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  • Va Form 10-10d. Application For Champ V. A. Benefits.

Get Va Form 10-10d. Application For Champ V. A. Benefits.

, PO Box 469028, Denver CO 80246-9028 Customer Service Center: 1-800-733-8387 FAX: 303-331-7809 ATTENTION: Please refer to the information on the following pages for assistance completing this form in its entirety (print or type only). Return the form and any additional, requested information to the address shown above. If applicants indicate in Section II that they have Medicare or other health insurance, each applicant must submit VA Form 10-7959c, CHAMPVA Other Health Insurance (OHI) Certif.

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ChampVA is a health insurance program provided by the Department of Veterans Affairs to DIC recipients. There are no premiums. The coverage is free.

You are not required to enroll in Medicare Part D in order to become or remain CHAMPVA eligible. To continue to receive CHAMPVA benefits after age 65, you must meet the following conditions: If you turned 65 on or after June 5, 2001, you must be enrolled in Medicare Part A and Part B to remain eligible for CHAMPVA.

To apply for CHAMPVA benefits, you must submit the following documents: Application for CHAMPVA Benefits, VA Form 10-10d. Other Health Insurance (OHI) Certification, VA Form 10-7959c (Spanish version available) For individuals who are eligible for Medicare for any reason, we need a copy of your Medicare card.

If you're the spouse or child of a Veteran with disabilities, or the surviving spouse or child of a Veteran who has died, use VA Form 10-10d to apply for health insurance through CHAMPVA (the Civilian Health and Medical Program of the Department of Veterans Affairs).

If you provide only the required documents, and not the optional documents, processing can take two to eight months since the VA has to confirm information with other federal agencies. Once the VA gets your application, the VA will review it to be sure it is complete and that all the required forms are included.

At least one of these must be true: You're the spouse or child of a Veteran who's been rated permanently and totally disabled for a service-connected disability by a VA regional office, or. You're the surviving spouse or child of a Veteran who died from a VA-rated service-connected disability, or.

Spouses and dependent children of veterans who are rated as “permanently and totally disabled” by the VA because of a service-connected condition are eligible for CHAMPVA.

To determine CHAMPVA eligibility, SSA documentation of enrollment in both Medicare Part A and Medicare Part B is required. Acceptable documentation includes a copy of the beneficiary Medicare card, a letter from the SSA that provides the dates of Medicare eligibility, or any valid verification from SSA.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232