1 being the highest priority for enrollment. Under the Uniform Benefits Package, the same services are generally available to all enrolled veterans.

Priority Group 1

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

Priority Group 2

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

Priority Group 3

• Veterans who are former POWs

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

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

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

Priority Group 4

• Veterans who are receiving aid and attendance or housebound benefits

• Veterans who have been determined by VA to be Catastrophically Disabled (Individuals who have a severely disabling injury, disorder, or disease which permanently compromises their ability to carry out the activities of daily living to such a degree that they require personal or mechanical assistance to leave home or bed or require constant supervision to avoid physical harm to self or others.)

Priority Group 5

Nonservice-connected Nonservice-Connected (An eligible veteran who has been discharged from active military duty and does not have an illness or injury incurred in or aggravated during military service.) veterans and service-connected veterans rated 0% disabled whose annual income and net worth are below the established dollar threshold

Priority Group 6

All other eligible veterans who are not required to make Co-payment (A specific dollar amount of a covered health service expense for which a veteran is responsible to pay.) for their care, including:

• World War I and Mexican Border War veterans

• Veterans receiving care solely for disabilities resulting from exposure to toxic substances, radiation or for disorders associated with service in the Gulf War; or for any illness associated with service in combat in a war after the Gulf War or during a period of hostility after November 11, 1998

• Compensable (A veteran who has been rated by VA as being service-connected and who receives monetary benefit.) 0% service-connected veterans

Priority Group 7

Nonservice-connected veterans and Compensable (A veteran who has been rated by VA as being service-connected and who receives monetary benefit.) 0% service-connected veterans whose needed care cannot be provided by enrolling in any of the groups above and who agree to pay specified co-payment.

Uniform Benefits Package

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