Fill out VA 10-7959C (CHAMPVA Other Health Insurance Certification) online
VA Form 10-7959C certifies other health insurance (OHI) coverage for CHAMPVA applicants and beneficiaries. It is required when applying for CHAMPVA if the applicant has other health insurance, and is also used to report insurance changes for existing CHAMPVA enrollees. CHAMPVA is the secondary payer when other insurance is present.
How to fill out VA 10-7959C (CHAMPVA Other Health Insurance Certification)
Enter the CHAMPVA beneficiary information
Provide the beneficiary's full name, Social Security Number, date of birth, and the veteran sponsor's information.
Report the other health insurance details
Enter the name of the insurance company, policy or group number, the name of the policyholder, and the type of coverage (medical, dental, prescription, etc.).
Indicate coverage dates and status
Specify when the other health insurance coverage began and whether it is currently active. If reporting a change, indicate whether coverage was added, modified, or terminated.
Attach insurance card and sign
Include a photocopy of both the front and back of the other health insurance card. Sign and date the form. Submit with Form VA 10-10D if applying for CHAMPVA for the first time.
About VA 10-7959C (CHAMPVA Other Health Insurance Certification)
Who needs this form
CHAMPVA applicants and existing CHAMPVA beneficiaries who have other health insurance coverage (including Medicare, employer-sponsored plans, or individual policies) to declare or update.
Where to submit
Mail to VHA Office of Integrated Veteran Care, CHAMPVA Eligibility, along with Form VA 10-10D (for new applicants). Existing beneficiaries can also submit online at va.gov. Include a copy of the insurance card front and back.
Source and content freshness
- Filing deadlines may shift for weekends and holidays. Verify due dates with official instructions.
Common mistakes to avoid
- Not including a copy of the health insurance card (front and back)
- Forgetting to report Medicare enrollment (Medicare must be reported as OHI)
- Not updating this form when insurance coverage changes
- Submitting without the corresponding CHAMPVA application (VA 10-10D) for new applicants
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