Defense Health Care

DOD's Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) pays for a substantial portion of the health care that civilian hospitals, physicians, and other providers give to DOD beneficiaries. This report compares the benefits for mental and substance abuse treatment available under CHAMPUS with similar benefits under private-sector plans and under the Federal Employees Health Benefits Program.

GAO found that: (1) CHAMPUS benefits and cost-sharing requirements for mental health and substance abuse are more generous than those offered to private-sector and federal employees; (2) while the CHAMPUS acute care inpatient limit of 30 days a year for adults is comparable with the limits under private-sector plans and the federal employees program, the 45-day limit for children is higher than that under most other plans; (3) CHAMPUS allows the day limits to be raised, which is virtually unprecedented; (4) CHAMPUS allows more than twice the number of outpatient visits than most other plans, and requires beneficiaries to pay only half of what most other plans require; (5) CHAMPUS provides outpatient substance abuse, which is unavailable to 40 percent of employees in the private sector and in 3 of the 12 federal employee plans; (6) although families of active-duty personnel pay only a nominal fee for inpatient care under the CHAMPUS program, retirees and their families pay significantly more; (7) the CHAMPUS catastrophic limit for families of active-duty personnel is significantly lower than that under other plans, particularly the federal employees program, which requires separate and higher limits for mental health care; and (8) unlike most other plans, CHAMPUS has no lifetime dollar limits on mental health and substance abuse care.