Income verification division
Surrendered life insurance
*Cancellation of permanent whole life insurance policy. *Termination. *Early death benefits paid to policy holder. Policy paid for extended term insurance.
How to request proof of Surrendered Life insurance
*Payee should contact the insurance provider and request a letter to prove insurance policy was surrendered *Request copy of 1099-R
How many Veteran Integrated Service Networks (VISN) are there?
18
How many days from the initial letter does a veteran (HEC 200-1a) or Spouse (220-1a) have to respond
45 days
Ministers/Clergyman
Always ask for a copy of w-2 along with a complete copy of the complete 1040 tax return year in review
If you see real estate sale
Ask Vet if it was their primary residence. If yes, ask Vet to select "attest sale estate" on HEC 200-1a
Gambling winnings
Ask for 2019 win/loss statements
Stocks/Bonds if loss occurred
Ask for the sighted company or companies. Ask vet to send in year plus company name end of year consolidated 1099-B. Also ask for paid medical if loss of gains isn't enough
Gambling
Ask for win/loss statement if it brings Veteran below the means test threshold
Compromise
Assistance that is an offer and acceptance of partial payment to a veteran for satisfying a debt
Repayment Plan (aka Collection by installment)
Based on current financial situation. Results in a lesser amt of payment due from the Vet, with the total amt being paid over a 12 mnth period in equal payments.
If case status says checklist letters
Case manager needs additional information
DOR
Declaration of Representative. Form can be faxed or mailed to callers seeking to assist Veteran
EDB
Enrollment data base
Ex-POW
Ex prisoner of war
Where in EDB can you find the Veterans and Spouse Annual Earned and Unearned income
FTI details tab
FTI
Federal Tax Information
What agency is VHA's authoritative source for VA health care enrollment and eligibility activities which supports the delivery of VA health care benefits
Health Eligibility Center (HEC)
Option 3 on HEC form 702-200B states:
I disagree with the financial information provided by the IRS/SSA & disputing with supporting documentation
Employment
If you recognize duplicate income, ask veteran to provide a copy of w2 or 1099, which one is present in edb
5 letters sent to veterans
Initial, spouse, non-response, MT-RX, checklist
ICARE
Integrity, commitment, advocacy, respect, excellence
What system is referred to as a enterprise wide system that allows information from subject matter experts to be shared and leveraged in order to provide the most current and accurate information in real time
KM-knowledge management
If Vet is closed MT/RX/GMT and they or representative call
Look where they sent in documents and if it wasn't enough you can suggest additional documents be sent
If receive HEC form in WRAP set case to
Manual and Open folder
If case is closed and all 3 letters mailed and history is blank
Means Vet didnt respond and the case closed automatically
MT exempt/RX required
Medication copay only. 0% service connected (non-compensable) (for non service connection conditions only) Non-service connected veterans (income below the MT and above the pension rate)
Rona is a
Missed call
MT copay Exempt/RX exempt
No copays- Vets income is below the VA national means threshold and the maximum allowable pension rate
Priority group 8a(Non compensable 0% service connected)
Non compensable 0% service connected. Enrolled as of Jan 16, 2003 and have remained enrolled since that date and or placed in the sub due to changed eligibility status
Priority group 8c (Non service connected)
Non service connected enrolled as of Jan 16, 2003 and have remained enrolled since that date and or placed in this sub group due to changed eligibility status.
Priority group 8d (Non service connected)
Non service connected. Enrolled on or after June 15, 2009 whose income exceeds the current VA or Geographic threshold by 10% or less
Priority group 8b (Non compensable 0% service connected)
Non-compensable 0% service connected. Enrolled on or after June 16, 2009 whose income exceeds the current VA or geographic threshold by 10% or less
NOD
Notice of Disagreement
MT required/ RX copay exempt
Office copay only. Income is below the pension threshold, but income plus assets are greater than $80K. Applies for income years before 2014
MT required/RX required
Office visit copay and medication copay: 0% service connected (non compensable for non service connected conditions only) None service connected Veterans whose income is above the Means Test and VA Pension thresholds
OMIT
Over Means Test Threshold
Which priority group refers to Veterans whose gross household income is above the VA national threshold and income is below the geographical income threshold who agree to pay copays
Priority Group 7
Types of documents to ask for when an occasional sale
Proof of prior years paid property taxes on property sold settlement statement complete signed and dated 1040 tax return with all schedules, attachments (w2/1099s)
Priority group 8e
Rejected- Non compensable 0% service connected. Eligible for care of their service connected condition only
Priority group 8g
Rejected- Non service connected
Review Good year & MT due date
Review the financial tab
SC
Service Connected-disability incurred in the line of duty in active military service
When linking what order is advised
Thicks, thins, option 1's
Only Link in WRAP and EDB
Thin, Thick, Appeals, Option 1A and undeliverables
PL(Public Law) 99-272, Consolidated Omnibus Budget Reconciliation Act
This legislation also established means testing
What source of authority governs Internal Revenue Code; confidentiality & disclosure of returns & return information. This gives VA right to verify Veterans total gross income against records maintained by the IRS
Title 26 USC Section 6103 (7)(D)(Vii)
What source of authority established eligibility assessment AKA means test threshold procedures, based on income levels (Determination of Veterans inability to defray necessary expenses; income threshold)
Title 38 USC 1722
FTI review tab displays
Total gross income, discrepancy amts, means test thresholds, total dependents, veteran/spouse and earned and unearned income
A veterans "good year" can be found in EDB under the financial tab
True
Calls must be entered into WRAP during or upon the completion of a call
True
Priority group 8a and 8b are veterans who are non compensable 0% service connected
True
When a veteran receives a veterans RX letter (702-454) and disagrees with the VA's decision and would like an appeals, what form must they submit to initiate further review
VA Form 20-0995. Decision Review Request (Supplemental Claim)
Veterans who sound like they may hurt themselves should be transferred to
VCL- veterans crisis line
If case closed MT/RX
Vet HH is over the means test threshold and he didnt have enough paid medical or other documentation to bring them below threshold
If case closed GMT
Vet Household is above the Means test threshold and below the geographical threshold. May not have enough medical or other documents to bring them below threshold
If case is closed exempt
Vet doesnt pay any copays and is under the pension rate
Large distributions unacknowledged by veteran means
Vet has rolled them over
If case closed RX
Vet has sent in paid medical, 1099b or something to bring household below means test threshold
If case is closed eligibility updated
Vet is service connected
If case is closed deceased
Vet only has passed
Which income is counted in total gross household income
Veteran, Spouse, Dependent over the age of 18(w/ disability that began prior to the age of 18)
Waiver
Veterans have a right to request a waiver within 180 calendar days from the date of the VA statement. May be granted for all or a portion of the charges. Veteran must complete form VA 20-5655
Priority group 8
Veterans whos gross income is above the VA threshold and geographical adjusted income limits for their resident location and agrees to pay copays
Priority Group 7
Veterans with income above the VA national income threshold and below the geographic income threshold who agree to pay copays
When linking a case always assign to
WRAP WRAP & check the box
Closed cases
When a veteran agrees if a veteran doesnt respond after a nonresponse letter is sent If a vet responds and verifies matched income the case is closed or the vet is sent a response confirmation checklist If no response is received with in 30 days the case is closed by sending veteran the rx,mt/rx or gmt/rx copay
Income Tax Return
When asking for a return ask for complete signed/dated prepared by a professional tax accountant, have vet sign and date the tax document on the date speaking with the vet
Hardhip
applies to veterans with income exceeding the MTT. Only apply to future MT copayments. Hardship cannot apply for medication copayments
EED
eligibility and enrollment division
Four challenge questions
full name, social, dob, full address
MT/RX letters
letter is mailed when case is closed or adjudicated with the veterans total gross household income exceeding the MTT and RX copay threshold. Vet responsible for both Medical and pharmacy copays
GMT/RX Copay letterq
mailed when case is closed or adjudicated with the veterans total gross household income exceeding the MTT but is lower than the GMT. Vet responsible for 20% copay
Priority group 5
non service connected and non compensable service connected veterans rated at 0% disabled by VA and whose annual income is below the VA National threshold
To retrieve workload in WRAP
open work items assigned
Information used on the means test to determine veterans ability to defray the cost of healthcare
prior year income info, total gross household income, paid out of pocket deductions
What priority groups impact the veterans eligibility based on income
priority group 5, 7, 8 (a,b,c,d)
When answering a call
review the financial tab (edb means test) and look for a good year view to see spouse or dependents & insurance review discrepancy amts view dependents sections to make sure they were captured view means test threshold sections
When a RONA occurs
send an email with the reason for RONAs (icon spinning, could not answer, etc.) and an IT ticket number. The subject line should be RONA.
If FTI is in a file you are linking you should
send transaction number to supervisor
3 major factors used in determining an individuals eligibility for VA healthcare
service veteran, duration of service, honorable dischagre
What are the 6 departments of Dept of Veterans Affairs
veterans: benefits health cemetary board of appeals office of general counsel Office of the inspector general
