Loading
Get Va 10-7959c 2008
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the VA 10-7959c online
The VA 10-7959c form is essential for veterans to report and certify their other health insurance information. This guide provides clear, step-by-step instructions to assist you in completing the form accurately and efficiently online.
Follow the steps to successfully complete the VA 10-7959c form.
- Click ‘Get Form’ button to obtain the form and open it for completion.
- In Section I, provide the beneficiary information. Include the first name, last name, middle initial, address (number, street, PO Box, apartment number), city, state, ZIP code, phone number, and social security number. If you have a new address, check the designated box.
- In Section II, if you are a Medicare beneficiary, indicate whether you have Part A, Part B, and Part D coverage by selecting 'Yes' or 'No'. Attach a copy of your Medicare card to this section.
- In Section III, if you have other health insurance apart from Medicare, provide the details of your insurance. Fill in the name of the insurance, effective date, and termination date if applicable. Indicate whether the insurance is through employment, if it covers prescriptions, and specify the type of insurance (HMO, PPO, etc.).
- If you have multiple other health insurance policies, use plain bond paper to list additional policies, including your name, social security number, and relevant information for each policy.
- In Section IV, certify the accuracy of the information by signing and dating the form. If you are submitting electronically, type your signature in the designated area.
- Review the form for any mistakes or incomplete information. Ensure you have attached the necessary documents, including copies of your Medicare card and other health insurance cards.
- Once completed, save your changes and choose to download, print, or share the form according to your needs.
Complete your VA 10-7959c form online today and ensure your health coverage is properly reported.
Get form
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
To have the VA fill your prescriptions, you must first enroll in the VA healthcare system and provide a prescription from a VA-authorized healthcare provider. Once enrolled, you can have your prescriptions refilled through the VA’s online system, in person, or by mail. Utilizing VA Form 10 7959C can help you communicate any specific needs or concerns regarding your medications.
Get This Form Now!
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.