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19 wrz 2023 · If you’re the spouse or child of a Veteran with disabilities, or the surviving spouse or child of a Veteran who has died, use VA Form 10-10d to apply for health insurance through CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs).
- VHA 10-7959c
10-7959c. CHAMPVA OTHER HEALTH INSURANCE (OHI) CERTIFICATION...
- CHAMPVA Benefits
To apply, submit these required documents: Application for...
- VHA 10-7959c
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.
To apply, submit these required documents: Application for CHAMPVA Benefits (VA Form 10-10d), and. Other Health Insurance Certification (VA Form 10-7959c), and. Documents related to your Medicare status: If you qualify for Medicare for any reason, you’ll need to submit a copy of your Medicare card.
This form is also used to report any changes in your other health insurance status. Updates can be sent by FAX or call by phone. PLEASE READ INSTRUCTIONS AND INFORMATION ON THE REVERSE SIDE BEFORE COMPLETING THIS FORM. SECTION I: BENEFICIARY INFORMATION - PLEASE USE A SEPARATE FORM FOR EACH FAMILY MEMBER.
You need to submit both an Application for CHAMPVA Benefits (VA Form 10-10d), and VA Form 10-7959c, and your Medicare card. For those who don’t qualify for Medicare, you have to prove that you don’t qualify under anyone’s SSN by providing the appropriate documents from the SSA.
Other Health Insurance (OHI) Certification, VA Form 10-7959c (Certificacion CHAMPVA de Otros Seguros de Salud (OSS), Forma VA 10 7959c) For individuals who are eligible for Medicare for any reason, we need a copy of your Medicare card.
The latest form for CHAMPVA Benefits - Application, Claim, Other Health Insurance, Potential Liability & Misc Expenses expires 2021-03-31 and can be found here. Office of Management and Budget control number searchable database.
