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Get VA 10-10EZR 2021-2022

Complete only the sections that apply to you sign and date the form. VA FORM APR 2017 10-10EZR Continued. INSTRUCTIONS FOR COMPLETING HEALTH BENEFITS UPDATE FORM Please Read Before You Start. What is VA Form 10-10EZR used for VA Form 10-10EZR is used by VA to update your personal insurance or financial information after you are enrolled. Where can I get help filling out the form and if I have questions This update form is available for completion online at www. If the form is not signed and dated appropriately VA will return it for you to complete. 3. Attach any continuation sheets a copy of supporting materials or your Power of Attorney documents to your application. Where do I mail my update Mail the completed VA Form 10-10EZR and any supporting materials to the Health Eligibility Center 2957 Clairmont Road Suite 200 Atlanta GA 30329. va*gov/healthbenefits. You may use ANY of the following to request assistance Ask VA to help you fill out the form by calling us at 1-877-222-VETS 8387. Contact the Enrollment Coordinator at your local VA health care facility. Contact a National or State Veterans Service Organization* Definitions of terms used on this form SERVICE-CONNECTED SC A VA determination that an illness or injury was incurred or aggravated in the line of duty in the active military naval or air service. COMPENSABLE A VA determination that a service-connected disability is severe enough to warrant monetary compensation* NONCOMPENSABLE A VA determination that a service-connected disability is not severe enough to warrant monetary compensation* NONSERVICE-CONNECTED NSC A Veteran who does not have a VA determined service-related condition* SPOUSE If you are certifying that a person is your spouse for the purpose of VA benefits your marriage must be recognized by the place where you and/or your spouse resided at the time of marriage or where you and/or your spouse reside when you file your claim or at a later date when you become eligible for benefits 38 U*S*C. 103 c. Additional guidance on when VA recognizes marriages is available at http //www. va*gov/opa/marriage/. ALL VETERANS MUST COMPLETE SECTIONS I II VI and VII Directions for Sections I - II Section I - General Information Answer all questions. Section II - Insurance Information Include information for all health insurance companies that cover you this includes coverage provided through a spouse or significant other. If you have more than one health insurer provide this information on a separate sheet of paper and attach to the application* If you have access to a copier attach a copy of your insurance cards Medicare card and/or Medicaid card Medicaid is a federal/state health insurance program for certain low-income people. Bring these cards with you to each health care appointment. COMPLETE SECTION III only if you complete Sections IV Section III - Dependent Information Your spouse and dependent social security numbers s are required so we can verify their financial information through a computer-matching program* You may count your spouse as your dependent even if you did not live together as long as you contributed support last calendar year.

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