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Get Va 10-7959c 2004
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How to use or fill out the VA 10-7959c online
Filling out the VA 10-7959c form online can streamline the process of certifying other health insurance for CHAMPVA eligibility. This guide provides comprehensive, step-by-step instructions to assist users in accurately completing the form.
Follow the steps to effectively complete the VA 10-7959c form.
- Use the 'Get Form' button to access the VA 10-7959c form and load it into your online document editor.
- Begin with Section I - Beneficiary Information. Input the sponsor's spouse's details first, followed by other eligible family members. For each individual with other health insurance coverage, ensure all relevant OHI information is provided.
- Within Section I, for each family member, include their last name, first name, middle initial, social security number, and answer whether they have had OHI since becoming CHAMPVA eligible.
- If the individual has OHI, fill in the OHI policy name, policy number, start date, expiration date, and phone number. Also, indicate if it is a CHAMPVA-supplemental policy or an FEHB policy, if applicable.
- Proceed to Section II - Medicare Information. If applicable, enter the first name of the Medicare-eligible beneficiary, the start dates for Medicare Part A and Part B, and the Medicare card number. Repeat for additional beneficiaries as necessary.
- Answer the questions regarding Medicare coverage for individuals listed in Section I and attach a copy of the Medicare card for anyone covered.
- Move to Section III - Certification. The beneficiary, sponsor, or legal guardian must read the certification statement, sign, date, and provide their contact information, including phone number and address.
- Ensure all sections are filled out completely before finalizing. Once finished, you can save changes, download the completed form, print it, or share it as needed.
Complete the VA 10-7959c form online today to ensure you receive the benefits you deserve.
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Yes, you can submit CHAMPVA claims online, making the process more convenient for you. By utilizing the VA's online portal, you can quickly fill out necessary forms and attach supporting documentation. This streamlined approach allows for faster processing of your claims and gives you peace of mind in knowing your submissions are handled efficiently.
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