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19 wrz 2023 · Get VA Form 10-7959C, CHAMPVA Other Health Insurance (OHI) Certification. Use this VA form as part of your CHAMPVA 10-10d benefit application if you have other health insurance, or to report changes in your other health insurance, such as new beneficiaries or coverage changes.
1 lut 2017 · Download Fillable Va Form 10-7959c In Pdf - The Latest Version Applicable For 2024. Fill Out The Champva Other Health Insurance (ohi) Certification Online And Print It Out For Free.
10-7959c. CHAMPVA OTHER HEALTH INSURANCE (OHI) CERTIFICATION NOTES, DEFINITIONS, AND INSTRUCTIONS. INSTRUCTIONS. Failure to complete all applicable sections on the front can result in a delay or denial of benefits. Use this form to report any changes in your other health insurance.
Get a VA 10-7959C here. Edit Online Instantly! - VA Form 10-7959C is a form used when applying for Civilian Health and Medical Program of the Department of Veterans Affairs and have other health insurance to declare as part of your VA Form 10-10d application.
Also known as CHAMPVA Other Health Insurance (OHI) Certification, VA Form 10-7959C is a document used to certify and report health insurance coverage for beneficiaries of the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA).
person, I agree to promptly notify VA's Health Administration Center. Sign, date below and return to the address at the top of the form. SECTION I: BENEFICIARY INFORMATION - PLEASE USE A SEPARATE FORM FOR EACH FAMILY MEMBER Name of insurance # 2 SECTION IV: CERTIFICATION BY BENEFICIARY, SPONSOR OR LEGAL GUARDIAN DATE (MMDDYYYY) VA FORM SEP 2020
View, download and print fillable Va 10-7959c - Champva Other Health Insurance (ohi) Certification in PDF format online. Browse 2 Va Form 10-7959c Templates collected for any of your needs.
