Get U.s. Deopartment Of Veterans Affairs Document: Vha-10-7959c-form ...

Filling out the U.S. Department of Veterans Affairs Document Vha-10-7959c-form online can streamline the process of certifying other health insurance for CHAMPVA beneficiaries. This guide provides step-by-step instructions to help users complete the form accurately and confidently.

Follow the steps to complete the form online.

1. Press the ‘Get Form’ button to download the Vha-10-7959c-form and open it in your preferred editor.
2. Begin by filling out Section I, which requires beneficiary information. Start with the sponsor's spouse and include all CHAMPVA-eligible family members. Provide their last name, first name, middle initial, social security number, and other health insurance (OHI) details if applicable.
3. For each family member listed, specify whether they have had OHI since becoming CHAMPVA eligible. If they do, fill out the OHI policy name, policy number, coverage dates, and contact number.
4. If applicable, continue to add information for other eligible family members in the same manner. If you run out of space, use an additional sheet to provide complete details.
5. Once all necessary information in Section I is complete, proceed to Section II. Here, confirm if any individuals listed are covered by Medicare. If yes, provide their Medicare start dates and card numbers.
6. In Section III, the beneficiary, sponsor, or legal guardian must certify the accuracy of the information provided. Sign and date the section, and include contact details and relationship to the beneficiaries.
7. After ensuring all fields are filled correctly, save any changes made to the form. You can then download, print, or share your completed Vha-10-7959c-form as necessary.

Complete the Vha-10-7959c-form online today to ensure timely submission and processing of your benefits.