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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.
- 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
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.
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.
Please notify the VHA Office of Community Care (VHA OCC) of any changes in your health insurance coverage by submitting VA Form 10-7959c, CHAMPVA Other Health Insurance (OHI) Certification. Q5. How do I find a pharmacy that accepts CHAMPVA?
