Fill out VA 10-10EZ (Application for Health Benefits) online
VA Form 10-10EZ is the primary application for enrollment in the VA healthcare system. Veterans use this form to apply for comprehensive healthcare benefits at VA medical facilities and approved community providers. The form collects personal, military service, insurance, and financial information to determine eligibility and priority group placement.
How to fill out VA 10-10EZ (Application for Health Benefits)
Enter personal and military service information
Provide your full name, Social Security Number, date of birth, and contact information. Enter your military service details including branch, service dates, and discharge status.
Report your current insurance and financial information
List any current health insurance coverage (private, employer-sponsored, Medicare, Medicaid). Provide your gross household income, including wages, retirement income, and other sources.
Disclose service-connected conditions
Indicate whether you have any service-connected disabilities or conditions. If you have a VA disability rating, provide the rating percentage. This information affects your priority group placement.
Review, sign, and submit
Review all information for accuracy. Sign and date the application. Attach a copy of your DD-214 or other discharge documentation. Submit via your preferred method (online, mail, phone, or in person).
About VA 10-10EZ (Application for Health Benefits)
Who needs this form
Veterans who want to enroll in VA healthcare benefits. Eligibility is based on military service history, disability rating, income, and other factors. Most veterans who served in active military service and were honorably discharged are eligible.
Where to submit
Submit online at va.gov, mail to Health Eligibility Center, PO Box 5207, Janesville, WI 53547-5207, call 1-877-222-8387, or apply in person at any VA medical center.
Source and content freshness
- Filing deadlines may shift for weekends and holidays. Verify due dates with official instructions.
Common mistakes to avoid
- Not providing complete military service information (dates, branch, discharge status)
- Omitting current health insurance information (required even if you plan to use VA as primary)
- Not disclosing financial information (needed for priority group determination and copay assessment)
- Forgetting to include the DD-214 or equivalent discharge document
Frequently asked questions
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How long does it take to process a VA healthcare application?
Online applications are typically processed within one week. Paper applications may take longer. Once enrolled, you can schedule your first appointment by calling your local VA medical center or using the VA online scheduling tool. Veterans with service-connected disabilities or who meet certain income thresholds receive the highest priority for enrollment.
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