Get Va 10-7959c 2020-2025

Filling out the VA 10-7959c, the CHAMPVA Other Health Insurance Certification form, online can streamline the process of updating your health insurance information. This guide provides a detailed overview and step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to successfully complete the VA 10-7959c online.

1. Click the ‘Get Form’ button to obtain the form and open it in the online editor.
2. Begin by entering the beneficiary information in Section I, which includes the last name, first name, middle initial, address, city, state, ZIP code, phone number, sex, and Social Security number. Ensure this information is accurate as it is essential for processing your certification.
3. If applicable, fill out Section II regarding Medicare beneficiaries. Indicate whether you have Part A, Part B, and Part D coverage by selecting 'Yes' or 'No' and provide the effective dates and carrier names.
4. In Section III, provide details of all other health insurance coverage since becoming CHAMPVA eligible. Input the effective date, termination date (if applicable), and whether the insurance is through employment. Specify the type of insurance and whether it covers prescriptions.
5. Complete Section IV by certifying that the information provided is correct. If submitting electronically, sign the form digitally and enter the date.
6. After finishing all sections, review your entries for accuracy. Once confirmed, save your changes, download the completed form, and prepare to print or share it if necessary.

Complete your VA 10-7959c form online today to ensure proper maintenance of your health benefits.