VA Form 10-7959C is the CHAMPVA Other Health Insurance (OHI) Certification. You use it to tell the VA about any health coverage you carry besides CHAMPVA — Medicare, an employer plan, an individual policy, or a supplemental plan — so the VA knows which insurer pays first when you get care. To complete it, fill in four short sections covering your identifying information, Medicare enrollment, other insurance, and signature; then attach copies of every insurance card and your Medicare card and submit the packet online, by mail, or by fax.
When You Have to File It
Three situations require this form.
The first is your initial CHAMPVA application. If you indicated on VA Form 10-10d that you have Medicare or other health insurance, the 10-7959C has to go in with your application.1U.S. Department of Veterans Affairs. VA Form 10-10D Application for CHAMPVA Benefits Without it, your enrollment stalls.
The second is any change to your coverage after you’re already enrolled: a new plan through a job, a dropped policy, a switch between insurers, or dependents added to an existing plan. The VA’s form page tells enrolled beneficiaries to file when reporting “new beneficiaries or coverage changes.”2Veterans Affairs. VA Form 10-7959C CHAMPVA OHI Certification
The third is Medicare. A CHAMPVA beneficiary approaching 65 must enroll in both Medicare Part A and Part B to keep CHAMPVA benefits.3Veterans Affairs. CHAMPVA Benefits Once you have your Medicare card, submit a new 10-7959C with a copy of the card so the VA can update your file and issue you a new CHAMPVA ID card with an extended expiration date.4My Army Benefits. Medicare Open Enrollment and Your CHAMPVA Eligibility
If you have no other insurance at all, you still submit the form at initial application. Just check “No” on the Medicare and OHI sections and sign.
Skipping the form has a specific consequence. The form itself warns that missing OHI information “will result in a delay or denial of reimbursement until OHI information is received.”5U.S. Department of Veterans Affairs. CHAMPVA Other Health Insurance Certification VA Form 10-7959C Your medical bills sit until the VA gets the paperwork.
What to Have in Front of You
Gather this before you open the form:
- Your Social Security number and current mailing address.
- Every active health insurance card, front and back. You’ll copy details off them and also attach photocopies.
- Your Medicare card, if you have one. You’ll need the 11-character Medicare Beneficiary Identifier printed on it, plus the effective date for each part.6Centers for Medicare and Medicaid Services. Medicare Beneficiary Identifiers MBIs
- For each other plan: whether it’s through an employer, whether it covers prescriptions, and whether the insurer issues Explanation of Benefits statements for prescriptions.
- Your schedule of benefits, but only if your insurer doesn’t issue EOBs. You’ll attach it in that case.
Filling Out the Four Sections
None of the sections are long, but the form warns that failing to complete “all applicable sections” can lead to denial.5U.S. Department of Veterans Affairs. CHAMPVA Other Health Insurance Certification VA Form 10-7959C
Section I: Beneficiary Information
Enter your last name, first name, middle initial, full mailing address, phone number with area code, sex, and Social Security number. If your address changed since your last filing, check the “New Address” box. A single transposed digit in your SSN can route the form to the wrong file, so verify it before moving on.
Section II: Medicare
This section asks whether you’re enrolled in Medicare Part A, Part B, and Part D. Each has a yes/no checkbox, an effective date, and a carrier name. Two more questions ask whether you’re on a Medicare HMO (a Medicare Advantage plan) and whether your Medicare provides pharmacy benefits. A Medicare Advantage plan counts as having both Part A and Part B for CHAMPVA eligibility.3Veterans Affairs. CHAMPVA Benefits If you have no Medicare coverage, skip to Section III.
Section III: Other Health Insurance
If you have any coverage besides Medicare, report it here. There’s room for two plans. For each, list the insurance name, effective date, whether the policy is through employment, whether it covers prescriptions, and whether the plan provides EOBs for prescription claims. A checkbox menu asks for the plan type: HMO, PPO, Medicaid or state assistance, prescription discount, Medigap (with a letter designation A through J), or other. Fill in a termination date only for policies that have ended; leave that field blank for active coverage.
If you have no health insurance other than Medicare, check “No” at the top of the section and go to Section IV.
Section IV: Certification and Signature
Sign and date the form. Your signature certifies the information is correct and that you’ll notify the VA promptly if your insurance changes. A legal representative or guardian can sign on the beneficiary’s behalf. The certification carries a penalty notice under 18 U.S.C. §§ 287 and 1001 for knowingly submitting false statements to a federal agency.5U.S. Department of Veterans Affairs. CHAMPVA Other Health Insurance Certification VA Form 10-7959C
What to Attach
The form alone isn’t enough, and this is where submissions get held up. Include whichever of these apply:
- Copies of every active health insurance card, front and back. That covers medical, dental, vision, and accidental insurance.
- A copy of your Medicare card, if you have any Medicare coverage.
- Your schedule of benefits, but only if your insurer doesn’t issue EOBs. The document should show your copayments.
The VA uses those card copies to verify the carrier names, policy numbers, and group numbers you wrote on the form.7Veterans Affairs. Submit Other Health Insurance Form 10-7959C
Where to Send It
You have three options.
If you originally applied for CHAMPVA online, use the online submission tool on the Form 10-7959C page at va.gov.2Veterans Affairs. VA Form 10-7959C CHAMPVA OHI Certification
If you applied by mail, download the PDF from the same page, fill it out, and mail the packet to:
VHA Office of Integrated Veteran Care
P.O. Box 469063
Denver, CO 80246-9063
You can also fax the completed form and attachments to 303-331-7809. Keep the fax confirmation page as proof of delivery. If you mail, photocopy everything you send before sealing the envelope.
What Happens After You Submit
VA staff enter your insurance details into the CHAMPVA claims database, and future claims will reflect the correct payment order automatically. CHAMPVA is almost always the last payer, so once your OHI is on file, your provider bills the other insurer first and CHAMPVA picks up covered costs the primary didn’t pay, up to the CHAMPVA allowable amount.8Veterans Affairs. CHAMPVA Care
You can call CHAMPVA customer service at 800-733-8387, 8:05 a.m. to 7:30 p.m. ET, Monday through Friday, to confirm the update posted.9U.S. Department of Veterans Affairs. CHAMPVA Information for Providers Making that call before your next appointment saves billing surprises at the provider’s office.
If you filed because you turned 65 and enrolled in Medicare, the VA will mail a new CHAMPVA ID card with an updated expiration date once your record is processed.4My Army Benefits. Medicare Open Enrollment and Your CHAMPVA Eligibility Keep your old card until the new one arrives.
Two Situations That Trip People Up
You Lost Your Other Coverage
When private coverage ends through a job change, divorce, or aging off a parent’s plan, file an updated 10-7959C with the termination date filled in. Once the VA processes it, CHAMPVA becomes your primary payer. Until you file, the system still expects another insurer to pay first, and your claims wait for an EOB that will never arrive.
Medicare Part B Is Not Optional
If you’re entitled to Medicare Part A, you generally must also enroll in Part B to keep CHAMPVA. The rule at 38 CFR 17.271 applies to beneficiaries under 65 with Part A, and to those who turned 65 on or after June 5, 2001.10eCFR. 38 CFR 17.271 – CHAMPVA Eligibility Part B carries a monthly premium, and skipping it to save money can cost you CHAMPVA coverage entirely. If you aren’t eligible for Part A at all, you’ll need a Social Security Administration Notice of Disallowance to prove it and keep CHAMPVA without Medicare.