The short answer
CHAMPVA covers well-child care from birth through age 6 with no deductible and no cost share. That includes the newborn exam and screening, circumcision, regular checkups, vaccines, vision, hearing, and dental screenings, developmental checks, lead and anemia tests, and more. Your baby needs their own CHAMPVA enrollment first. After 6, other preventive rules apply.
What's included?
38 CFR 17.272(a)(30)(i) lists:
- newborn exam,
- hereditary and metabolic screening,
- newborn circumcision,
- history and physical at regular checkups,
- vision, hearing, and dental screening,
- developmental checks, including height and weight,
- vaccines recommended by the CDC,
- lead testing,
- tuberculosis screening,
- blood pressure screening,
- anemia testing, and
- urinalysis.
The CHAMPVA Guidebook adds behavioral and developmental assessments that follow American Academy of Pediatrics guidance.
The regulation says these are covered when given by the child's pediatrician, family physician, or pediatric nurse practitioner as part of well-child care.
What does it cost?
Nothing. 38 CFR 17.274 waives both the deductible and the cost share for well-child care through age 6, and separately for vaccines at any age.
Does my newborn need to be enrolled?
Yes. VA's CHAMPVA page says it can't pay a newborn's claims until the baby is enrolled. As soon as you can:
- Get the baby a Social Security number.
- Add the baby as the Veteran's dependent with VA.
- Apply for CHAMPVA for the baby.
The Guidebook treats the first 30 days as the newborn period and says mother and baby claims are billed separately. More here: How to add a new dependent.
What if a screening finds something?
Follow-up care is covered when it's medically necessary, but it follows the regular CHAMPVA rules for that service. It isn't part of the free well-child visit.
Screenings don't make treatment free either. A dental screening doesn't create dental coverage, and a vision screening doesn't cover glasses. More here: CHAMPVA dental care and CHAMPVA vision coverage.
What happens after age 6?
The well-child category ends, but the regulation still covers:
- vaccines,
- yearly physicals, and
- school-required physicals through age 17.
More here: CHAMPVA preventive care.
Before a checkup
- Make sure your child is enrolled.
- Tell the office it's a well-child visit.
- Ask which screenings and vaccines are planned.
- Keep the EOB.
You were charged for a well-child visit
Check the EOB to see what was processed: the checkup, a vaccine, a screening, or a separate sick visit. A sick visit at the same appointment can have a cost. If a well-child service was charged, ask the office about the coding, then call CHAMPVA at 800-733-8387.