CurrentUnitedHealthcarePolicy BIP189.O

Veteran's Administration (VA)

Defines UnitedHealthcare coverage rules for members who are VA-eligible (veterans, retired military, eligible dependents), specifying covered emergency/urgent services at VA facilities, skilled nursing facility (SNF) interactions, and exclusions for service-connected care and self-directed non-emergent VA services.

Policy Summary

PayerUnitedHealthcare

PolicyVeteran's Administration (VA)

Policy CodePolicy BIP189.O

Change TypeRoutine reviewno material changes

Effective DateFeb 1, 2026

Next Review DateN/A

Key ActionWhen a member treated at a VA facility is stable for transfer, transfer them to a contracted UnitedHealthcare facility.

SourceLink

POLICY UPDATE CHANGES

Routine review; no change to coverage guidelines.

Emergency & urgent care coveredVA facility emergency/urgent services considered out-of-network but covered per member benefits

SNF continuation allowedContinued SNF care covered when VA SNF benefit exhausted and UnitedHealthcare criteria met

Service-connected excludedCoverage excludes service-related (service-connected) services

VA-eligible membersPopulation governed by this policy

38 USC 1729

Policy Summary

PayerUnitedHealthcare

PolicyVeteran's Administration (VA)

Policy CodePolicy BIP189.O

Change TypeRoutine reviewno material changes

Effective DateFeb 1, 2026

Next Review DateN/A

Key ActionWhen a member treated at a VA facility is stable for transfer, transfer them to a contracted UnitedHealthcare facility.

SourceLink

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Coverage Criteria and Exclusions

Coverage criteria and exclusions for VA facility services

Coverage is determined by type of service, member eligibility, and authorization status; consult the member's Evidence of Coverage (EOC)/Schedule of Benefits (SOB) for plan-specific provisions and to resolve any discrepancies.

Member is VA-eligible (veteran, retired military personnel, or eligible dependent).

Emergency and urgent out-of-area care

Service is emergency or out-of-area urgent care provided by a VA facility.
Service is provided in accordance with the member's emergency services benefits.
When the member is stable for transfer, the member must be transferred to a contracted UnitedHealthcare facility for continued care.

Skilled Nursing Facility (SNF) continuation

Member has exhausted VA-authorized/paid VA SNF benefit days.
Criteria for SNF care are met and a skilled level determination is made by the member's network medical group or UnitedHealthcare.
Care is directed, furnished, and authorized by the member's PCP, network medical group, or UnitedHealthcare.

Exclusions (not covered)

Service-related (service-connected) services (examples include but are not limited to military service-related PTSD treatment, Gulf War syndrome, Agent Orange treatments).
Non-emergency, in-area urgent, or routine services obtained at a VA facility that are not authorized and directed by the member's network medical group or UnitedHealthcare (includes self-directed outpatient labs/x-rays).
Post-stabilization emergency services when the member could have been safely transferred to the member's network medical group hospital had the network medical group or UnitedHealthcare been contacted.

If this policy conflicts with the member's EOC/SOB, the EOC/SOB governs.

Billing and Coding Notes

No specific billing/coding codes specifiedmixed

No codes listed

inv-03: Transfer when stable

Transfer requirementWhen the member is stable for transfer, the member must be transferred to a contracted UnitedHealthcare facility for continued care

Applies toEmergency and out-of-area urgent care provided by a VA facility considered out-of-network

Governing noteRefer to the Benefit Interpretation Policy titled Emergency and Urgent Services

Authorization and Transfer Requirements

Prior Authorization

Authorize emergency/urgent VA care as out-of-network and transfer when stable

UnitedHealthcare will cover emergency and out-of-area urgent care provided by a VA facility in accordance with the member's emergency services benefits, but these services are considered out-of-network. When the member is stable for transfer, the member must be transferred to a contracted UnitedHealthcare facility for continued care.

Emergency and out-of-area urgent care at VA facilities is covered per the member's emergency services benefits but treated as out-of-network.
When stable for transfer, transfer the member to a contracted UnitedHealthcare facility for continued care.

Key Definitions

inv-05: Members who are veterans, retired military personnel, and eligible dependents

DefinitionMembers who are veterans, retired military personnel, and eligible dependents (VA-eligible members)

ScopePolicy applies to coverage determinations for VA-eligible members for emergency, urgent, and SNF services

Benefit interactionEach benefit plan's Evidence of Coverage/Schedule of Benefits (EOC/SOB) governs if discrepant

inv-06: Emergency and urgent care provided by a VA facility

Coverage stanceUnitedHealthcare will cover emergency and out-of-area urgent care provided by a VA facility in accordance with the member's emergency services benefits; such services are considered out-of-network

Post-stabilizationWhen stable for transfer, member must be transferred to a contracted UnitedHealthcare facility