An application (VA
Form 10-10d) must be submitted to us before you or your physician
submits bills for health care services. You must have a Social
Security Number (SSN) for each individual on the application,
including newborns. If you need an SSN for a member of your family,
contact your nearest Social Security Office. After your application
is processed, we will mail a CHAMPVA Authorization Card (A-Card) to
each authorized family member.
New family members: To establish CHAMPVA eligibility for new
dependents (including spouse, newborns, adopted children,
stepchild), the following must be done before submitting
an application:
Obtain a Social Security Number (if the dependent doesn't have one).
Establish dependency to the veteran sponsor by contacting the VARO.
No claim will be paid until CHAMPVA eligibility is established.
The Application Process:
To apply for benefits, send the
following information to the HAC, CHAMPVA-Eligibility, PO Box 469028,
Denver, CO 80246-9028. Forms are available from the voice mail menu,
at 1-800-733-8387, 24 hours a day, 7 days per week. Please consider
placing calls for an application form during evening or weekend
hours. You may also obtain the necessary forms from our website at
www.va.gov/hac.
By selecting FORMS from the left panel.
VA Form 10-10d, Application for CHAMPVA Benefits
VA Form 10-7959c, CHAMPVA Other Health Insurance Certification
A copy of your Medicare card if you are also eligible for Medicare
A copy of the veteran's DD 214
Form, Certificate of Release or Discharge from Active Duty (or
Report of Separation for WWII and Korean era veterans). If you
cannot find this form, send in your application without it. We
will obtain one from the VA Regional Office.
Federal law requires that family
members of the veteran be legal dependents. The relationship of the
veteran to the individual applying for CHAMPVA benefits will be
verified with the VA Regional Office. If you have not previously
contacted the VA Regional Office to establish your legal relationship
to the veteran, you should do so prior to applying for CHAMPVA. Once
you have done so, submit your application for CHAMPVA benefits to us.
To reduce the time it takes to process your application, we recommend
you also send a copy (never the original) of the following documents
that are applicable to you with your application. These documents do
not need to be notarized. If the documents are included with your
application and the forms are filled out correctly, it normally takes
45 days to process your application from the date it is
received:
Documentation
When Needed
The Department of VeteransAffairs (VA) rating decision
Qualifying sponsor is
permanently and totally disabled due to a
service-connected condition
Qualifying sponsor died
as a result of a service-connected condition or was
permanently and totally disabled at the time of
death
The casualty report
Qualifying sponsor died on active duty
Marriage license/certificate
Spouse/widow(er) applications
Birth certificate
Dependent children
applications (birth, adopted, stepchildren)
Adoption court order
Adopted
children
School certification letter
Dependent children
between the ages of 18 and 23
An eligibility determination will be made
based on the information provided. If all the necessary documentation
is received, a CHAMPVA Authorization card will be issued. However,
VA Form 3884 (Exchange of Beneficiary Information and Request
for Eligibility Data - CHAMPVA) will still be sent to the VARO
to verify the information. Additionally, the information will
be sent to DEERS to verify there is not TRICARE eligibility.
Chapter I, Section 3.1
A certificate of
naturalization may be accepted in lieu of a birth
certificate.
