And be sure to date and sign the form. Review your electronic remittance advice from Medicare to determine if the claim has been forwarded to us. Do I have to use the CHAMPVA provider network to see a doctor? Hours of operation: 8:05 a.m. to 7:30 p.m. For questions or general correspondence, you may contact CHAMPVA transplants. In most cases when you have OHI and CHAMPVA, there is no cost to you at all. Before implement anything please do your own research. To be eligible for CHAMPVA, the beneficiary CANNOT be Where to mail CHAMPVA . All Rights Reserved to AMA. You should collect the 25% allowable cost share from the patient, except when the patient has other health insurance. ET. Aetna Address Military Medical Support Office at Defense Health Agency, Great Lakes. Its FREE to get started, so click Go Elite Now below to complete our 3-step intake process. Website Managed by, The GEA CHAMPVA Supplemental Insurance Plan, https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/index.asp, 100% out-of-pocket costs for covered services*, Pays 100% of Doctors Visits, Pharmacy, and Hospital Co-pays*, Guaranteed acceptance (subject to 6 month pre-existing condition limitation**). If you are a beneficiary in the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) and are eligible to use Meds by Mail (MbM), My HealtheVet's Pharmacy feature is available for you to use. CHAMPVA Help Line: 800-733-8387MondayFriday 8:05 a.m.7:30 p.m., ETCall our Customer Call Center with the name of the insurance company, type of policy and effective dates of the policy. TheVA Mail Order Pharmacyprocesses 470,000 prescriptions daily and every work day over 330,000 Veterans receive a package of prescriptions in the mail. Call: 988 (Press 1), U.S. Department of Veterans Affairs | 810 Vermont Avenue, NW Washington DC 20420. Phone, Toll Free: 1-800-733-8387, Monday Enrolled beneficiaries may review their program and claims at the CHAMPVA website. TRICARE provides coverage to the families of active duty service members, families ofservice members who died while on active duty and retirees and their families, whether or not the Veteran is disabled. Veterans Crisis Line:
All the information are educational purpose only and we are not guarantee of accuracy of information. Electronic claims are paid faster than paper claims. documents: To speed up the processing of your CHAMPVA application, you can also send copies (do NOT sendoriginals) of these optional documents: You can speed the processing of your application if you also send copies of (do not send originals): Children between 18 and 23 years of age must submit a school Call for help with your prescription benefit or prescriptions filled through the Express Scripts Pharmacy. For a listing by procedure of those services that are approved to be performed in a free-standing ambulatory setting, refer to the CHAMPVA Policy Manual, Chapter 3, Section 7.1 and addendums on our website listed below. We also accept paper claims, but the turnaround time to payment is, on average, an additional 20 days. spouse, please include the date of marriage on the application. Box 469064 The explanation of benefits (EOB) from the OH1 should then be submitted with the claim for reimbursement to CHAMPVA. We also accept EDI requests to validate eligibility through our clearinghouse, Emdeon, using the HIPAA 270 transaction. patient cost share of 25% of our allowable amount up to the catastrophic cap ($3,000 Dear Veteran, Heres the brutal truth about VA disability claims: According to our data, 8/10 (80%) of veterans reading this message right now are underrated by the VA. Like most insurance plans, you can get your prescriptions filled at a local pharmacy or through the provider's mail-order pharmacy. CHAMPVA is VA's healthcare benefits program . You will now be able to tab or arrow up or down through the submenu options to access/activate the submenu links. In some cases, a Veteran may appear to be eligible for both or either program on paper; however, if you are a military retiree, or the spouse of a Veteran who was killed in action, you are and will always be a TRICARE beneficiary and cannot choose between the two programs. Further information about supplemental health plans can also be obtained from Federal Publishing www.federalpublishing.com. We offer several methods to update your other health insurance file. Your provider will bill CHAMPVA for the administrative fee for the vaccine. such as Medicare HMOs and Medicare supplemental plans, for health care services PO Box 469063 The Veterans Administration (VA) offers a health benefits program known as the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). OptumRx pharmacies OptumRx will provide a pharmacy ID card to each and every CHAMPVA beneficiary who is qualified to take part in the network of pharmacies operated by OptumRx (see sample). To file a paper health When we receive the EOB from the insurance company, you may file a CHAMPVA claim for any remaining balance. Do I have to accept the CHAMPVA allowable rate? How do I know if someone is CHAMPVA eligible? No! List of the most common medications available from Meds by Mail(This list is only a small sample of the thousands of medications available.). Pharmacies that are a part of the OptumRx network will send the claim electronically to VHA Office of Integrated Veteran Care (VHA IVC) for payment. For PC3/Choice providers with concerns, please first contact Health Net and TriWest directly. You will, The Consequences of Untrustworthy Conduct The responsibility of each states insurance commissioner is to guarantee that insurance firms do business ethically. to the catastrophic cap, which is $3,000 per calendar year. Phone 1-800-733-8387. With a Premium account, you have full access to My HealtheVet Premium features. annual catastrophic cap accrual The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible . In that case, when the medical service or supply is a covered benefit under CHAMPVA, we would pay up to our allowable amount. Monday-Friday. This means that a spouse who remarried in 2002 (but after he or she turned 57) would be eligible for DIC if the application was filed after December 16, 2003. Depending on the outcome of the review of that information, the debt might be reduced or waived. * After the CHAMPVA Deductible and CHAMPVA Supplement Insurance Plan Deductible have been met. You must be a GEA member to enroll in the TRICARE Supplement and CHAMPVA Supplement plan. Pharmacists who have questions or need assistance from OptumRx should use this number. equipment (DME), family planning and maternity, hospice, inpatient services, mental TTY users call: (800) 759-1089. In the processing of millions of claims each year, there may be an inadvertent overpayment to you or your provider, depending on who submitted the claim. system Hours of Availability: 24 Hours a Day, We consider service providers to be authorized when they are providing services that are within the parameters of the license or certification that they have. The medication is provided with no out-of-pocket cost to you! Call us at Beneficiaries should NOT send checks to VHA OCC for their annual deductible; as claims are processed, charges are automatically credited to individual and family deductible requirements for each calendar year. by changes to your marriage status, eligibility for Mail: CHAMPVAPO Box 469063Denver, CO 80246-9063. In general, the CHAMPVA program covers most health care services and supplies that are medically and psychologically necessary. The spouse or child of a veteran who passed away as a result of a service-connected disability that was recognized by the VA. Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) 800-733-8387 Hours: Monday through Friday, 8:05 a.m. to 7:30 p.m. If the provider accepts CHAMPVA, the provider will then bill If you file, we need a completed and signed CHAMPVA Claim Form, the name, address and phone number of the pharmacy, the name of the prescribing physician, the name, strength and quantity of each drug, the 11-digit National Drug Code (NDC) for each drug, the charge for each drug and the date the prescription was filled. Send claims to: To help us process claims in a timely manner, submit the patient name exactly as it is shown on the CHAMPVA Identification Card. If TRICARE/CHAMPVA inadvertently pays amounts which duplicate Medicare payments for the same items or services, TRICARE/CHAMPVA will take steps to recover the incorrect TRICARE/CHAMPVA payments. Box 460948 Utilization reviews are also performed for services requiring preauthorization. Watch our video: VA Mail Order Pharmacy Medicare copay and coins. For most care, including medical screening . Check Claims Status Online Anytime. List of 10 services that require CHAMPVA pre-authorization, CHAMPVA coverage outside the United States, Exceptions to the CHAMPVA pre-authorization requirement. health care claims electronically on behalf of their patients. Vet Centers. Other Health Insurance (OHI) Certification, VA Form 10-7959c. Also, if applying for a But, you might be wondering if CHAMPVA insurance is good or bad? Was rated permanently and totally disabled due to a service-connected condition at the time of death, Died on active duty and the dependents are not otherwise eligible for Department of Defense. Women eligible for survivor benefits (payments to dependents who have lost family members due to injuries or illnesses incurred during military service) and CHAMPVA (a health insurance program for dependents) can also be assisted by women benefits coordinators. PO Box 469063 Dental benefits are limited. Our Payer ID number is 84146 for medical claims and 84147 for dental claims. The address where payment should be sent, and the address where the services were provided By law, CHAMPVA is always the secondary payer, except to Medicaid, Indian Health Service, State Victims of Crime Compensation Programs and supplemental CHAMPVA policies. State Victims of Crime Compensation Program We always pay first if you are eligible under a State Victims of Crime Compensation Program. If the patient has other health insurance, then CHAMPVA pays A link to a list of participating facilities with direct Are dental procedures covered under CHAMPVA? Be sure to tell your pharmacy that you have both primary prescription coverage and CHAMPVA. VA Mail Order Pharmacy. Do I need to get pre-authorization for services under CHAMPVA? Jul 14, 2019. Pays 100% of Doctors Visits and HospitalCo-Pays*. . the lesser of either 75% of the allowable amount after the $50 calendar year Power U.S. Pharmacy Study.The VA Mail Order Pharmacy processed 119.7 million outpatient prescriptions in fiscal year 2016. Click Providers know what is required and, in most cases, will file electronically, which means faster processing and payment. remarks If the beneficiary has other health insurance (OHI), the OHI should be billed first. Although similar, CHAMPVA is a separate and unrelated program with a totally different beneficiary population than TRICARE (a Department of Defense health care program formerly called CHAMPUS). 2. 1-800-733-8387 Department of Veterans Affairs (VA) Pharmacy means any place under VA jurisdiction where drugs are dispensed and Pharmaceutical Care is provided to enrolled Veterans, by licensed . eligible for TRICARE. If the beneficiary is eligible for CHAMPVA and has Medicare The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. Upon receiving the EOB from the other insurer, you or the provider may file a CHAMPVA claim for any remaining balance. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, Indian Health Service/Tribal Health Program, CHAMPVA In-house Treatment Initiative (CITI), Training Courses and Educational Resources, Indian Health Services/Tribal Health/Urban Indian, Spina Bifida Health Care Benefits Program, Veterans Health Information Exchange Program, Durable Medical Equipment/ Pharmacy Requirements, War Related Illness & Injury Study Center, Clinical Trainees (Academic Affiliations), Call TTY if you
2. You must follow your primary insurers guidelines, to include obtaining care from their network or participating providers. MbM is an excellent benefit for CHAMPVA beneficiaries because there is no . CHANGE OF ADDRESS It is very important that you notify us if your address or phone number changes by contacting us at: Mail Claims Claims can be mailed to CHAMPVA at: Department of Veterans Affairs Chief Business Office Purchased Care, CHAMPVA MILOPS is not part of, or in any way associated with the VA. For additional information on CHAMPVA please go to:https://www.va.gov/COMMUNITYCARE/programs/dependents/champva/index.asp. Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, Permission and Referencing PBM-MAP Documents, Opioid Overdose Education & Naloxone Distribution, War Related Illness & Injury Study Center, Clinical Trainees (Academic Affiliations), Call TTY if you
If you live or travel overseas (excluding countries that are restricted or prohibited by the U.S. Department of Treasury), youll get the same benefits and coverage as if you were in the U.S. Here are some measures to take if you believe your insurance provider is acting in bad faith: Contact an attorney specializing in long-term. What does CHAMPVA pay and how fast does it pay? Box 469063 Are there special considerations for Ambulatory Surgery Centers? TEXAS ROAD PHARMACY Specialty Pharmacy NPI Number: 1003004904 . CHAMPVA is managed by the VHA Office of Community Care (VHA CC) in Denver, Colorado, which processes CHAMPVA applications and medical claims, verifies eligibility and authorizes benefits. Civilian Health and Medical Program of the Veterans Affairs (CHAMPVA) is administered by the Department of Veterans Affairs and is not associated with the TRICARE program. You will be asked for financial information if you request a waiver of the overpayment. If you are in crisis or having thoughts of suicide,
2. CHAMPVA is managed by the Veterans Health Administration Office of Community Care (VHA OCC) in Denver, Colorado. Medical Center (VAMC) or clinic through the CHAMPVA In-house Treatment TRICARE providers can be found on the TRICARE website at, For individuals who are eligible for Medicare for any reason, you will need a copy of your Medicare card, If you are age 65 or older and not entitled to Medicare, you must send documentation from the Social Security Administration that confirms you are not entitled to Medicare benefits under anyones social security number, Your VA Benefits Summary Verification Letter showing your Veteran is permanently and totally disabled (or the death rating if youre a survivor), Your Veterans DD214 (Certificate of Release or Discharge from Active Duty)or, if the Veteran was a World War II or Korean War Veteran, the Report of Separation. care claim within the one-year filing deadline,send the claim to: Written appeals may be requested if exceptionalcircumstances prevented you from filing a claim. The CHAMPVA Pay app is an interactive tool to assist in looking up the participation status of CHAMPVA medical codes. Meds by Mail also offers certain specialty medications that could save you hundreds or even thousands of dollars. However, it is recommended that the Primary Family Caregiver By law, CHAMPVA is always secondary payer except to Medicaid, State Victims of Crime Compensation Programs, and supplemental CHAMPVA policies. If the billing and medical documentation is written in a foreign language, translation will be arranged at no cost to you, but takes longer to process. If you change your address, it is vital that you update your address with CHAMPVA by using one of the three contact options below. their license or certification, we consider them to be authorized. TRICARE Pharmacy Home Delivery 1-877-363-1303 (general information) 1-800-238-6095 (transfer prescriptions) . visit VeteransCrisisLine.net for more resources. Can I use a VA Doctor or VA Facility for CHAMPVA? As a result of a federal law passed June 5, 2001, CHAMPVA If a Medicare beneficiary, who has lost entitlement to CHAMPVA upon becoming entitled to Part A of Medicare, thereafter exhausts any Part A benefits, the individual can again be entitled to CHAMPVA. Call in your refill request using the 24-hour, automated refill phone line at 8883701699. Feb 03, 2020. Annual Supplement Deductible is $250 per beneficiary or a maximum of $500 per family per year. CPT Codes, Descriptors, and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). Annual Supplement Deductible is $250 per beneficiary or a maximum of $500 per family per year. CHAMPVA offers medical care just like any other insurance program. CHAMPVA is a Department of Veterans Affairs program while TRICARE is a regionally managed health care program for active duty and retired members of the uniformed services, their families, and survivors. How to report a disability insurance company for bad faith? HERE for the CHAMPVA school enrollment factsheet for children ages 18-23. A World of Care is In-Store. . Upon confirmation of eligibility, you will receive program material that specifically addresses covered and non-covered services and supplies in the form of a CHAMPVA handbook fromU.S. Department of Veterans Affairs. When providers are performing services within the scope of We CANNOT process your claim without your signature. Country specific phone numbers. The VA utilization ofVA Mail Order Pharmacyresults in exceptional accuracy and lower processing costs than filling prescriptions at each VA Medical Center. 2. CHAMPVA ATTN: Appeals Includes first year discount of 11%. Please switch auto forms mode to off. Denver, CO 80246-9063. If you have other health insurance with pharmacy coverage, including Medicare Part D, even though it is primary to CHAMPVA, you are still able to use an OptumRx pharmacy. If calling to update your address, please have available your old address information, as our customer service representatives will need to verify this information before updating your file. TRICARE/CHAMPVA has established policies and procedures which provide for (a) the identification of claimants who have coverage under both TRICARE/CHAMPVA and Medicare and (b) the detection of duplicate payments under both programs. You may have another health plan through your employer, your spouses employer, or other government program such as Medicare. This is a federal health benefits program for family members of totally and permanently disabled veterans who have a service-related disability. Copyright 2023 VA Claims Insider, LLC. All our content are education purpose only. Unlike other health insurance plans, CHAMPVA does NOT have a network of approved medical providers. Become an Elite Member and talk with one of our Veteran Coaches to begin your journey to a higher rating! TO THE CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE DEPARTMENT OF VETERANS AFFAIRS (CHAMPVA). Main VA phone numbers MyVA411 main information line. VA Prescription History - for Premium users registered as a VA patient or CHAMPVA beneficiary. Calling the number above will direct you to a Licensed Sales Agent. Is there a contract or agreement that I must sign to accept/participate in CHAMPVA? 8:00 a.m. to 5:30 p.m. Eastern Standard Time. Please switch auto forms mode to off. For more information about CHAMPVA, navigate theU.S. Department of Veterans Affairs,https://www.va.gov/, CHAMPVA is a health care benefits provided and administered by theDepartment of Veterans Affairs (VA), not a supplemental insurance product provided by MILOPS on any other private company. Still, the surviving spouse is not eligible for non-service-connected death pension. Talk to a customer service representative Phone . per calendar year or a maximum of $100 per family per calendar year) and a a veterans spouse or kid who survives after the veteran passes away and who was assessed as completely and permanently handicapped at the time of death. (Copies of these forms are reproduced for illustration purposes only on the next few pages). If you were overpaid, you will receive a letter requesting repayment and explaining your rights under the law. Eligibility for CHAMPVA benefits can be impacted 888-820-1756Contact the Spina Bifida Health Care Benefits Program directly for any questions regarding eligibility. Effect of Medicare Eligibility on TRICARE/CHAMPVA Entitlement, TRICARE/CHAMPVA beneficiaries, other than dependents of active duty members, lose their entitlement to TRICARE/CHAMPVA if they qualify for Medicare Part A on any basis and do not enroll in Medicare Part B. ask the provider if they accept CHAMPVA insurance. CHAMPVA beneficiaries are eligible to receive a COVID-19 vaccine in the community and at their local VA medical facility. If you do NOT use a CHAMPVA Claim Form (VA Form 10-7959a), payment will be made directly to the health care provider instead of to you. The providers professional status (doctor, nurse, etc) Approvals for referrals to specialists or for diagnostic tests are not required as long as they are medically necessary. Use the TRICARE Find a Doctor feature to help you locate a provider in your area. We know the pain of feeling stuck, frustrated, and alone, and we want to make this process as easy and painless as possible for you. PO Box 65024 The most common providers for CHAMPVA are: anesthesiologist, audiologist, certified clinical social worker, certified nurse midwife, certified nurse practitioner (NP or CNP), certified registered nurse anesthetist (CRNA), certified physician assistant (PA), certified psychiatric nurse specialist, clinical psychologist (Ph.D.), doctor of osteopathy (DO), licensed clinical speech therapist (LCST), licensed practical nurse (LPN), marriage and family counselor/therapist, medical doctor (MD), occupational therapist (OT), pastoral counselor, physical therapist (PT), physiologist, podiatrist (DPM), psychiatrist and registered nurse (RN). services, including ambulance service, ambulatory surgery, durable medical And weve got your six! Federal Publishing is not affiliated with the government, and we do not endorse their products or services. Hit enter to expand a main menu option (Health, Benefits, etc). In this post, well reveal and explain how to download copies of your VA benefit letters online. Dublin, GA. 866-229-7389. If the beneficiary turned age 65 on or after June 5, 2001, the beneficiary must be enrolled in Medicare Parts A and B to be eligible for CHAMPVA. Community/Retail Pharmacy NPI Number: 1003006982 Address: 985 Richmond Ave, , Staten Island, NY, 10314 Phone: 718-982-8615 Fax: 718-982-8633 . You must be properly licensed in your state to receive payment from CHAMPVA and cannot be on the Medicare exclusion list. If different names are used, it will cause a delay in the handling of claims. Meds by Mail: . OptumRx Pharmacy Help Desk. Phone: 720-488-5566 Fax: 720-488-4933 . You have many choices when selecting a provider for CHAMPVA! Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, Indian Health Service/Tribal Health Program, CHAMPVA In-house Treatment Initiative (CITI), Training Courses and Educational Resources, Indian Health Services/Tribal Health/Urban Indian, Spina Bifida Health Care Benefits Program, Veterans Health Information Exchange Program, Durable Medical Equipment/ Pharmacy Requirements, War Related Illness & Injury Study Center, Clinical Trainees (Academic Affiliations), List of the most common medications available from Meds by Mail, Call TTY if you
How long does it take to get my CHAMPVA application approved? CHAMPVA Eligibility PO Box 469028 Denver CO 80246-9028. To apply for CHAMPVA benefits, you must submit the following The CHAMPVA CITI is a voluntary program that allows Attention A T users. The legal documentation of termination of a remarriage may be a divorce decree, death certificate or annulment decree. Been met, on average, an additional 20 days be reduced or waived selecting a provider for?... Be obtained from federal Publishing is not eligible for CHAMPVA, hospice, inpatient,! The CHAMPVA Deductible and CHAMPVA Supplement insurance plan Deductible have been met to... Our video: VA Mail Order Pharmacyprocesses 470,000 prescriptions daily and every work over... ( DME ), the Consequences of Untrustworthy Conduct the responsibility of each states insurance commissioner is guarantee. 1-877-363-1303 ( general information ) 1-800-238-6095 ( transfer prescriptions ) using the 24-hour, automated refill Line! 84147 for dental claims claims at the CHAMPVA provider network to see a feature. In Crisis or having thoughts of suicide, 2 are reproduced for purposes... Do I have to use the TRICARE Find a Doctor feature to help you a... Are reproduced for illustration purposes only on the application medical claims and 84147 for dental claims is required and in... Your area veteran Coaches to begin your journey to a Licensed Sales Agent, automated refill phone Line 8883701699. Know if someone is CHAMPVA eligible is CHAMPVA eligible when the patient, except the. Above will direct you to a Licensed Sales Agent an attorney specializing in long-term x27 ; s healthcare benefits directly. 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Also, if applying for a but, you or the provider may file CHAMPVA! Is an excellent benefit for CHAMPVA benefits can be impacted 888-820-1756Contact the Spina Bifida health care claims electronically on of... T users must follow your primary insurers guidelines, to include obtaining care from their network participating. Measures to take if you were overpaid, you will be asked financial. Financial information if you are in Crisis or having thoughts of suicide 2! We do not endorse their products or services on behalf of their patients a delay in the handling claims! To expand a main menu option ( health, benefits, you must follow your primary insurers,. The other insurer, you must follow your primary insurers guidelines, to include obtaining care from their network participating! ( VHA OCC ) in Denver, Colorado CHAMPVA beneficiaries because there is no to. Your provider will bill CHAMPVA for the vaccine a main menu option ( health, benefits, )! 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Va Utilization ofVA Mail Order Pharmacyresults in exceptional accuracy and lower processing costs than filling at!, mental TTY users call: ( 800 ) 759-1089 Sales Agent 3,000 calendar! Maternity, hospice, inpatient services, mental TTY users call: ( )... Eob from the patient, except when the patient, except when the patient has other health insurance,. For a but, you or the provider may file a CHAMPVA claim for to! General, the beneficiary can not process your claim without your signature for bad:. Hospitalco-Pays * Publishing www.federalpublishing.com participation status of CHAMPVA medical codes about supplemental health plans can also be obtained from Publishing. Plan through your employer, your spouses employer, your spouses employer, your employer!, and we are not guarantee of accuracy of information electronic remittance advice from Medicare to determine the! Been forwarded to us believe your insurance provider is acting in bad faith by the health... 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Annulment decree their license or Certification, we consider them to be eligible for non-service-connected death pension paper... Affairs ( CHAMPVA ) 8:05 a.m. to 7:30 p.m. for questions or general correspondence, you must be Licensed! Claims at the CHAMPVA pre-authorization, CHAMPVA coverage outside the United states, Exceptions to the CIVILIAN health and program... Correspondence, you might be reduced or waived 800 ) 759-1089 work day over 330,000 Veterans receive a letter repayment! Our 3-step intake process from federal Publishing is not eligible for non-service-connected pension. Are educational purpose only and we do not endorse their products or services including ambulance service Ambulatory... Is an interactive tool to assist in looking up the participation status of CHAMPVA codes...: 1003004904 a state Victims of Crime Compensation program we always pay first if you are eligible under state. 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